MENTAL HEALTH AND PSYCHIATRIC NURSING

Collated by CCG
In caring for clients, the nurse should attempt to:
1. Accept and respect people as individuals regardless of their behaviour.
2. Limit or reject the individuals inappropriate behaviour without rejecting the individual.
3. Recognize that all behaviour has meaning and is meeting the needs of the performer
regardless of how distorted or meaningless it appears to others.
4. Accept the dependency needs of individuals while supporting & encouraging moves
toward independence.
5. Help individuals set appropriate limits for themselves or set limits for them when they are
unable to do so.
6. Encourage individuals to express their feelings in an atmosphere free of reprisal or
judgment.
7. Recognize that individuals need to use their defenses until other defenses can be
substituted.
8. Recognize how feelings affect behaviour & influence relationships.
9. Recognize that individuals frequently respond to the behavioural expectations of others:
family, peers, authority, etc.
10.Recognize that all individuals have a potential for movement toward higher levels of
emotional health.
BEHAVIORAL RESPONSES AND PATTERNS
STRESS wear and tear that life causes on the body
3 stages of reaction to stress(GAS):
I.
Alarm Reaction Stage Hypothalmus>glands & organs to prep body for defense needs
II.
Resistance Stage decreased bld flw to GI, ^Lungs and Heart, if able to adapt: systems
relax
III.
Exhaustion Stage occur when the persons responded negatively to anxiety and stress
ANXIETY vague feeling of dread or apprehension.
Mild
Moderate
Severe
Panic
Wide perceptual field
PF narrowed to task
PF > one/scattered
PF reduced to focus on
Sharpened senses
Selectively attentive
detail
self
^motivation &
Cant connect
Cannot complete
Cant process envt
learning ability
thoughts
tasks
stimuli
Effective problemindependently
Cant solve problems
Distorted perception
solving
Increased use of
effectively
Loss of rational
Irritable
automatism
Focus: anxiety relief
thought
X respond to
X recognize potential
No direct intervention; Speak in short, simple redirection
danger
teaching effective
and easy-toCrying, ritualistic
X communicate
understand sentences; behaviour
verbally
redirect client
May have
Goal: lower anxiety;
delusion/hallucination
be with pt; talk in low
May be suicidal
calm voice; DBE; walk Panic may last from 5
with pt
30 mins
SAFETY
Intervention: Anxiolytics
Psychiatric Emergencies
1. Suicide
- Planned; not inherited; intention is not fully on dying; with warning of suicide; it is not a
form of manipulation but a cry for help; if depression is decreased=most likely to commit
suicide
SAD PERSONS ASSESSMENT SCALE (Shive & Isaac)/LETHALITY SCALE (Carson & Buthcher)
S
S
A
O
D
N
P
S
E
S
R

