NCM 117: Psychiatric Nursing

2nd Semester | Prelims | Lecture | A.Y. 2024-2025

Mrs. Ma. Lourdes W. Alvarez, RN, MAN

Chapter 1: Introduction to Psychiatric Nursing

5.​ Mastery of the environment

WHAT IS HEALTH? Can deal with and influence the environment in a

capable, competent, and creative manner

●​ State of complete physical, mental, and

social wellness not merely the absence of 6.​ Reality orientation
disease or infirmity.
Can distinguish the real world from a dream, fact
●​ Emphasizes as a positive state of from fantasy, tolerate the stress and act
well-being, not just the absence of disease. accordingly.

WHAT IS MENTAL HEALTH? Common amongst Schizophrenic patients or those

who experience grandiose delusions

State of emotional, psychological, and social

wellness as evidenced by: 7.​ Stress management

1.​ Positive self-concept

Can tolerate life stresses appropriately, handle
2.​ Effective behavior and coping anxiety or grief and experience failure without
3.​ Satisfying interpersonal relationships devastation.
4.​ Emotional stability
WHAT IS MENTAL ILLNESS?
The adjunctive word that connotes the concept of
mental health is positivity, effectivity, satisfaction, A disturbance in a person’s thoughts, feelings, and
and stability behavior.

7 COMPONENTS Causes:

1.​ Genetic and Hereditary

-​ Play a big role
1.​ Autonomy and Independence
2.​ Stress and Immune System
●​ Person can look within themselves for -​ Psychoimmunology: examines the
guiding values and rules by which to live effect of psychosocial stressors on
the body’s immune system
●​ Can work interdependently or cooperatively
with others 3.​ Infection - viral

2.​ Tolerance of life’s uncertainties WHAT IS MENTAL DISORDER?

Faces challenges of day to day living with hope and Medically diagnosed illness results in significant
a positive outlook without knowing what lies ahead impairment of one’s cognitive, affective, or
relational abilities and is equivalent to mental
illness. Diagnosed to a specific kind of disorder
3.​ Maximize one’s potential

Focus towards growth and self-actualization Diagnostic and Statistical Manual for Mental
Disorders - Text Revision (DSM-V-TR)

4.​ Self-esteem
Describes all mental disorders, outlining specific
diagnostic criteria for each based on clinical
Has a realistic awareness of its abilities and experience and research
limitations

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

HISTORY OF MENTAL ILLNESS: 1960

●​ MAOI: first antidepressant

Ancient Times
●​ Haloperidol (Haldol): antipsychotic
●​ Benzodiazepines: Antianxiety agent
Mental disorders were viewed as being either
divine or demonic depending on their behavior
CHAPTER 2: Anatomy of the Brain
382-322 BC - Aristotle

A.​ CEREBRUM
Relates mental disorders to physical disorders and
developed his theory that amounts of blood, water,
yellow, and black bile in the body controlled Left Hemisphere
emotions
Controls the right side of the body and is the center
1-1000 AD - Early Christian for the logical reasoning and analytical
functions such as reading, writing, and
mathematical skills
●​ Primitive beliefs and superstitions were
strong
Right Hemisphere
●​ Diseases were blamed on demons and the
mentally ill were viewed as possessed Controls the left side of the body and is the center
for creative thinking, intuition, and artistic
1300-1600 - Renaissance abilities.

People with mental illness were distinguished as FRONTAL LOBE

criminals in England
●​ Controls the organization of thought, body
Sigmund Freud (1856-1939) movement, memories, emotions, and moral
behavior
Period of scientific study and treatment of mental
●​ Integration of all its information helps
disorders began
regulate: arousal, focus attention,
problem-solving skills, and
Emil Kraeplin (1856-1926) decision-making

●​ Abnormalities in the F.L. are associated:

Began classifying mental disorders according to
Schizophrenia, ADHD, and Dementia
their symptoms

PARIETAL LOBE
Eugene Bleuler ( 1857-1939)

Interprets sensations of taste and touch and assists

Coined the term Schizophrenia
in spatial orientation

1950 - Development of Psychotropic Drugs

TEMPORAL LOBE

●​ 1st drugs. Lithium: antimanic agents

Centers for the senses of smell and hearing, and
●​ Chlorpromazine (Thorazine): first with memory and emotional expression
antipsychotic drug

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

OCCIPITAL LOBE WHAT ARE THESE NEURONS OR

NERVE CELLS?
Assist in coordinating language generation and
visual interpretation such as depth perception Neurotransmitters

Chemical substances manufactured in the neuron

MIDBRAIN that aid in the transmission of information
throughout the body
Includes most of the reticular activating system and
extrapyramidal system 2 Mechanism of Actions:

A.​ Excitatory - evite or stimulate an action in

Reticular Activating System
the cells

Influences motor activity, sleep, consciousness, B.​ Inhibitory - inhibit or stop the action
and awareness
TYPES:
Extrapyramidal System
Dopamine
Relays information about movement and
coordination from the brain to the spinal nerves MOA: Excitatory

B.​ LOCUS COERULEUS PHYSIOLOGIC EFFECT: Controls complex

movements, motivation, cognition, regulates
emotional response
A small group of norepinephrine-producing neurons
in the brain stem is associated with stress, anxiety, PSYCHE IMPLICATION: Implicated in
and impulsive behavior. Schizophrenia and other psychoses as well as
movement in Parkinson’s disease
C.​ LIMBIC SYSTEM
Epinephrine (Adrenaline)
Includes the thalamus, hypothalamus,
hippocampus, and amygdala.
MOA: Excitatory

Thalamus PHYSIOLOGIC EFFECT: Controls flight or fight

response
Helps regulate activity, sensations, and emotions.
Norepinephrine (Noradrenaline)
Hypothalamus
-​ produced in Locus Coeruleus
Temperature regulation, appetite, control endocrine
functions, sexual drive, and impulsive behavior MOA: Excitatory
associated with feelings of anger, rage, or
excitement PHYSIOLOGIC EFFECT: Causes changes in
attention, learning and memory, sleep and
wakefulness, mood
Hippocampus and Amygdala
PSYCHE IMPLICATION: Excess has been
Emotional arousal and memory implicated in several anxiety; Deficits may
contribute to memory loss, social withdrawal and
depression

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

Serotonin GABA (Gamma Aminobutyric Acid)

MOA: Inhibitory MOA: Inhibitory

PHYSIOLOGIC EFFECT: Controls food intake, PHYSIOLOGIC EFFECT: Modulates other

sleep or wakefulness, temperature regulation, pain neurotransmitters
control, sexual behavior, regulation or emotions
PSYCHE IMPLICATION: Drugs that increases
PSYCHE IMPLICATION: GABA functions such as benzodiazepines are used
to treat anxiety and induce sleep
➔​ Plays important role in anxiety and mood
disorders seen in schizophrenia
BRAIN IMAGING TECHNIQUES

➔​ Contributes to delusions, hallucinations, and

withdrawn behaviors seen in schizophrenia Computed Tomography or
Computed Axial Tomography
Histamine
●​ Gives serial x-rays of the brain
MOA: Neuromodulator ●​ Shows structural images
●​ Schizophrenia has large ventricles on the
PHYSIOLOGIC EFFECT: Controls awareness,
gastric secretions, cardiac stimulations, peripheral brain
allergic response
Magnetic Resonance Imaging (MRI)
PSYCHE IMPLICATION: Some psychotropic drugs
blocks histamine, resulting in weight gain, sedation
and hypotension ●​ Detailed compared to CT scan
●​ Radio waves from brain detected from
Acetylcholine magnet
●​ Shows structural images
MOA: Excitatory or Inhibitory ●​ Reduction of cortical thickness in
schizophrenia
PHYSIOLOGIC EFFECT: Controls sleep or
wakefulness cycle, signals muscles to become alert

Positron Emission tomography (PET)

PSYCHE IMPLICATION: Alzheimer’s disease have
decreased acetylcholine secreting neurons
●​ A radioactive tracer is injected into the
bloodstream and monitored.
Glutamate

