PSYCHIATRIC NURSING REVIEW HANDOUT

MENTAL HEALTH balance in a persons internal life and adaptation to reality Mental ILL Health state of imbalance characterized by a disturbance in a persons thoughts, feelings and behavior Poverty and abuses are major risk factors Psychiatric nursing interpersonal process whereby the professional nurse practitioner ,through the therapeutic use of self(art) and nursing theories (science), assist clients to achieve psychosocial well being. Core of psych nursing interpersonal process human to human relationship(both for mentally healthy and ill) Neurosis any long term mental or behavioral d/o in which contact with reality is retained the condition is recognized by the patient as abnormal. Essentially features anxiety or behavior exagerrated designed to avoid anxiety ( anxiety d/o ; hysteria to conversion d/o,amnesia,fugue,multiple personality and depersonalization- dissociative d/o;oc d/o) Result of inappropriate early programming(psychoanalysis little value) Benefits from Behavior Therapy Psychosis Mental or behavioral disorder wherein patient looses contact with reality Presence of delusions, hallucinations,severe thought disturbances,alteration of mood, poverty of thought and abnormal behavior (schizophrenia , major disorder of affect ( mania depression), major paranoid states and organic mental disorder Benefits from psychoanalysis and antipsychotics Mental hygiene measures to promote mental health , prevent mental illness and suffering and facilitate rehabilitation.(and if necessary find meaning in these experiences) Main tool therapeutic use of self It requires self-awareness Methods to increase self-awareness: Introspection Discussion Experience Role play Mental health concepts Assessment (psychosocial processes ) Appearance , behavior or mood Speech , thought content and thought process Sensorium Insight and judgement Family relationships and work habits Level of growth and development

Common Behavioral Signs and Symptoms

Disturbances in perception Illusion- misinterpretation of an actual external stimuli Hallucinations false sensory perception in the absence of external stimuli Disturbances in thinking and speech neologism coining of words that people do not understand Circumstantiality over inclusion of inappropriate thoughts and details Word salad incoherent mixture of words and phrases with no logical sequence Verbigeration meaningless repetition of words and phrases Perseveration persistence of a response to a previous question Echolalia pathological repetition of words of others Aphasia speech difficulty and disturbance Expressive , receptive or global Flight of ideas- shifting of one topic from one subject to another in a somewhat related way Looseness of association-incoherent ,illogical flow of thoughts(unrelated way) Clang association sound of word gives direction to the flow of thought Delusion persistent false belief,rigidly held Delusions of grandeur- special /important in a way Persecutory-threatened Ideas of reference-situation/events involve them Somatic- body reacting in a particular way Magical thinking primitive thought process thoughts alone can change events Autistic thinking regressive thought process-subjective interpretations not validated with objective reality Disturbances of affect Inappropriate disharmony between the stimuli and the emotional reaction Blunted affect severe reduction in emotional reaction Flat affect absence or near absence of emotional reaction Apathy dulled emotional tone Depersonalization feeling of strangeness from ones self Derealization feeling of strangeness towards environment Agnosia lack of sensory stimuli integration Disturbances in motor activity Echopraxia imitation of posture of others Waxy flexibility maintaining position for a long period of time Ataxia loss of balance Akathesia extreme restlessness Dystonia- uncoordinated spastic movements of the body Tardive dyskenisia involuntary twitching or muscle movements Apraxia involuntary unpurposeful movements Disturbances in memory Confabulation filling of memory gaps

Dj vu 2nd time-like feeling Jamais vu- not having been to the place one has been before Amnesia memory loss (inability to recall past events) Retrograde-distant past Anterograde immediate past Anomia lack of memory of items

Dynamics of Human Behavior Behavior the way an individual reacts to a certain stimulus Conflict situation arising from the presence of two opposing drives Need - organismic condition that requires a certain activity Stress life events in which a demanding situation (warrants a response )taxes a persons resources( support systems or coping mechanisms/strategiesdistress and eustress Adaptation process of interacting with the environment to maintain homeostatic equilibrium Maladaptation ineffective coping Dynamics of Human Behavior Personality integration of systems and habits representing anindividuals characteristic adjustment to his environment expressed through behavior Individualistic, unique, predictable(stability and consistency) Determinants: psychological,cultural, biological ( not inhereted) and familial Analysis Potential support systems or stressors Potential risk factor Satisfaction of human needs Physiological(oxygen , fluids, nutrition, temp.,elimination,shelter,rest,sex) Safety and security(physical and psychological) Love and belongingness Self esteem Self actualization 3 divisions of the mind Conscious focussed on awareness Subconscious recalled at will Unconscious never recalled / largest part