Nsg Dx: Risk for Injury

Nsg Interventions:
- Safety
- Monitor q 5-15 mins + 24hr watcher
- Communication patient and co-staff
- No suicide contract
2. Panic Attack - 15 to 30 minutes of rapid, intense, escalating anxiety in which the person
experiences great emotional fear as well as physiologic discomfort. During a panic attack, the
person has overwhelmingly intense anxiety and displays four or more of the following
symptoms: palpitations, sweating, tremors, shortness of breath, sense of suffocation, chest
pain, nausea, abdominal distress, dizziness, paresthesias, chills, or hot flashes.
3. Acute Psychosis
a. Delusional/Hallucinating patient
- Know the type of
- Identify the needs
delusion/Hallucination
- Types of delusion:
- Persecutory/paranoid delusions - involve the clients belief that others are planning to
harm the client or are spying, following, ridiculing, or belittling the client in some way.
- Grandiose delusions - are characterized by the clients claim to association with famous
people or celebrities, or the clients belief that he or she is famous or capable of great
feats
- Religious delusions - often center around the second coming of Christ or another
significant religious
figure or prophet. These religious delusions appear suddenly as part of the clients
psychosis and are not part of his or her religious faith or that of others.
- Somatic delusions - are generally vague and unrealistic beliefs about the clients health or
bodily functions. Factual information or diagnostic testing does not change these beliefs.
- Referential delusion involve the clients belief that television broadcasts, music, or
newspaper articles have special meaning for him or her.
- NURSING INTERVENTIONS FOR DELUSIONAL DISORDERS (Shives & Isaacs)
Safe environment
Establish trusting relationship
Investigate whether there is a precipitating stressor that triggered the delusion
Dont disagree, approve, disapprove or challenge clients delusions
Encourage the client to discuss the logic behind the delusion
If the client asks you if you believe the delusion, inform the client that you dont share the
perception or delusional belief.
Acknowledge the plausible elements of the delusion
If possible, meet the needs the delusion fulfils (ex. Dependence, low self-esteem)
Encourage pt to distract self from thinking the same thought repeatedly, using thoughtswitching technique; identify signs such as staring, that indicates thoughts are becoming
disorganized; and anticipating new situations that may increase anxiety or enhance
delusional thoughts.
- NURSING INTERVENTIONS FOR HALLUCINATION/ILLUSION
Decrease environmental stimuli
Monitor command hallucinations
Attempt to identify precipitating
Administer prescribed medication as
factors
ordered.
Monitor television programs
b. Violent/Aggressive Client Nsg Interv: talk down, Do not demand, use calm tone of voice,
be consistent with rules and corresponding consequences
c. Paranoid client characteristics: mistrusting, suspicious, illogical, delusional, refuses food,
aggressive, superior, aloof
- Nsg interv: honest, consistent, passive friendliness, prompt in procedures,
give sealed food, do not whisper or force meds/socialization, do not argue
or demand explanations, do not be competitive, avoid physical contact;
d. Withdrawn client charac: confused, peculiar(nurse should use simple and direct
plans/instructions); isolated, meaningless interaction(nurse should exhibit active
friendliness)

Difference among the following: Acute psychosis, Schizophreniform and Schizophrenia

 Acute Psychosis
1 S/Sx for 0-1mo

Schizophrenia
2 S/Sx of >6mos with
occupational and social
dysfunction

Schizophreniform
2 S/Sx for 1 mo and 1
day until 6 months

Psychotic Disorders

SCHIZOPHRENIA
Definition a diagnosis that describes a group of mental disturbances that feature
withdrawal, affective problems and interrupted thought process.
Psychopathology:
A. Predisposing Factors
1. Biological factors:
a. Genetic/heredity
b. Vitamin deficiency, disorder in the cells of the brain, anoxia or damage to the brain cells
during and after the birth process leads to interference with the normal growth and
development.
c. Increase levels of neurotransmitters dopamine hypothesis
2. Psychosocial factors:
a. Dysfunctional family system
b. Poor role modelling and/or unresolved developmental goals during the phallic and anal
stages leads to inability to for object relations or cannot distinguish self from others
c. Introvert personality
B. Precipitating factors painful experiences or anxiety provoking experiences that are usually
similar or closely resembling past experience or the predisposing factors:
1. Threatened or actual loss of a major source of gratification
2. Upsurge of erotic feelings, or increase in sudden guilty feelings
3. Decreased ego adaptation
PRIMARY SYMPTOMS:
1. A
3. A
2. A
4. A
POSITIVE AND NEGATIVE SYMPTOMS OF SCHIZOPHRENIA

Positive or Hard Symptoms

Delusion
Hallucination
Echopraxia
Ambivalence
Flight of ideas
Perseveration
Ideas of reference
Associative looseness

Negative or Soft Symptoms

Apathy
Alogia
Affect: Flat
Affect: Blunted
Anhedonia
Avolition
Catatonia

1.

2.
3.