●​ It analyzes if the portion of the brain is still

MOA: Excitatory functional or is there movement

PHYSIOLOGIC EFFECT: Results in neurotoxicity ●​ Schizophrenia demonstrated a decreased

if levels are too high blood flow

PSYCHE IMPLICATION: Implicated in brain

damage caused by hypoxia and some degenerative
diseases such as Alzheimer’s

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

Fatal S/E: NMS Fatal S/E:

CHAPTER 3: Psychopharmacology (Neuroleptic Agranulocytosis
Malignant Syndrome)

EFFICACY
Conventional or Typical Antipsychotics Drugs

Maximal therapeutic effect that a drug can achieve

1.​ Haloperidol (Haldol)
2.​ Chlorpromazine HCL (Laractyl or
POTENCY
Thorazine)
3.​ Serenace
Describes the amount of drug needed to achieve
that maximum effect
Non Conventional or Atypical Antipsychotics Drugs
Depends on the tolerance of the patient; case to
case basis
1.​ Clozapine (Clozaril)
2.​ Risperidone (Risperdal)
HALF-LIFE 3.​ Olanzapine (Zyprexa)
4.​ Quetiapine (Seroquel)
Time it takes for half of the drug to be removed
5.​ Amisulpride (Solian)
from the bloodstream

Lower the dosage until halting the medication then Side Effects:
introduce the new drug after 3 days or else there
may be rebounds of symptoms
EXTRAPYRAMIDAL SYMPTOMS (EPS)

BLACK-BOX WARNING Blockage of D2 receptors in the midbrain region of

the brainstem is responsible for the development of
Separate text that shows warning about the serious EPS
life-threatening side effects.
1.​ Pseudoparkinsonism
ANTIPSYCHOTICS OR NEUROLEPTICS
Drug-induced
Used to treat the symptoms of psychosis such
as delusions and the hallucinations in S/S:
schizophrenia, manic phases of bipolar disorders. ➔​ Stiff stooped posture
➔​ Mask like face
Kinds: ➔​ Shuffling gait
➔​ Drooling
Conventional/Typical Nonconventional/
➔​ Pill rolling of thumb or finger at rest
Atypical

Blocks the reuptake of Blocks the reuptake of Tx: Akineton and Amantadine
D2, D3, D4 receptors D1, D2, and serotonin
receptors Adjunctive drug: manage the symptoms of the
D2: highly reactive first drug
dopamine

Treats positive Treats both positive

symptoms and negative
symptoms

Common S/E: EPS Common S/E: Dry

mouth, Constipation,
wt. gain

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

2.​ Acute Dystonia III. AGRANULOCYTOSIS

Includes the acute muscular rigidity and cramping ●​ Fatal S/E of atypical such as clozapine
of a stiff or thick tongue with difficulty swallowing
and in severe cases laryngospasm and respiratory ●​ Produces suddenly and is characterized by
difficulties fever, malaise, ulcerative sore throat, and
leukopenia
Tx:
●​ Blood samples taken week to monitor WBC
Spasms or stiffness in muscle groups can produce:
ANTIDEPRESSANTS
1.​ -
2.​ -
3.​ - ●​ Treat major depressive illness, anxiety
disorders.

3.​ Akathisia ●​ Interacts with 2 neurotransmitters:

Norepinephrine and Serotonin
Increased need to move about. Appears restless
and anxious. Divided into 4 Major Groups:

Tx: Propranolol (beta-blocker), Valium and I. Tricyclic or Cyclic Antidepressants

Ativan (benzodiazepine)

●​ Blocks the reuptake of norepinephrine

4.​ Tardive Dyskinesia primarily and serotonin to some degree

●​ Syndrome of permanent involuntary ●​ May take 4 o 6 weeks for effectiveness

movements of the tongue, facial and neck
muscles, upper and lower extremities, and Ex.
truncal musculature ●​ Imipramine (Tofranil)
●​ Amitriptyline (Elavil)
●​ Tongue thrusting and protruding, lip
●​ Desipramine (Norpramin)
smacking, blinking, grimacing, and other
excessive unnecessary facial movements
II. Selective Serotonin Reuptake Inhibitors
Tx: keeping maintenance of antipsychotics as low
as possible
●​ Blocks reuptake of serotonin

II. NEUROLEPTIC MALIGNANT SYNDROME (NMS) ●​ 2 to 3 weeks for its effect

●​ Potentially fatal, idiosyncratic reaction to Ex.

antipsychotics. ●​ Fluoxetine (Prozac)
●​ Fluvoxamine (Luvox)
●​ Major S/S: rigidity, high fever, autonomic
●​ Paroxetine (paxil)
instability such as unstable blood pressure,
diaphoresis pallor, and delirium elevated ●​ Sertraline (Zoloft)
CPK enzymes

●​ Tx: immediate discontinuance of

antipsychotics and treat dehydration and
hyperthermia

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

III. Monoamine Oxidase Inhibitors II. Valproic Acid (anticonvulsants)

●​ Major interaction is on the monoamine Are known to increase the levels of GABA.
neurotransmitter particularly norepinephrine Stabilizes the mood by inhibiting the kindling
and serotonin, has little effect in dopamine process. NA snowball like effect seen with minor
seizure activity
●​ May take 2-4 weeks for its effect
1. DEPAKOTE
Ex.
●​ Phenelzine (Nardil) -​ Can cause hepatic failure resulting in
●​ Tranylcypromine (Parnate) fatality. (hepatotoxic)
●​ Isocarboxazid (Marplan)
-​ Liver Function test must be performed
Life Threatening S/E: Hypertensive Crisis before therapy and for the first 6 months

●​ If taken with tyramine rich foods 2. CARBAMAZEPINE (TEGRETOL)

○​ A: all processed food Can cause aplastic anemia and agranulocytosis

at a rate 5 to 8 times greater
○​ B: beers, beans, rotten banana
(black spots) 3. LAMOTRIGINE (LAMICTAL)

○​ C: Cheese (Parmesan, Blue, Queso Cause serious rashes requiring hospitalization of

de bola) toxic epidermal necrolysis.

MOOD STABILIZING DRUGS ANXIOLYTICS (ANTIANXIETY DRUGS)

Used to treat bipolar by stabilizing the client’s mood Used to treat anxiety and anxiety disorders
and treating acute episodes of mania
Benzodiazepines
●​ Lorazepam (Ativan)
I. Lithium (0.5 to 1.5 meq/L)
●​ Chlordiazepoxide (Librium)

●​ Most/main established mood stabilizer ●​ Diazepam (Valium)

●​ Flurazepam (Dalmane)
●​ Normalizes the reuptake of certain
neurotransmitters such as serotonin,
norepinephrine, acetylcholine, and Nonbenzodiazepines
dopamine ●​ Buspirone (Buspar)

●​ Common S/E: mid nausea or diarrhea, I. Benzodiazepines

polyuria, lethargic metallic taste in mouth
and weight gain.
●​ Proven to be the most effective to relieve
anxiety. Mediate the actions of the amino
●​ Fatal S/E: Lithium toxicity if the level is at 2
acid GABA, the major inhibitory
meq/L
neurotransmitter in the brain.
S/S
●​ Common S/E: sedation, drowsiness, poor
-​ Severe diarrhea
coordination and clouded
-​ Vomiting
-​ Muscle weakness
●​ Serious S/E: tendency to cause physical
-​ Lack of coordination
dependence, strongly potentiate the effects
of alcohol
*Check blood level once a month if the client is
stable

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

*One drink may have the effects of 3 drinks

CHAPTER 4: Theories of Mental Health
DISULFIRAM (ANTABUSE) Psychiatric Nursing

●​ A synthesizing agent that causes an

adverse reaction when mixed with alcohol SIGMUND FREUD

●​ Used to deter client from drinking alcohol ●​ Father of Psychoanalysis and Psychosexual
theory
●​ Inhibits the enzymes aldehyde
dehydrogenase which is involved in ●​ Conceptualized personality structure in 3
metabolism with ethanol components:

●​ S/E: fatigue, drowsiness, halitosis, tremors,

and impotence Id

HERBAL MEDICINES Reflects basic for innate desires such as

pleasure-seeking behavior aggression and sexual
impulses
St. John’s Wort
Superego
Treats depression
Reflects moral and ethical concepts, values, and
Kava parental and social expectations

Treat anxiety potentiate the effect of alcohol Ego

Valerian Balancing and mediating force, represents a

maguire and adaptive behavior which allows a
person to function successfully.
Helps produce sleep, used to relieve stress and
anxiety.
3 LEVELS OF CONSCIOUSNESS
Ginkgo Biloba

Conscious
Improve memory, also take for fatigue , anxiety, and
depression
Exist in persons awareness

Preconscious

Not currently in person's awareness but can recall

them with some effort.