Learning change in behavior through insight , relearning and remotivation Theories of personality development Psychosexual Psychosocial Cognitive Developmental tasks Moral Interpersonal Freuds psychosexual theory

Libido inner drive Parts of body focus of gratification Unsuccesful resolution - fixation Structures of personality

Id pleasure principle-instinct Ego controls action and perception reality principle Superego moral behavior - conscience 0-18 m0s ;oral mouth trust and discriminating 18 mos. 3 years ; anal bowels holding on or letting go Negativism and toilet training age 3 -6 years phallic ; genitals exploration and discovery ( inc. sexual tension) Gender identification and genital awareness Oedipus and Electra complex // Castration anxiety and penis envy 6-12 years latency (quiet stage) sexual energy diverted to play. Institution of superegocontrol of instinctual impulses 12 young adult genital ; reawakening of sexual drives relationships Sexual maturation Sexual identity ,ability to love and work PsychosocialErickson developmental milestones //delay 0-12mos; TRUST 1-3y AUTONOMY 3.6 INITIATIVE 6.12 INDUSTRY 12.18 IDENTITY 18.25 INTIMACY 25.60 GENERATIVITY 60 and above EGO INTEGRITY INFANCY CONSISTENT MATERNAL CHILD INTERACTION TRUST INNER FEELING OF SELF WORTH HOPE TODDLER ALLOW EXPLORATION PROVIDE FOR SAFETY NO NO NEGATIVISM OFFER CHOICES / REVERSE PSYCHOLOGY TOILET TRAINING 18 MOS.-BOWEL DAYTIME BLADDER -2 Y NIGHTIME BLADDER 3 Y REWARD W/ PRAISE AND AFFECTION INDEPENDENCE PRE-SCHOOL PROVIDE PLAY MATERIALS SATISFY CURIOSITY

TEACH AND REINFORCE(HYGIENE,SOCIAL BEHAVIOR) SIBLING RIVALRY WILLPOWER SCHOOL AGE HOW TO DO THINGS WELL-SUPPORT EFFORTS CHUMS AND HOBBIES NEEDS TO EXCEL/ACCOMPLISH NEED FOR PRIVACY AND PEER INTERACTION COMPETENCE ADOLESCENCE MAKE DECISION,EMANCIPATION FROM PARENTS BODY IMAGE CHANGES NEED TO CONFORM BUT KEEP INDIVIDUALITY SELF AWARENESS YOUNG ADULT COMMITMENT AND FIDELITY RESPONSIBILITY ACHIEVEMENT OF INDEPENDENCE MIDDLE ADULTHOOD SUPPORT-PERIOD OF ROLE TRANSITIONS MIDLIFE CRISIS ADJUSTMENT AND COMPROMISE MOST PRODUCTIVE AND CREATIVE ALTRUISM LATE ADULTHOOD SELF ACCEPTANCE SELF WORTH WISDOM

PIAGETS COGNITIVE THEORY 0-2 SENSORIMOTOR REFLEXES IMITATIVE REPETITIVE BEHAVIOR SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT. TRIAL AND ERROR RESULTS IN PROBLEM SOLVING 2-7Y PRE-OPERATIONAL SELF-CENTERED,EGOCENTRIC CANNOT CONCEPTUALIZE OTHERS VIEW ANIMISTIC THINKING IMAGINARY PLAYMATE SYMBOLIC MENTAL REPRESENTATION CREATIVITY 2-4 PRE-CONCEPTUAL (PRE-LOGICAL) 4-7 INTUITIVE (UNDERSTANDING OF ROLES) 7-12Y CONCRETE OPERATIONAL LOGICAL CONCRETE THOUGHT INDUCTIVE RESAONING (SPECIFIC TO GENERAL) CAN RELATE ,PROBLEM SOLVING ABILITY REASONING AND SELF-REGULATION