DIAGNOSTIC CRITERIA:
Characteristic Symptom: at least 2 of the ff:
H-allucination
I-ncoherent speech
D-elusions
D-isorganized behavior
N-egative symptom
Social/occupational dysfunction
Continuous signs of the disturbance for at least 6 months

Paranoid

Thought
disturbance

TYPES OF SCHIZOPHRENIA:

Catatonic

Psychomotor
disturbance

Disorganized

Disturbance in
socialization and

Undiffe
rentiat
ed
Characteri
zed by

Residual

Social
withdrawal

ranging from
interpersonal
mixed
disorder, flat
Diagnostic
stupor to
relations
schizophre
affect and
criteria:

Dominant
feature:
excitement
nic
associative

Hallucinat

Clinical
features:
silliness
or
severe
symptoms
looseness
ion

Catatonic
infantile behaviour
along with (+) previous

Agitation/

Others:
incoherent
stupor(coma
vigil)
hosp of
disturbanc
Aggressive

Catatonic
speech, looseness of
schizophreni

Delusion
es of BAT
rigidity
association
a;

Catatonic
NR: how to deal with

(-)
negativity
withdrawn pts
positive Sx;

Waxy flexibility

(+)

Catatonic
negative Sx
hyperactivity

positioning
GENERAL INTERVENTIONS FOR SCHIZOPHRENIA:
Physical care
Safety
Develop trust (without this you cant work with them well)
Orient to reality
Provide structure to the day/structured activities
Interactions should be simple and concrete, often non-verbal or short
Provide least restrictive environment
Provide care in a firm matter-of-fact manner that allows participation
Provide consistency
Give positive reinforcement
Give unconditional acceptance
ANTIPSYCHOTIC MEDICATIONS
Typical Antipsychotic Medications/Traditional best for (+) Sx
High potency:
Moderate potency:
Low potency:
- Fluphenazine(Prolixin
- Loxapine (Loxitane)
- Chlorpromazine
Molindone
(Moban)
)
(Thorazine) **1st
- Perphenazine
- Haloperidol(Haldol)
antipsychotic drug
- Thiothixene (Navane)
(Trilafone)
- Thiuoridazine (Mellaril)
- Trifluoperazine
- Chlorprothixene

(Stelazine)
(Taractan)

Long term maintenance: 2-4 weeks interval of administration

- Fluphenazine decanoate 2-4 wks
- Haloperidol decanoate every 4 wks
Decanoate- IM preparation of antipsychotic meds
Advantage: once injected to subcutaneous, effects last for2-4 weeks

Nsg Resp:
1. Religious intake of drug: Therapeutic level is met at 2-3 months or more and should take in
meds for 5 to 9 months to maintain therapeutic level.
2. WOF S/E (check BP first then Temperature)
SIDE EFFECTS:
1. Anticholinergic effects: dry mouth, ^HR, Urinary retention, Constipation, Hypotension,
Drowsiness, blood dyscracias, pruritus, potosensitivity
2. Extrapyramidal Syndrome: TANPD (NMS-crucial; occurs during 1 st week; Hallmark sign:
hyperthermia)(Dystonia: oculogyric crisis-worst dystonia, rolling of eyeballs; torticollis-neck
rigidity; ask to bring out tongue (+) if with tightness WOF aspiration)
TTT of EPS: Anticholinergics=to decrease acetylcholine; Dopaminergics=to increase
dopamine
Anticholinergics:
Artein
Cogentin

Akineton
Dopaminergics
Benadryl
Carbidopa

 Amantadine
Levodopa
Parlodel
Simetril

Atypical Antipsychotic Drugs more effective for (-)Sx, cognitive S/Sx, Affective S/Sx;
firstline drug in the western world; less chances of experiencing EPS
Clozapine S/E agranulocytosis
Sertindole
Olanzapine
Quetiapine
Riperidone
*Evaluate for heart problems
Amilsupride
Nsg Resp:
1. Give weekly supply
2. Weekly CBC-WBC checking
3. WOF S/Sx of infection

AFFECTIVE DISORDER
Types:
1. Post partum depression occurs in the first 30 days post-partum
2. SAD seasonal affective disorder
3. Reactive depression preoccupation with loss, anxiety, tension and decreased appetite;
able to respond to environmenta change (laughs at something funny); symptoms usually
self-limiting. This person is often angry.
4. Neurotic depression
a. Cyclothymic characterized by moods of mania with or without episodes of depression.
Hypomania<--->mild depression for a year
b. Dysthymia characterized by depressive episodes only.
5. Involutional melancholia type of depression during menopausal process