Unconscious

Realm of thoughts and feelings which motivates a

person even if totally unaware

Realms: includes most defense mechanisms.

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

WHAT ARE THESE EGO DEFENSE MECHANISMS? Denial

These methods attempt to protect the self and cope Failure to acknowledge an unbearable condition
with basic drives or emotionally painful feelings,
thoughts or events -​ A woman who was told she has cancer
says, “The doctor made a mistake in the
Projection diagnosis”

Unconscious blaming of unacceptable inclination to Conversion

others
Expression of emotional conflict through the
-​ A mother often feels guilty that she has no development of physical symptoms.
time for her child to help her with her
studies, and blames the teacher for the -​ A teenager who is not allowed to be a
poor grade marathon athlete by his parents, complains
of severe pain on his knees every time he
Rationalization walks

Excusing behavior to avoid guilt, responsibility, or Resistance

loss
Antagonism toward remembering or processing
-​ I didn’t do well in the games because of anxiety-producing information
the bad weather
-​ A member who joins with the group for a
Compensation project to be submitted refuses to
participate in the task given

Overachievement in one area to offset real or

perceived deficiency in another area Undoing

-​ An inspiring music artist who is poor at Exhibiting acceptable behavior to make up for the
singing became a good guitarist to please unacceptable behavior
the band leader
-​ A boyfriend who cheats on her girlfriend
Regression gives her chocolates and sweet messages

Moving back to a previous developmental stage to Fixation

feel safe
Immobilization of a portion of the personality
-​ A 12-year-old child bed wets every time he resulting from unsuccessful completion of a task in
is scolded by his teacher. the developmental stage

Displacement -​ Never engages in meaningful relationships

as a young adult
Ventilation of intense feelings toward persons less
threatening than the one who aroused those
feelings

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

Repression Reaction Formation

Excluding emotionally painful or anxiety-provoking Acting the opposite of what one thinks or feels.
thoughts and feelings from conscious awareness
leaving them to operate in the subconscious. -​ Student who dislikes a teacher so much
but, prepares a beautiful tribute for the
-​ A rape victim remembers nothing of the teacher
sexual encounter with the rapist but shakes
uncontrollably when faced with the subject
Substitution

Sublimation
Replacing the desired gratification with one that is
more readily available
Substituting a socially acceptable activity for an
impulse that is unacceptable. -​ A frustrated fashion designer who doesn’t
know how to use a sewing machine opened
-​ A father who quits drinking alcohol, enjoys up a ready-to-wear boutique
grape juice every time he feels like drinking
again
Introjection

Identification
Accepting another person’s attitude, beliefs, and
values as one’s own
Modeling actions and opinions of influential others
while searching for identity. -​ A girl who dislikes to be “kikay”, became a
“fashionista” just like her best friend
-​ A student nurse became an OR nurse
because this is the specialty of the clinical
Transference
instructor she admires

The client displaces onto the therapist's feelings

Intellectualization
and attitudes that the client originally felt in other
relationships
Separation of the emotions of a painful event from
the facts involved
-​ An elderly client who works with a nursing
-​ A young man shows no remorse when told assistant who is about the same age as her
that his new motorcycle that was parked on daughter whom she doesn’t get along finds
the side street was hit by a running man it hard to participate in her care

Suppression Dissociation

Conscious exclusion of unacceptable thoughts and Dealing with emotional conflict by temporary
feelings from conscious awareness. alteration in consciousness or identity. “Alter Ego”

-​ A girl decides not to think of her recent -​ A young adult has no memory before age 5
breakup with her boyfriend to concentrate when he was sold to a stranger by his
on her final exams tomorrow abusive father

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

FREUD’S PSYCHOSEXUAL DEVELOPMENT Jean Piaget

Believed that sexual energy or libido is the driving ●​ Founded the Cognitive Stages of
force of human behavior Development

●​ Strongly believes that biological changes

Phase Age Focus
and maturation are responsible for cognitive
Oral 0-18 mos area of development
gratification is
mouth
INTERPERSONAL THEORIES
Anal 18mos - 3 anus and
years surrounding
areas major Harry Stack Sullivan
source of
interest,
●​ Gave the significance of interpersonal
sphincter
control (toilet relationships and milieu therapy
training)
●​ Milieu Therapy: Involves client's interaction
Phallic 3-5 yrs genital focus with one another, practicing interpersonal
of interest skills, giving feedback, and working
Latency 5-11 yrs resolution of cooperatively as a group
oedipal
complex.
Hildegard Peplau
Sexual energy
is channeled
into socially Initiated Therapeutic Nurse-Client Relationship
appropriate
activities such
as sports or 4 Phases
school

Genital 11-13 yrs puberty 1.​ Orientation

begins. 2.​ Identification
3.​ Exploitation
Biologic 4.​ Resolution
capacity for
orgasm,
capacity for HUMANISTIC THEORIES
true intimacy

Abraham Maslow
DEVELOPMENTAL THEORIES
●​ Ranked the Hierarchy of Needs
Erik Erikson
●​ Used a pyramid to arrange the basic drives
that motivate people
●​ Developed the psychosocial theory

●​ Each person must complete a life task that Carl Rogers

is essential for wellbeing
●​ Emphasized client-centered therapy

●​ Focuses on the role of the client rather than

the therapist.

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

BEHAVIORAL THEORIES William Glasser

Reality Therapy: Need for identity through

Ivan Pavlov
responsible behavior

●​ Father of Classical conditioning

CHAPTER 5: Treatment Modalities

●​ Conditioning with external or environmental

conditions or stimuli.
INDIVIDUAL PSYCHOTHERAPY

B.F. Skinner
Involves one relationship between the therapist and
the client
●​ Studied the operant conditioning

●​ People learned their behavior from their GROUPS

history, particularly those experiences that
were repeatedly reinforced Involves a number of persons in a face-to-face
setting to accomplish tasks that require
Behavior Modification: method of attempting to cooperation, collaboration, or working together
strengthen a desired behavior or response by
reinforcement either positive or negative.
GROUP COHESIVENESS

Positive reinforcement: giving clients attention

and positive feedback. Degree to which members work together
cooperatively to accomplish a purpose
Negative reinforcement: removing a stimulus
immediately after a behavior occurs so that the beis What are its therapeutic gains and results?
more likely not to occ again.
●​ New information and learning
Systematic desensitization: used to overcome ●​ Inspiration and hope
irrational fear. Client is exposed to the least anxiety
●​ Interaction with others
provoking situations and using relaxation
techniques to manage anxiety ●​ Acceptance and belonging
●​ Aware that one is not alone and others
EXISTENTIAL THEORIES share the same problems
●​ Altruism: giving of oneself for the benefit of

Albert Ellis others.