12-ABOVE FORMAL OPERATIONAL THOUGHT Abstract thinking Separation of fantasy and fact Reality oriented Deductive reasoning Apply scientific method Havighurst Developmental Tasks Baby to early childhood Right from wrong and Conscience Late childhood Physical skills,wholesome attitude,social roles Conscience morality and values Fundamental skills in academics Personal independence Adolescence Sexual social roles Relationships Independence and ideology Early adulthood Career Selecting a mate Finding Civic or social responsibility Middle age Achieving Civic or social responsibility Adjusting to changes Satisfactory career performance Adjusting to aging parents Adjusting to parental roles Old age Adjusting to changes Establishing satisfactory living arrangements and affiliations Kohlberg MORAL DEVELOPMENT/ THINKING/ JUDGEMENT

PRE-CONVENTIONAL (0-6) PUNISHMENT AND OBEDIENCE OBEDIENCE TO RULES TO AVOID PUNISHMENT CONVENTIONAL ( 6-12 ) MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS CONFORMITY SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE

AND

POST CONVENTIONAL (12 18 Y) PRIOR RIGHT OR SOCIAL CONTRACT UNIVERSAL ETHICAL PRINCIPLE ABIDE FOR COMMON GOOD RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS

PSYCHIATRIC NURSING LECTURE 2 basic concepts continuation and NURSE PATIENT RELATIONSHIP DEFENSE MECHANISMS unconscious intrapsychic adoptive efforts to resolve emotional conflict and cope with anxiety automatic pathology is determined by the frequency of use examples of DEFENSE MECHANISMS DENIAL failure to acknowledge an intolerable thought , feeling, experience or reality DISPLACEMENT redirection of emotions or feelings to a subject that is more acceptable or less threatening PROJECTION attributing to others ones feelings, impulses , thought or wishes UNDOING an attempt to erase an act , thought , feeling or desire COMPENSATION an attempt to overcome real or imagined shortcoming SYMBOLIZATION a less threatening object or idea is used to represent another SUBSTITUTION replacing desired , impractical , unattainable object with one that is acceptable INTROJECTION a form of identification in which there is a taking into oneself the characteristic of another(love object) REPRESSION unacceptable thoughts is kept from awareness(unconscious) SUPPRESSION- consciously putting a disturbing thought or incident out of awareness REACTION FORMATION - expressing attitude directly opposite to unconscious wish or fear REGRESSION returning to an earlier developmental phase in the face of stress DISSOCIATION detachment of painful emotional conflicts from consciousness CONVERSION emotional problems are converted into symptoms FANTASY conscious distortion of unconscious feelings or wishes IDENTIFICATION conscious patterning of ones self from another person INTELLECTUALIZATION - over use of intellectual concepts by an individual to avoid expression of feelings RATIONALIZATION justifying ones actions which are based on other motives SUBLIMATION - rechanneling of unacceptable instinctual drives with one hat is aceptable NURSE PATIENT RELATIONSHIP SULLIVANS THEORY ON INTERPERSONAL RELATIONSHIP DEVELOPED BY PEPLAU INTO NURSE- PATIENT RELATIONSHIP SERIES OF INTERACTION BETWEEN THE NURSE AND PATIENT IN WHICH THE NURSE ASSISTS THE PATIENT TO ATTAIN POSITIVE BEHAVIORAL CHANGE T RUST R APPORT U NCONDITIONAL POSITIVE REGARD S ETTING LIMITS T HERAPEUTIC COMUNICATION