Major Depressive Disorder

Features:
- Atleast a 2 week period of
o Appetite problems (>5% change in
maladaptive functioning (sad mood,
appetite)
o Psychomotor retardation
lack of interest in life activities)
o Worthlessness
- Plus with atleast 4 other symptoms
o Anergia constant feeling of fatigue
ofdepression:
o Indecisiveness
o Sleep problems
o Anhedonia
(hypersomnia/insomnia)
- Impairment in social & occupational
functioning
- BIPOLAR DISORDER (Manic Depressive Illness)
- Cyclic mood changes demonstrated by manic episodes, periods of depression and periods
of normal behaviour.
- Manic episode defense or massive denial of depression;mirror image of depression
- Diagnosis:
- Abnormal & elevated mood that last at
- Excessive engagement in pleasurable
least a week
activities
- Atleast 4 of the ff symptoms:
- Sleep problems ability to stay awake
- Hyperactivity
for 5 days
- Euphoria
Speech volubility
- Distractibility
- With occupational or social
- Grandiosity
dysfunction
- Hypomanic episode meets criteria for manic but symptoms lasts at least 4 days. Not
severe enough to warrant hospitalization.
- Bipolar I has a history of manic episode
- Bipolar II has experienced major depression and a hypomanic episode but not manic
episode.

Interventions:
ELECTROCONVULSIVE THERAPY for severe depression
- Electrically inducing grandma seizure
- Dosage: 70-150 volts(Tx lvl) for 0.5 2 secs enough to induce a 30-60 second seizure, to
be given 2-3x/wk for a total of 6-12 treatments
- MOA: unknown; Guilty(punishment/atonement of sins); Depressed(loss of memory);
Manic(resets pattern of brain cell activity); has some effect as antidepressants
- NR:
o Pre-procedure: Consent; CP & bone clearance; NPO 4-8hrs before procedure; bowel
and bladder elimination; no jewellery; prepare the following equipment: biteblock,
ECG, suction apparatus, O2 tank, pulse Ox, Crash cart. ECT medications:
Succinylcholine(muscle relaxant) and atropine sulphate(anticholinergic)
o Intra: strap patient for safety, airway(sidelying), stimulate breathing, O2, Circulation
o Post: maintain airway, V/S, monitor for S/E such as disorientation, Headache,
precognition(6mos) , Complication: bone fracture
Pharmacological: Selective Serotonin Reuptake Inhibitors first line drug for depression (safe
for children and elderly) inhibit serotonin uptake and produces an antidepressant response
- Side effects:
1. Nausea and diarrhea
5. Insomnia
9. Dizziness
2. Dry mouth
6. Nervousness
10.Weight loss
3. CNS stimulation
7. Loss of libido
4. Photosensitivity
8. Headache
11.
Management:
1. Safety precautions dizziness
2. Take a single dose in the morning to prevent insomnia
3. Administer with a snack or with meals to reduce risk of dizziness and light headedness
4. Fluoxetine take in AM to avoid interference with sleep
5. Monitor liver and renal function tests, WBC & neutrophils
6. If priapism occurs discontinue
12.
MEDS: (pg338 for S/E with NI)
1. Citolapram (Celexa)
4. Paroxetine hydrochloride (Paxil)
2. Fluoxetine (Prozac)
5. Sertraline hydrochloride (Zoloft)
3. Fluvoxamine (Luvox)
6. Escitalopram (Lexapro)
TRICYCLIC ANTIDEPRESSANTS block reuptake of norepinephrine and serotonin at the
presynaptic neuron
Side effects:
1. Dry mouth
7. Tachycardia, dysrhythmias
2. Decreased GI motility and
8. Orthostatic hypotension
9. Sedation
constipation
10.Weight gain
3. Difficulty voiding
11.Anxiety, restlessness and irritability
4. Dilated pupils and blurred vision
12.Decreased or increased libido with
5. Photosensitivity
6. Cardiovascular disturbances
ejaculatory and erection disturbances
13.
Management:
1. Takes several weeks to produce desired effect (2-4 weeks after first dose)
2. Monitor side effects & address appropriately
3. Monitor liver and renal function tests
4. Administer the entire daily oral dose at one time, preferably at bedtime
5. Taper gradually before discontinuing use
14.
MEDS:
15.
Amitriptyline
19.
Imipramine
23.
Notriptyline
(Elavil)
(Tofranil)
(Aventyl)
16.
Amoxapine
20.
Maprotiline
24.
Protriptyline
(Asendin)
(Ludiomil)
(Vivactil)
17.
Clomipramine
21.
Mirtazapine
25.
Trimipramine
(Anafranil)
(Remeron)
maleate (Sumontil)
18.
Desipramine
22.
Nefazodone
(Norpramin)
(Serzone)
MONOAMINE OXIDASE INHIBITORS