Rational Emotive Theory PSYCHOTHERAPY GROUP

Viktor E. Frankl Goal: for members to learn about their behavior

and to make positive changes in their behavior by
Logotherapy: designed to help individuals assume interaction and communication
personal responsibilities
TYPES OF PSYCHOTHERAPY GROUP:
Frederick S. Peris

Open
Gestalt Therapy: focusing on identifying feelings of
here and now which leads to self-acceptance
Are ongoing and run indefinitely, allowing members
to join or leave the group as they need to

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

Close Psychiatric Nurse

Are structured to keep the same members in the Registered nurse gained experience in working with
group for a specified number of sessions clients with psychiatric disorders

Family Therapy Psychiatric Social Worker

A form of group therapy in which the client and the May practice therapy and often have the primary
family members participate responsibility for working with family, community
support, and referral
Education Group
Vocational Rehabilitation Specialist
To provide information to members on specific
issues like stress management, medication, or Includes determining client interests or activities
assertiveness training and matching them with vocational choices

Support Group Occupational Therapist

Are organized to help members who share a May have an associate degree or baccalaureate
common problem cope with it degree in certified occupational therapy

Psychiatric Rehabilitation Recreation Therapist

●​ Involves providing services to people with Helps the client achieve a balance of work and play
severe and persistent mental illness to help and provides activities that promote constructive
them live in the community use of leisure

●​ Also called community support services or CHAPTER 6

programs.

INTERDISCIPLINARY OR HOW DO YOU BUILD A

MULTIDISCIPLINARY HEALTH TEAM NURSE-CLIENT RELATIONSHIP?

An approach that is most useful in dealing with The most important thing is to build trust.
multifaceted problems of clients with mental illness
●​ It is built when the client is confident in
Psychiatrist the nurse.
●​ The nurse’s presence conveys integrity
Physician certified in psychiatry. The function is to
and reliability.
diagnose memory disorders and give prescriptions
for medications ●​ Must convey congruence, words and
actions match
Psychologist

WHAT OTHER BEHAVIORS MUST THE

Has a doctorate degree in clinical psychology. NURSE EXHIBIT?
Participated in the design of therapy programs for
groups or individuals
Friendliness, understanding, interest, caring, etc.

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

➔​ Attitude - general feelings or frame of

Genuine Interest
reference

Clearly focused on the client. By developing self-awareness, the nurse can

begin to use aspects of his or her personality,
Empathy experiences, values, needs, coping skills, and
intelligence to establish a relationship with the
client.. this is called therapeutic use of self.
The ability of the nurse to perceive the meanings
and feelings of the client
JOHARI WINDOW
Acceptance
A tool that is useful in learning more about oneself.
Avoiding judgments no matter what the behavior is.
A word portrait of the 4 areas:

Positive Regard
Known to self Unknown to
self
Appreciates the client as a unique, worthwhile
human being and respect.
Known to 1st 2nd
others open/public blind/unaware
In order to become therapeutic…
You must know yourself first. It requires Unknown to 3rd 4th area of the
self-awareness others hidden/private unknown

WHAT IS SELF-AWARENESS? TYPES OF RELATIONSHIP

●​ It is the process by which the nurse gains Social Relationship

recognition of his or her own feelings,
values, beliefs, and attitudes
Initiated for the purpose of friendship, socialization,
●​ The nurse needs to discover himself or companionship or accomplishment of a task
herself and what he or she believes before
trying to help others with different views Intimate Relationship

Involves two people who are emotionally committed

VALUES
to each other

Abstract standards that give a person a sense of

Therapeutic Relationship
right or wrong and conduct for living.

Gaining these values requires 3 steps: Focuses on the needs, experiences, and feelings of
the client
●​ Choosing - considers a range of
possibilities and freely chooses the value
that feels right

●​ Prizing - considers the value, cherishes it,

and publicly attaches it to himself or herself

●​ Acting - a person puts the value in action

➔​ Beliefs - are ideas that one holds to be true

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

FOUR PHASES OF NPR CHAPTER 7: Therapeutic Communication and

Client’s Response to Illness
Pre-interaction/Pre Orientation

COMMUNICATION
Begins when the nurse is assigned to a patient

Patients can be excluded from any activity or WHAT IS THERAPEUTIC COMMUNICATION?

participation. The nurse feels a certain degree of
anxiety. An interpersonal interaction between the nurse and
the client during which the nurse focuses on the
●​ Major task: develop self-awareness. client‘s specific need to promote an effective
●​ Data-gathering planning for the first exchange of information
interaction.

WHAT ARE THE DIFFERENT NON

Orientation Phase THERAPEUTIC TECHNIQUES?

Begins when nurse and patient interact for the first Boundaries and formal settings
time
PROXEMICS
●​ Parameters of the relationship are laid
●​ Major task: build trust
●​ Assessment, establish rapport Study of distance zones between people during
communication
●​ Confidentiality: means respecting the
client’s right to keep private any information FOUR DISTANCE ZONES

●​ Duty to ward: The nurse must report any

homicidal threat to the nursing supervisor Intimate Zone
and attending physician so that the victim
and police can be notified ●​ (0-18 inches) comfortable for parents and
young children, people who desire personal
●​ Self-disclosure - revealing personal contact, and people whispering.
information such as biographical information
and personal ideas, thoughts, and feelings ●​ Invasion of this zone by anyone else
produces anxiety
Exploitation Phase
Personal Zone
More structured, longest, and most productive
phase. Limit-setting is employed. (18-36 inches) comfortable between family and
friends who are talking
●​ Major task: implementation and
resolution of the patient’s problem.
●​ Problem-identification Social Zone

(4-12 feet) acceptable for communication in social,

Termination Phase
work or business settings

The client has feelings of anxiety, fear, and loss.

Must be recognized during the orientation phase Public Zone

●​ Major task: The client transfers what he (12 to 25 feet) acceptable distance between a
has learned to others. speaker and audience, informal functions

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

TOUCH CUES

Can be comforting and supportive when it is Verbal or nonverbal messages that signal keywords
welcome and permitted or issues for the client

FIVE TYPES OF TOUCH Overt Cues

Clear statements of intent

1.​ Functional-professional Touch

Covert Cues
Used in examinations or procedures such as when
the nurse does the assessment
Vague or hidden messages that need interpretation
and exploration
2.​ Social-polite Touch

NON VERBAL COMMUNICATION SKILLS

Used in greeting, such as handshake and air
kisses, or guiding someone for direction
Facial Expression
3.​ Friendship-warmth Touch
Produces the most visible, complex, sometimes
confusing nonverbal messages.
Involves a hug in greeting, arm thrown around the
shoulder
Impassive Face: frozen, emotionless deadpan
expression similar to a mask.
4.​ Love-intimacy Touch
Confusing facial expression: acting the opposite
Involves hugs and kisses between lovers and close of what one wants to convey.
relatives
Expressive face

5.​ Sexual-arousal Touch

Body Language

Touch used by lovers

Closed body position: crossed legs or arms
folded across the chest, indicates that the
VERBAL COMMUNICATION SKILLS interaction might threaten

Concrete Message Vocal Cues

●​ There is an accurate information exchange Nonverbal sound signals transmitted along with the
content. Includes voice volume, tone, pitch,
●​ Uses nouns instead of pronouns
intensity, emphasis, speed and pauses
●​ It is clear, direct, and easy to understand
Circumstantiality: use of extraneous words of
Example: Ms. Ledesma will have her duty at 3 long, tedious descriptions
o’clock this afternoon
Eye Contact
Abstract Message
Looking into the person’s eye, used to assess and
Unclear patterns of words that often contain figures to indicate whose turn to speak
of speech that are difficult to interpret. (Ex: “She’s
green?”

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

Silence MOOD AND AFFECT

Pauses may indicate that the client is thoughtfully

Mood
considering the question before responding.

●​ Refers to the client's pervasive and

CHAPTER 8: Mental Status Assessment
enduring state (inner)
●​ Described as being happy, sad, depressed,

Factors influencing assessment euphoric or angry

1. ​ Client participation and feedback

Labile Mood
2. Client’s health status
3. ​ Client’s previous
experiences/misconceptions Rapidly changing (ex. From depressed to sudden
4. ​ Client’s ability to understand euphoria)

Contents needed for an assessment

Affect

HISTORY
Outward expression of client’s emotional state

Includes: age, developmental stage, cultural and

Blunted Affect
spiritual beliefs

Showing little or slow response facial expression

GENERAL APPEARANCE AND MOTOR BEHAVIOR

Broad Affect
Includes: hygiene and grooming, appropriate
dressing, posture, eye contact, unusual movement
and mannerisms Displaying a full range of emotional expressions

Automatisms Flat Affect

Repeated, purposeless behaviors indicative of Showing no facial expression

anxiety
Inappropriate Affect
Psychomotor Retardation
Displays incongruent with mood or situation.
Overall slowed movements
Restricted Affect
Waxy Flexibility
Displaying one type of expression, usually serious
Maintenance of posture or position over time even or somber
if it’s awkward or uncomfortable
THOUGHT PROCESS AND CONTENT
Neologism
Thought process: How client is thinking
Speech: invented words that have meaning only for
Thought content: What client is thinking or says.
the client
Circumstantial thinking: Client answers question
Stuttering but only after giving unnecessary details

Delusions: Fixed, false belief not based in reality

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NCM 117: Psychiatric Nursing
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Mrs. Ma. Lourdes W. Alvarez, RN, MAN

(1) delusion of grandeur: client thinks highly of Echolalia: client’s limitation or repetition of what
himself or with importance. nurse says.

(2) delusion of poverty: client thinks he is

Sensorium and Intellectual Processes
nothing or of no importance at all.

(3) religious delusion: client gives religious Orientation: client’s recognition of place, person,
association with things. and time.

(4) referential delusion: client believes that Memory: includes both recent or remote
any circumstances have something to do with
Ability to concentrate: asking the client to perform
him.
certain tasks. (ex. Repeat days backward, serial
(5) paranoid delusion: client believes that fives, three part tasks, abstract thinking and
another person is after him. intellectual abilities.)

(6) nihilistic delusion: client believes that any Sensory-Perceptual Alterations

part of his body does not belong to him.
Hallucinations: false sensory perceptions that do
(7) delusion of alien control:
not exist in reality. (command hallucination)
(8) somatic delusion: client believes that there
is something wrong with him. Such as ailment Judgement and Insight

Flight of Ideas: excessive amount and rate of Judgment: ability to interpret one’s environment
speech composed of fragmented or unrelated and situation correctly and adapt one’s behavior
ideas. and decisions accordingly.

Loose Association: disorganized thinking that Ex. of poor judgment: spends large amount on
jumps from one idea to another with little or no shoes and bags in which there’s not enough
evident relation. food

Ideas of Reference: client’s inaccurate Insight: ability to understand the true nature of
interpretation that any events or situation are one’s situation and accept some personal
generally directed to him responsibility for that situation

Tangential Thinking: wandering off the topic and

SELF - CONCEPT
never provides information.

Thought Blocking: stopping abruptly in the middle Clients view oneself in terms of personal worth and
of a sentence and unable to continue. dignity.

Thought Broadcasting: a delusional belief that ROLES AND RELATIONSHIP

others can hear or know what the client is thinking.
Includes: current roles occupied, role satisfaction,
Thought Insertion: ideas of the client are not his
significant relationship, support systems.
but has delusional belief that others are putting
ideas unto his.
PHYSIOLOGIC AND SELF-CARE CONSIDERATIONS
Thought Withdrawal: a delusional belief that
others are taking the client’s thoughts away and are Includes: eating and sleeping habits, medication
powerless to stop it. compliance, health problems, perform ADL

Word Salad: flow of unconnected words that

convey no meaning.

Clang Associations: are ideas based on sound or

rhyming rather than meaning

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

ETHICAL DILEMMA
CHAPTER 9: Legal and Ethical Issues

Situation in which there is conflict with ethical

ETHICS principles or when there is no clear course of action
in a given situation. (Example: The client who
refuses medication or treatment is allowed to do so
Branch of philosophy that deals with values of
based on the principle of autonomy.)
human conduct is either good or bad
​ ​ ​
Voluntary Admission
Utilitarianism

Clients or folks are willing to seek treatment and

Consider which actions would produce the greatest
agree to be hospitalized
benefit for most people

Involuntary Admission
Deontology

Clients do not wish to be hospitalized but need to

Decisions are based on whether or not an action is
be confined because they pause danger to
morally right with no regard for the result or
themselves or others
consequence.

Conservator
Autonomy

Acts as legal guardian who assumes

Person’s right to self- determination and
responsibilities such as giving informed consent,
independence.
writing checks and entering contracts

Beneficence
Least restrictive environment

One’s duty to benefit or to promote good for others.

Client must be free of restraint or seclusion unless
it is necessary
Nonmaleficence

RESTRAINT
Requirement to do no harm to others either
intentionally or unintentionally
Direct application of physical force to a person,
without his or her permission, to restrict freedom of
Justice movement.

Refers to treating all people fairly and equally

Human Restraint

Veracity
Staff physically control the client and move him to
seclusion.
Duty to be honest or truthful

Mechanical Restraint
Fidelity

Devices usually ankle or wrist restraint fastened to

Obligation to honor commitments and contracts bed

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

SECLUSION CHAPTER 10: Abuse and Violence

Involuntary confinement of a person in a specially ​ ​ ​ ​ ​

constructed locked room with a security window or ABUSE
camera.

Wrongful use & maltreatment of another person.

DUTY TO WARN

FAMILY VIOLENCE
If a client has threats or a tendency to harm a
person the nurse must inform the person of the
Includes spouse battering, neglect & physical,
client's plot even if there’s breach of confidentiality.
emotional or sexual abuse of children, elder abuse
and marital rape.
TORT

CHARACTERISTICS OF VIOLENT FAMILIES

Wrongful act that results in injury, loss or damage.

Unintentional Tort Social Isolation

a.​ Negligence: involves causing harm by They keep to themselves and do not invite others
failing to do what is reasonable and prudent.
Abuse of power and control
b.​ Malpractice: type of negligence which may
cause injury, loss or death
Abuser always holds a position of power and
control of the victim

Intentional Tort
Alcohol and other drug abuse

Voluntary acts that result in harm to the client.

Triggers violence
a.​ Assault: involves any action that causes a
person to fear of being touched in a way Intergenerational transmission process
that is offensive without consent or authority.​
Patterns of violence are perpetuated from one
b.​ Battery: involves harmful or unwanted
generation to the next through role modeling and
contact with a client, actual harm or injury
social learning

c.​ False imprisonment: the unjustifiable

detention of a client such as the SPOUSE OR PARTNER ABUSE
inappropriate use of restraint or seclusion
Mistreatment or misuse of one person by another in
an intimate relationship.

TYPICAL ABUSER

Has a strong feeling of inadequacy and low

self-esteem as well as poor problem solving &
social skills. are emotionally immature, irrational,
jealous and possessive​
​ ​ ​

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

a.​ Emotional or Psychological Abuse Psychological (Emotional Abuse)

​ ​ ​
Name calling, belittling, screaming, yelling, Includes verbal assaults such as blaming,
destroying property, making threats, ignoring or screaming, name-calling, parents fighting and
refusing to speak yelling

TREATMENT AND INTERVENTION

b.​ Physical Abuse
-​ child safety and well-being may involve
removing the child from home
Ranges from shoving and pushing to severe
battering and choking, bleeding, broken limbs or
ELDER ABUSE
homicide

The maltreatment of older adults by family

c.​ Sexual Abuse
members or caretakers. Includes: physical, sexual,
psychological, neglect, financial exploitation, denial
Assaults during sexual relations​ of adequate medical treatment.
​
TREATMENT AND INTERVENTION ​ TREATMENT AND INTERVENTION
-​ Removal of the elderly from its caretaker or
-​ Woman can obtain a restraining order family
(protection order)
RAPE AND ASSAULT
-​ Prohibits the abuser from coming near or
contacts
Rape: is a crime of violence and humiliation of the
victim expressed through sexual means
CHILD ABUSE

MALE RAPIST HAS 4 CATEGORIES:

Intentional injury of the child

Parents who abuse are emotionally immature, Sexual Sadist

needy and incapable of meeting their own needs

Aroused by the pain of their victims

TYPES OF CHILD ABUSE

Exploitive Predators
Physical
Impulsively use their victims as objects for
Results from unreasonable punishment. o hitting, gratification
biting, burning, cutting, poking, twisting limbs
Inadequate Men
Sexual
Believes that no woman would voluntarily have
Sexual act performed by an adult to a child 18 and sexual relations with them and are possessed with
below fantasies about sex

Neglect Displace Anger and Rage

Malicious or ignorant withholding or physical, Expressed through rape

emotional or educational necessities

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

INTERVENTIONS
PSYCHIATRIC DISORDERS RELATED TO
ABUSE AND VIOLENCE ●​ promote client’s safety
●​ helping client cope with stress & emotions

Post-traumatic Stress Disorder (PTSD) GROUNDING TECHNIQUES

●​ Remind the client that he or she is in the
present as an adult and safe
Disturbing pattern of behavior demonstrated by
●​ helping client promote self-esteem
someone who has experienced a traumatic event
●​ view the client as survivor rather than a
victim - establishing social support
3 CLUSTERS OF SYMPTOMS:
​ ​
●​ Reliving the event
CHAPTER 11: Anger, Hostility and Aggression
●​ Avoiding reminders of the event
●​ Being on guard (hyper-arousal)
ANGER

DISSOCIATIVE DISORDER A normal human emotion, a strong, uncomfortable,

emotional response to a real/perceived
Dissociation: is a subconscious defense provocation. Results when a person is frustrated,
mechanism that helps a person protect his hurt or afraid.
emotional self from recognizing the full effects of
some horrifying or traumatic event by allowing the ●​ If handled appropriately & expressed
mind to forget or remove from memory. assertively;
​ -​ it can be a positive force that helps a
person resolve conflicts, solve
DSM-V-TR DESCRIBES 4 DIFFERENT TYPES problems, & make decisions

●​ When Expressed Appropriately Or

Dissociative Amnesia
Suppressed;
-​ can cause physical or emotional
Clients cannot remember important personal problems or interfere with
information usually of a traumatic or stressful relationships
nature. -​ can also lead to hostility and
aggression​
Dissociative Fugue ​ ​ ​ ​
HOSTILITY
Clients have episodes of suddenly leaving the
home or place of work without any explanation, ●​ Also called verbal aggression
traveling to another city, and being unable to
remember his or her past or identity ●​ An emotion expressed through verbal
abuse, lack of cooperation, violation of rules
Dissociative Identity Disorder or norms, or threatening behavior

(Formerly multiple personality disorder): client PHYSICAL AGGRESSION

displays two or more distinctive identities or
personality that takes control of his or her behavior A behavior in which a person attacks or injures
another person or that involves destruction of
property
Depersonalization Disorder

A persistent or recurrent feeling of being detached

from his or her mental processes or body.

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NCM 117: Psychiatric Nursing
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Mrs. Ma. Lourdes W. Alvarez, RN, MAN

CATHARSIS PHARMACOLOGIC TREATMENTS

Expressed anger that engages in aggressive but

Lithium
safe activities such as hitting a punching bag or
yelling
Lithium: has been effective in treating aggressive
clients with bipolar disorder, conduct disorders in
INTERMITTENT EXPLOSIVE DISORDER
children & mental retardation.

A rare psychiatric diagnosis characterized by

Carbamazepine (Tegretol)
episodes of aggressive impulses that result in
serious assaults or destruction of property.
Associated with aggressions in dementia,
psychosis, and personality disorders
ACTING OUT

An immature defense mechanism by which the Atypical Antipsychotic Agents:

person deals with emotional conflicts or stressors
through actions rather than through reflections or ●​ Clozapine (Clozaril)
feelings.
●​ Risperidone (Risperdal)
NEUROBIOLOGIC THEORIES
●​ Olanzapine (Zyprexa) - have been effective
with aggressive clients in dementia, brain
Low Serotonin Levels injury, mental retardation and personality
disorders.
May lead to increased aggressive behavior
THE COCKTAIL METHOD
Increased activity of
Dopamine and Norepinephrine ●​ Involves giving two medications, in
successive doses until the client is sedated.

Associated with increased impulsively violent

●​ Haloperidol (Haldol) and Lorazepam
behavior.
(Ativan)​
​
PSYCHOSOCIAL THEORIES
5 PHASES OF AGGRESSION CYCLE

Temper Tantrums
Triggering

Common response from toddlers whose wishes are

●​ Event or circumstances in the environment
not granted
which initiate the client to respond with
anger & hostility
Amok
●​ S/S: restlessness, anxiety, irritability, pacing,
muscle tension, rapid breathing,
Dissociative episode characterized by a period of
perspiration, loud voice, anger
brooding followed by an outburst of violent,
aggressive, or homicidal behavior directed at other
●​ Approach the client in a nonthreatening
people and objects
calm manner

●​ Empathetic encourage to express anger

verbally

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

CHAPTER 12: Schizophrenia

Escalation

●​ Escalating behaviors that indicate

movement toward a loss of control SCHIZOPHRENIA

●​ S/S: Pale or flushed face, yelling, swearing, ●​ “Split mind”

agitated, threatening, demanding, clenched ●​ A mental disorder which exhibits distorted
fists, threatening gestures, hostility, loss of and bizarre thoughts, perceptions,
ability to solve the problem or think clearly emotions, movements, and behavior.

●​ A nurse must take control of the situation,

PEAK INCIDENT OF ONSET
provide a calm, firm voice

A.​ Late Adolescent or Early Adulthood

Crisis ➔​ 15-25 (Men)
➔​ 25-35 (Women)
●​ Client losses control
ETIOLOGY
●​ S/S: loss of emotional and physical control,
throwing objects, kicking, hitting, spitting,
biting, scratching, screaming, inability to Interpersonal Theorists
communicate
Suggested that schizophrenia resulted from
●​ Staff must take charge of the situation for dysfunctional relationships in early lie and
the safety of everyone. Seclusion or adolescence
restraint if necessary
Biological Theories
Recovery
A.​ Genetic Factors
●​ Client regains physical & emotional control ●​ Focused on immediate families
●​ Identical twins: 50% risk
●​ S/S: lowers voice, decreased muscle ●​ Fraternal Twins: 15% risk
tension, clearer communication, physical ●​ One biological parent: 15% risk
relaxation encouraged to talk, assess for ●​ Both biological parents 35% risk
injuries B.​ Neuroanatomic/Neurochemical Factors

i. Neuroanatomy shows:
Postcrisis
●​ Less brain tissue and CSF
●​ Attempts reconciliation with others, returns ●​ Enlarged ventricles
level of functioning before aggressive ●​ Cortical Atrophy
incident
Decreased brain volume and abnormal brain
function in:

●​ S/S: Remorse, apologies, crying, quiet ●​ Temporal lobe: correlates with (+) signs
withdrawn behavior ●​ Frontal lobe: correlates with (-) signs

ii. Neurochemical shows: increase in

dopamine and serotonin
●​ Can remove restraints or from seclusion
and encourage to join in activities A.​ Intrauterine Influences
-​ Includes poor nutrition, tobacco,
alcohol, drugs, and stress of the
mother during pregnancy

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NCM 117: Psychiatric Nursing
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Mrs. Ma. Lourdes W. Alvarez, RN, MAN

TYPES OF SCHIZOPHRENIA
B.​ Immunovirology Factors
●​ Cytokines are a chemical messenger
between Immune cells which mediates Paranoid
inflammatory and immune response
●​ Examples: Encephalitis and Meningitis
Characterized by persecutory feeling, grandiose
Symptoms are divided into 2: delusions, hallucinations and occasionally
excessive religiosity or hostile and aggressive
behavior
I.​ POSITIVE OR HARD

Disorganized
Ambivalence - holding seemingly contradictory
beliefs about the same person, event or situation
Characterized by grossly inappropriate or flat affect,
Associative looseness - fragmented or poorly incoherence, loose associations and extremely
related thoughts or ideas disorganized behavior

Delusions - fixed false belief not based on reality. Catatonic

Echopraxia - imitation of movements or gestures

of another person. Characterized by marked psychomotor disturbance,
either motionless or excessive motor activity.
Flight of ideas - continuous flow of verbalization (motor immobility may manifest: catalepsy, waxy
which the person jumps from one topic to another flexibility, or stupor) (excessive motor activity is
purposeless and not influenced by external stimuli.)
Hallucinations - false sensory perception
Undifferentiated
Ideas of reference - false impressions that
external events have special meaning to him.
Characterized by mixed schizophrenic symptoms
Perseveration - persistent adherence to a single along with disturbances of thoughts, affect, and
idea or topic behavior.