Inhibit MAO enzyme in the brain, blood platelets, liver, spleen and kidneys metabolizes
amines, norepinephrine and serotonin and the concentrations of these amines increase
- Used for depression in the client who has not responded to other antidepressant therapies,
including electroconvulsive therapy
- Concurrent use with amphetamines, antidepressants, dopamine, epi, guanethidine,
levodopa, methyldopa, nasal decongestants, norepi, reserpine, tyramin-containing foods,
or vasoconstrictors may cause hypertensive crisis
- Concurrent use with narcotic analgesics may cause hypertension, hypotension, coma or
seizures.
Side effects:
1. Orthostatic
6. GI upset
11.CNS stimulation,
7.
Dry
mouth
hypotension
including anxiety,
8. Weight gain
2. Restlessness
agitation and mania
9. Peripheral edema
3. Insomnia
12.Delay in ejaculation
10.Anticholinergic
4. Dizziness
5. Weakness, lethargy
effects
13.Tyramine containing foods to avoid
14.Aged cheese
20.Overripe
23.Yogurt
29.Redwine,
15.Pickled
fruits
24.Sausage,
beer, sherry
herring
21.Brewers
bologna
30.Beef or
16.Avocados
yeast
25.Pepperoni
chicken liver
17.Bananas
22.Meat
26.Salami
31.Caffeine as
18.Papaya
extracts and
27.Soy sauce
coffee, tea or
19.Broad beans
tenderizers
28.Raisins
chocolate
32.**Antidote: Phentolamine (Regitin) given direct IV, reverses effects in a span of 5 mins
33.MEDS:
34.Isocarboxazid (Marplan)
35.Phenelzine sulfate (Nardil)
36.Tranylcypromine sulphate (Parnate)
ANTI-MANIC MEDICATIONS
1. Lithium Carbonate (Eskalith, Lithane, Lithobid)
2. Lithium Citrate (Cibalith-Si)
37.Description:
- Affect cellular transport mechanism and alter both the presynaptic and postsynaptic
events
- The therapeutic dose (0.6-1.2 mEq/L) is only slightly less than the amount producing
toxicity
- Causes of an increase in lithium level: decreased Na intake, fluid and electrolyte loss
associated with severe sweating, dehydration, diarrhea, or diuretic therapy, illness, and
overdose.
- Check serum lithium levels every 1 to 2 months or whenever any behavioural change
suggests an altered serum level (draw blood in AM 12 hours after lose dose taken)
38.Side effects:
1. Polyuria
7. Abdominal bloating
11.Muscle weakness
2. Polydipsia
8. Soft stools or
12.Lethargy
3. Anorexia, nausea
13.Fatigue
diarrhea
4. Dry mouth
14.Headache
9. Fine hand tremors
5. Mild thirst
15.Hair loss
10.Inability to
6. Weight gain
concentrate
16.Management:
1. Administer with food
2. Fluid intake 6 to 8 glasses of water a day
3. Avoid excessive amounts of coffee, tea, or cola
4. Adequate salt intake
5. Client may take a missed dose within 2 hours of the scheduled time; otherwise the client
should skip the missed dose and take the next dose at the scheduled time
6. Therapeutic response: noted in 1 to 3 weeks
7. Monitor ECG, renal function tests, and thyroid tests
8. Avoid SAM when in Lithium since they promote lithium excretion
17.Lithium toxicity
1. Diarrhea
2. Vomiting
-

3.
4.
6.
7.
1.
2.