II.​ NEGATIVE OR SOFT Residual

Alogia - poverty of content or tendency to speak Characterized by at least one previous, though not
little substance a current episode: social withdrawal, flat affect and
looseness associations.
Anhedonia - feeling no joy or pleasure.
Other related disorders:
Apathy - feeling of indifference toward people,
activities or events Schizophreniform Disorder

Blunted affect - showing little or slow response

facial expression Exhibits the symptoms of schizophrenia but for less
than 6 months necessary to meet the diagnostic
Flat affect - showing no facial expression criteria for schizophrenia. Social or occupational
functioning may or may not be impaired
Lack of volition - absence of will, ambition or drive
Schizoaffective Disorder
Catatonia - psychologically induced immobility with
periods of agitation or client becomes motionless.
Exhibits the symptoms of psychosis and at the
same time, all the features of a mood

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NCM 117: Psychiatric Nursing
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Mrs. Ma. Lourdes W. Alvarez, RN, MAN

Delusional disorder Family Education and Therapy

Client has one or more non bizarre delusions, the Helps to diminish the negative effects of
focus of the delusion is believable. Psychosocial schizophrenia and reduce relapse rates
functioning is not markedly impaired and behavior
is not obviously odd or bizarre MOOD DISORDERS

Brief Psychotic disorder ●​ Also called affective disorders

Clients experience the sudden onset of at least one ●​ Pervasive alterations in emotions that are
psychotic symptom such as delusions, manifested in depression, mania, or both
hallucinations,disorders, which last from 1 day to 1
month ●​ Most common psychiatric diagnoses
associated with suicide
Shared Psychotic disorder
MAJOR DEPRESSIVE DISORDERS
Two people share a similar delusion. The person
with this diagnosis develops this delusion in the Lasts at least 2 weeks during which the person
context of a close relationship with someone who experiences a depressed mood or loss of pleasure
has psychotic delusions in nearly all activities

PHARMACOLOGICAL TREATMENT ➔​ Changes in appetite

➔​ Sleep or psychomotor activity
Antipsychotics: typical and atypical ➔​ Decreased energy feeling of worthlessness
or guilt
PSYCHOSOCIAL TREATMENT ➔​ Difficulty thinking concentration
➔​ Difficulty making decision
➔​ Recurrent thoughts of death
➔​ Suicidal ideation
➔​ Plans to attempt or commit suicide
Individual and Group Therapy

PSYCHOTIC DEPRESSION
Often supportive in nature gives the client the
opportunity for social contact and meaningful
relationships with others BIPOLAR DISORDER

Cognitive Adaptation Training Mood cycles between extreme mania and

depression
Uses environmental support designed to improve
adaptive functioning in the home setting
Mania

Cognitive Enhancement Therapy

A distinct period in which mood is abnormally and
persistently elevated,expansive, or irritable
Combines computer based cognitive training with
group sessions which allow clients to practice and ➔​ Inflated self esteem or grandiosity
develop social skills ➔​ Decreased need for sleep
➔​ Pressured speech
➔​ Flight of ideas
➔​ Distractibility
➔​ Increased involvement in goal-directed
activity
➔​ Psychomotor agitation

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NCM 117: Psychiatric Nursing
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Mrs. Ma. Lourdes W. Alvarez, RN, MAN

➔​ Excessive involvement in pleasure seeking CHAPTER 14: Personality Disorder

activities with a high potential for painful
consequences
➔​ Some may exhibit delusions or
hallucinations during manic episode PERSONALITY

●​ Enduring pattern of behaving and relating to

Hypomania
self, others and the environment

●​ A period of abnormally and persistently ●​ It includes perceptions, attitudes and

elevated, expansive or irritable mood lasting emotions
for 4 days and including 3 or 4 of the
additional symptoms.
PERSONALITY DISORDERS
●​ It does not impair the person’s ability to
function. He may be quiet and productive ●​ When personality traits become inflexible,
and there are no psychotic features maladaptive and significantly interfere with
how a person functions in society and cause
the person emotional distress
Rapid Cycling
●​ Not usually diagnosed until adulthood
Mixed episode when the person experiences both (same with Schizophrenia)
mania and depression anxiety every day for at least
1 week ●​ Diagnosis is made when it exhibits enduring
behavioral patterns that deviate from
A.​ Bipolar 1: one or more manic or mixed cultural expectations in two or more areas
episodes usually accompanied by major
depressive episodes
COGNITION

B.​ Bipolar 2: one or more major depressive

episodes accompanied by at least one Ways of perceiving and interpreting self, other
hypomanic episode people, and events

Related disorders: AFFECT

Dysthymic Disorder Range, intensity, lability, and appropriateness of

emotional response
Characterized by at least 2 years of depressed
mood for more days than not with some additional INTERPERSONAL FUNCTIONING
less severe symptoms that do not meet the criteria
for a major depressive disorder
IMPULSE CONTROL

Cyclothymic Disorder
Ability to control impulses or express behavior at
the appropriate time and place
Characterized by 2 years of numerous periods of
both hypomanic symptoms that do not meet the
criteria for bipolar disorder
​ ​ ​
​ ​
​ ​
​ ​

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NCM 117: Psychiatric Nursing
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Mrs. Ma. Lourdes W. Alvarez, RN, MAN

CHAPTER 15: Anxiety

CLUSTER A

Paranoid
ANXIETY

Mistrust and suspicious of others; guarded

●​ A vague feeling of dread of apprehension
restricted affect
●​ A response to external or internal stimuli
Schizoid that can have behavioral, emotional,
cognitive, and physical symptoms​
Detached from social relationships; restricted ​
affect; involved with things more than people AUTONOMIC NERVOUS SYSTEM (ANS)

Schizotypal ●​ Generates the involuntary activities of the

body
●​ Ex. tremors
Acute discomfort in relationships; cognitive or
perceptual distortions; eccentric behavior
SYMPATHETIC NERVE FIBERS
CLUSTER B
Triggers the vital signs
Appears dramatic, emotional and erratic
ADRENAL GLANDS
Antisocial
Releases adrenaline (epinephrine)

Disregard rights of others, rules and laws

Epinephrine causes the body to:
➔​ Increase demand for oxygen
Borderline ➔​ Dilate the pupils
➔​ Increase arterial pressure and heart rate
➔​ Constricting the peripheral vessels
Affects more on women, unstable relationships,
self-image and affect; impulsivity; self mutilation
PARASYMPATHETIC NERVE FIBERS
Histrionic
Returns the body to normal operating conditions

Excessive emotionality and attention seeking

Theories which connects anxiety:

Narcissistic
BIOLOGICAL THEORIES

Grandiose, lack of empathy; need for admiration

Genetic Theories

CLUSTER C
First degree relative clients with increased anxiety
have higher rates of developing anxiety
Appears to be anxious or feal

Avoidant

Social inhibitions; feeling of inadequacy

hypersensitive to negative evaluation

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

Neurochemical Theories NURSING INTERVENTIONS FOR EACH LEVEL

●​ GABA: reduces anxiety Mild

●​ Norepinephrine: increases anxiety,

suspected in panic disorder, GAD, and Requires no direct intervention, teaching can be
PTSD very effective

●​ Serotonin: plays a role in OCD panic Moderate

disorder and GAD (Generalized Anxiety
Disorder)
●​ Speaking in short, simple and
easy-to-understand sentences is effective
4 LEVELS OF ANXIETY
●​ Nurse may need to redirect the client back
to the topic if the client goes off
Mild

Severe
●​ Sensation that something is different and
warrants special attention. Sensory
stimulation increases and helps the person ●​ Nurse must lower the person’s anxiety level
focus attention to learn, solve problems, to moderate or mild
think, act, feel, and protect himself or herself
●​ Remain with the person, walk with him if he
●​ Often motivates a person to make changes cannot sit still
or to engage in fola directed activity
●​ Ask to take deep breaths

Moderate
Panic

●​ A disturbing feeling that something is

definitely wrong, becomes nervous or Person safety is the primary concern, approach in a
agitated. comforting manner, quiet and nonstimulating
environment
●​ Can still process information, solve
problems and learn new things with THERAPEUTIC TREATMENT
assistance from others

●​ Often has difficulty concentrating Positive Reframing

independently but can be redirected to the
topic Turning negative messages into positive messages

Severe Decatastrophizing

●​ Has trouble thinking and reasoning. Involves the therapist's use of question to more
realistically appraise the situation
●​ Muscle tightens and vital signs increase.
Person places; restless, irritable, and angry

Panic

Emotional-psychomotor realms predominate with

accompanying fight, flight or freeze responses

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

TYPES OF ANXIETY OBSESSION

Agoraphobia Recurrent, persistent, intrusive, and unwanted

thoughts, images,or impulses that cause marked
anxiety and interfere with interpersonal, social, or
Avoidance of places or situations from which might occupational function.
be difficult or help might be unavailable

COMPULSION
Panic Disorder

Ritualistic or repetitive behaviors or mental acts that

●​ Characterized recurrent, unexpected panic a person carries out continuously in an attempt to
attacks that need constant concern neutralize anxiety

●​ Composed of discrete episodes of panic

attacks that are 15 to 30 minutes of rapid, GENERALIZED ANXIETY DISORDER
intense, escalating anxiety in which a
person experiences great emotional fear as Characterized by at least 6 months or persistent or
well as physiological discomfort excessive worry and anxiety

Symptoms have 4 or more: 3 or more of these symptoms:

➔​ Palpitations ➔​ Uneasiness
➔​ Sweating ➔​ Irritability
➔​ Tremors ➔​ Muscle tension
➔​ Shortness of breath ➔​ Fatigue
➔​ Sense of suffocation ➔​ Difficulty thinking
➔​ Chest pain ➔​ Sleep alteration
➔​ Nausea
➔​ Abdominal distress
ACUTE STRESS DISORDER
➔​ Dizziness
➔​ Paresthesia
Development of anxiety dissociation, and other
symptoms within 1 month or exposure to an
Specific Phobia
extremely traumatic stressor, or it lasts 2 days to 4
weeks
Characterized by anxiety or specific fear

POST TRAUMATIC STRESS DISORDER

Social Phobia

●​ Characterized by the re-experiencing of an

Provoked by certain types of social or performance extremely traumatic event
situations, which often leads to avoidance behavior
●​ Ex. Victims or war, Veterans, Victims of
OBSESSIVE-COMPULSIVE DISORDER calamities

Involves obsession that causes marked anxiety and SEPARATION ANXIETY DISORDER
compulsion (repetitive behavior or mental acts) that
attempts to neutralize anxiety Excessive anxiety concerning separation from
home or from persons to whom the client is
attached

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

ADJUSTMENT DISORDER Herpetophobia reptiles

Hydrophobia water
Emotional stressful events such as involving
financial issues, medical illnesses, or a relationship Microphobia small things
problem.
Mysophobia dirt and germs

PHOBIAS Necrophobia death and dead things

Nosocomephobia hospital
Illogical, intense, persistent fear of a specific object
Pathophobia disease
or a social situation that causes extreme distress
and interferes with normal functioning Pedophobia children

1.​ Agoraphobia Philophobia love

2.​ Specific phobia: irrational fear of an object
Phobophobia phobia
or situation
3.​ Social phobia Nyctophobia darkness

Pyrophobia fire
KINDS OF PHOBIAS
Scolionophobia school

Acrophobia heights Xenophobia strangers or foreigners

Agliophobia pain Zoophobia animals

Androphobia men
TREATMENT
Anthrophobia flowers

Arachnophobia spiders
Flooding
Arithmophobia numbers
Form of rapid desensitization in which a behavioral
Astraphobia thunder and lightning
therapist confronts the client with the phobic object
Atychiphobia failure until it no longer produces anxiety

Bacteriophobia bacteria
Behavioral Therapy
Belonephobia pins and needles

Bibliophobia books Behavioral therapy such as systematic

desensitization: which the client progressively
Botanophobia plants exposes to the threatening object in a safe setting
Cacophobia ugliness
FACTS
Chromophobia colors

Claustrophobia confined spaces

Fact 1
Cyberphobia computers

Cynophobia dogs ●​ Around 20% of the world's children and

adolescents have mental disorders or
Insectophobia insects problems

Gamophobia marriage ●​ About half of mental disorders begin before

Gynophobia women the age of 14

Hemophobia blood

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

Fact 2 Fact 8

●​ Mental and substance use disorders are the Globally, there is huge inequity in the distribution of
leading cause of disability worldwide skilled Human Resources for mental health.
Shortage of psychiatric nurses, psychologists, and
●​ About 23% of all years due to disability is social workers are among the barriers to providing
caused by mental and substance use treatment
disorders
Fact 9
Fact 3
There are 5 key barriers to increasing mental health
●​ About 900,000 people commit suicide every services availability:
year
1.​ The absence of mental health from the
●​ 86% of suicides occur in low and public health agenda and the implications
middle-income countries. More than half are for funding
aged between 15 and 44. The highest
suicide rates are found among men in 2.​ The current organization of mental health
eastern european countries services

3.​ Lack of integration within primary care

Fact 4

4.​ Inadequate human resources for mental

War and disasters have a large impact on mental health
health and psychosocial wellbeing
5.​ Lack of public mental health leadership
Fact 5
Fact 10
Mental disorders are important risk factors for other
diseases, as well as unintentional and intentional ●​ Financial resources to increase services are
injury relatively modest

Fact 6 ●​ 66th World Health Assembly 2013. “There

can be no health without mental health.”

Stigma and discrimination against patients and

families prevent people from seeking mental health PUBLIC MENTAL HEALTH
care. This stigma can lead to abuse, rejection, and
isolation and exclude people from healthcare or Purpose: promote and protect mental capital,
support mental health, emotional wellbeing , prevent mental
illness, prolong life and the quality of life through
Fact 7 organized efforts of society

Outlines:
Human rights violations of people with mental and ●​ Global Scenario and Action
psychosocial disability are routinely reported in
most countries. These include physical restraints, ●​ National objectives for mental health
seclusion, and denial of basic needs and privacy ●​ Subnational mental health initiatives
●​ Mental health gap action program (mhGAP)
●​ Medicine Access Program (MAP)

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NCM 117: Psychiatric Nursing
2nd Semester | Prelims | Lecture | A.Y. 2024-2025
Mrs. Ma. Lourdes W. Alvarez, RN, MAN

WHAT IS mhGAP AND WHO IT IS NEEDED?

●​ mhGAP is a WHO program to scale up

mental health

●​ mhGAP was launched by the WHO

Director-General Dr. Margaret Chan on
2008

●​ The initial focus is on increasing non

specialist care, including primary
healthcare, to address the unmet needs of
people over the world

WHO ARE THE TARGET AUDIENCE FOR

mhGAP?

●​ Staff not specialized in mental health or

neurology
●​ General physicians, family physicians,
nurses
●​ First point of contact and outpatient car
●​ First level referral centers

GENERAL PRINCIPLES OF CARE

1.​ Communication with people seeking care

and their carers
2.​ Assessment
3.​ Treating and monitoring
4.​ Mobilizing and providing social support.
5.​ Protection of Human Rights
6.​ Attention to overall well being

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