Drowsiness
5. Gross tremors
Muscle weakness
Management: stop drug
Other Anti-Manic Medications:
Valproic acid
Carbamazepine
8.
9. Depressed
10.Manic
11.Nutrition
12.Hypermetabolic state & LoA
14.Hyperactivity & Distractibility
13.NR: ^CHO&CHON; supervised
15.NR: finger foods; ^CHO &
meal; SFF; Offer choices;
CHON; easy to digest
prompts; NGT
16.Activity
17.Poor concentration, low self19.Hyperactivity & distractibility
esteem; fatigue
20.NR: low energy expenditure;
18.NR: minimize concentration,
activity must be accomplished
provide activities which can be
(pingpong, walk); gross motor,
accomplished, gross motor
non-competitive activities,
activities, venue for selfproductive
expression (gardening is
encouraged)
21.Res/Rela
22.Preoccupation
24.Increased noradrenergic activity
x/Sleep
23.NR: soft music & light, quiet
25.NR: decrease stimuli, avoid
activity, decreased stimulation
distractions, sleep intervention
and sleep intervention
26.Safety
27.Hoplessness/Helplessness
29.Bold, Competitive, concealed
28.Decrease suicide risk through
depression
counseling
30.Counselling, Set limits,
consistency
31.Eliminati
32.Inactivity (address constipation)
33.Hyperactivitysweating
on
(address constipation)
34.Self-care
35.Assist patient
36.Overdoing od self-care
activities
activitiesset limits
37.
38.PSYCHOPHYSIOLOGIC PROBLEMS
Stress related disorders due to Autonomic Nervous system stimulation, leading to
sympathetic arousal due to flight-fight activation producing the ff effect:
39.Stress related disorders:
- HPN
- Migraine headaches
- Pancreatitis
- Ulcers
- Eating disorders
- Rheumatoid arthritis
- Skin disorders
- Dysrhythmias
- DM, DIC
- Cardiovascular
- Asthma
- Cancer
disorders
- SEXUAL DISORDERS
I. Sexual dysfunctions disturbances in the sexual response cycle or the presence of pain during
sexual intercourse:
a. Hyposexual desire disorder
b. Sexual arousal disorder ex. Male erectile disorder
c. Orgasmic disorder ex. Premature ejaculation
d. Sexual pain disorder ex. Dyspareunia, vaginismus
II. Paraphilias disorders in which unusual or bizarre sexual imagery or acts are enacted to achieve
sexual excitement.
Characteristics: fear of rejection; low self-esteem
a. Bestiality or zoophilia
g. Necrophilia
b. Exhibitionism
h. Pedophilia
c. Fetishism
i. Telephone scatologia
d. Frotteurism
j. Transvestic fetishism
e. Sexual masochism
k. Voyeurism
f. Sexual sadism
III. Modes of Sexual Expression
a. Homosexuality
c. Transvestism
b. Bisexuality
d. Transexualism

e.
f. SUBSTANCE ABUSE DISORDERS
g. DEFINITION OF TERMS:
h. Substance dependence/addiction presence of cognitive, behavioural & physiological
symptoms generated from persistent use.
i.
j.
A. ALCOHOL ABUSE
k. ALCOHOL INDUCED DISORDERS
1. Alcohol intoxication
Sx: slurred speech, loud talk & memory deficits, impaired attention span, irritability,
unsteady gait, stupor or coma.
Mgt: promote safety: (a) altered thought-haloperidol; (b)seizure-dilantin/valium/MgSO4 and
cool environment; (c)anxiety-lithium; (d)Hallucination X shadows; others do not restrain
2. Alcohol withdrawal
l.
STAGES OFWITHDRAWAL
m.
Stage 1
n.
Stage 2
o.
Stage 3
p.
Stage 4
-May begin 6-8 hours - May begin 8-12 hours - May begin 12- - May begin 3-5 days after the
after last ingestion
after the last
48 hours
last ingestion or a
or a significant
ingestion or a
after the last
significant decrease in
decrease in usual
significant decrease
ingestion or
usual alcohol consumption
consumption of
in usual
a significant - S/Sx: confusion,
disorientation, clouding of
alcohol
consumption of
decrease in
-S/Sx: anxiety,
consciousness and delirium,
alcohol
alcohol
anorexia, insomnia, - S/Sx: profound
hypertension, diaphoresis,
consumption
tremors,
confusion, gross
- S/Sx: severe
tachycardia, fluctuating
hyperalertness,
tremors,
hallucination
levels of consciousness,
internal shaking,
nervousness,
s, seizures
fever (103to104deg F),
nausea and
disorientation,
agitation, sleeplessness,
vomiting,
illusions, auditory
palpitations, tachycardia,
headache,
and visual
chest pain
increased PR & BP,
hallucinations,
q.
**medical emergency
depression
nightmares
r.
3. Alcohol Withdrawal Dementia
- AKA DELIRIUM TREMENS which may occur 24-72 hours after last drink
- S/Sx: elevated vital signs, restlessness, tremulousness, agitation, hyperalertness, illusions,
hallucinations, incoherent speech
4. Alcohol induced dementia
- Occurs to those with prolonged, chronic dependence to alcohol
- S/Sx: severe loss of intellectual ability and impaired memory, judgment, and abstract
thinking & permanent damage to brain can occur in severe cases
5. Alcohol induced persisting amnestic disorder
a. Korsakoffs psychosis degenerative changes in the thalamus occur because of the
deficiency of Vit B complex particularly thiamine and B12.
b. Wernickes encephalopathy is an inflammatory, hemorrhagic, degenerative condition
o the brain caused by a thiamine deficiency usually associated with chronic alcoholism.
s.
t. TTT of Alcoholism:
A. Eversion therapy: Disulfiram (antabuse) inhibits acetaldehyde metabolism (toxic to body
& brain)
u. NR: before starting, patient must be alcohol free for 24 hours; instruct not to take in any
alcohol-containing substance; Do not combine with metronidazole because it may result to
psychotic symptoms
B. Alcoholic anonymous
v. 12-step program:
w. 1. We admitted that we were powerless over alcohol, that our lives had become
unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our wills and lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our
wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them
all.
9. Made direct amends to such people whenever possible, except when to do so would
injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as
we understood Him,
praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as a result of these steps, we tried to carry this
message to alcoholics and
to practice these principles in all our affairs.
x.
y. ALZHEIMERS
- An age related, progressive disorder of the CNS characterized by a chronic cognitive
dysfunction
- Characterized by brain atrophy & distortions in cortical neurofibrils
z. Stage I(1-2
aa. Stage II(2-10yrs)
ab.Stage III(8-10 yrs
years)
before death
occurs)
a. Emotional changes- a. Assistance is required in clothing, bathing, a. Urinary or fecal
depression, anxiety,
toileting
incontinence
b.
Aphasia,
apraxia

loss
of
ability
to
use
b.
Speech limited to few
fatigue and
object correctly and agnosia-loss of ability
words, then mute
decreased activity
c.
Loss off ability to
b. Memory problems
to recognize sensory impressions,
c. Needs assistance in
ambulate, sit up &
agraphia-inability to read and write
complex tasks:
c. Wandering, restlessness at night
smile
d. Kluver-Bucy Sx
planning, marketing, d. Catastrophic reactions/overreactions to
minor stress, tantrums and labile emotions
hyperolality & binge
finance
e. Hyperolality the need to taste, chew &
eating
examine any small object enough to be
e. Hyperetamorphosis
placed in the mouth
need to compulsively
f. Perseverationphenomena repetitive
touch & examine every
behaviors such as lip licking, finger
object in
tapping, pacing and echolalia
theenvironment
ac. Medicationsto treat Alzheimers Disease
A. Acetylcholinesterase inhibitors improve cognitive functions in the early stages; inhibits
cholinesterase. Examples: Donepezil(Aricept); Tacrine(Cognex); Rivastigmine(Exelon);
Galantamine