 PHASES PRE-INTERACTION SELF AWARENESS ORIENTATION PHASE DEVELOP A MUTUALLY ACCEPTABLE CONTACT WORKING IDENTIFICATION AND RESOLUTION OF THE PATIENTS PROBLEMS TERMINATION ASSIST PATIENT TO REVIEW WHAT HE HAS LEARNED AND TRANSFER HIS LEARNING TO HIS REL. W/ OTHERS WHEN TO TERMINATE NPR GOALS ACCOMPLISHED EMOTIONALLY STABLE GREATER INDEPENDENCE ABLE TO COPE WITH ANXIETY, LOSS , FEAR AND SEPARATION COMMON PROBLEMS - NPR TRANSFERENCE DEVELOPMENT OF EMOTIONAL ATTITUDE + OR TOWARDS THE NURSE RESISTANCE DEVELOPMNET OF AMBIVALENT FEELINGS TOWARDS SELF EXPLORATION COUNTER TRANS FERENCE TRANSFERENCE AS EXPERIENCED BY THE NURSE PRINCIPLES OF CARE ACCPETS PATIENT AS UNIQUE WITH INHERENT VALUE AND WORTH PATIENT IS VIEWED AS HOLISTIC HUMAN BEINGS WITH INTERDEPENDENT AND INTERRELATED NEEDS FOCUS ON STRENGTHS AND ASSETS NON JUDGEMENTAL ASSISTANCE TOWARDS COPING EXPLORE THE PATIENTS BEHAVIOR AND THE NEED IT IS DESIGNED TO MEET AND THE MESSAGE IT IS COMMUNICATING LEVELS OF INTERVENTION PRIMARY INTERVENTIONS AIMED AT THE PROMOTION OF MENTAL HEALTH AND LOWERING THE RATE OF CASES BY ALTERING THE STRESSORS SECONDARY INTERVENTIONS THAT LIMIT THE SEVERITY OF THE DISORDER CASE FINDING AND PROMPT Tx TERTIARY REDUCING THE DISABILITY AFTER A DISORDER PREVENTION OF COMPLICATION AND ACTIVE PROGRAM OF REHABILITATION CHARACTERISTICS OF A PSYCHIATRIC NURSE-major roles of a nurse socializing agent and patient advocate EMPATHY- ability to see beyond outward behavior and sense accurately another persons inner experience GENUINENESS/CONGRUENCE ability to use therapeutic tools appropriately UNCONDITIONAL POSITIVE REGARD - respect THERAPEUTIC COMMUNICATION CLARIFICATION LIMIT SETTING EMPATHETIC / ENCOURAGE EXPRESSION ANSWERS NEEDS REFLECTIVE AND INSIGHTFUL THERAPEUTIC COMMUNICATION FOCUS ON FEELING TONE ,NEEDS ,MOTIVATION MUST HAVE CONSISTENCY AND IS NON JUDGEMENTAL

 CRITERIA OF SUCCESSFUL COMMUNICATION APPROPRIATENESS, FLEXIBILITY AND EFFICIENCY TECHNIQUES OF COMMUNICATION TO INITIATE A CONVERSATION giving broad openings giving recognition / acknowledgement TO ESTABLISH RAPPORT GIVING INFORMATION USE OF SILENCE TO GATHER INFORMATION FOCUSING VALIDATING REFLECTING RESTATING TO CLOSE A CONVERSATION summarizing

FEEDBACK

TREATMENT MODALITIES common psychotherapeutic interventions applied to psychiatric nursing BIOLOGICAL EMOTIONAL PROBLEM IS AN ILLNESS cause may be inherited or chemical in origin FOCUS OF TREATMENT IS MEDICATIONS AND ECT* REMOTIVATION THERAPY TREATMENT MODALITY THAT PROMOTES EXPRESSION OF FEELINGS THROUGH INTERACTION FACILITATED BY DISCUSSION OF NEUTRAL TOPICS STEPS : climate of acceptance creating bridge to reality sharing the world we live in appreciation of works of the world climate of appreciation MUSIC THERAPY INVOLVES USE OF MUSIC TPO FACILITATE EXPRESSION OF FEELINGS,FACILITATE RELAXATION AND OUTLET OF TENSION PLAY THERAPY enables patient to experience intense emotion in a safe environment with the use of play children express themselves more easily in play. revealing as reflection of childs situation in the family provide toys and materials facilitate interaction observe and help child resolve problems through play Group therapy Treatment modality involving three or more patients with a therapist to relieve emotional difficulties, increase self esteem, develop insight , LEARN NEW ADAPTIVE WAYS TO COPE WITH STRESS and improve behavior with others( RELATIONSHIP WITH OTHERS CAN BE WORKED THROUGH) IDEAL 8 10 MEMBERS MILIEU THERAPY

 CONSISTS OF TREATMENT BY MEANS OF CONTROLLED MODIFICATION OF THE PATIENTS ENVIRONMENT , FACILITATE POSITIVE BEHAVIORAL CHANGE INCREASE PATIENTS AWARENESS OF FEELINGS, INCREASE SENSE OF RESPONSIBILITY AND HELP ETURN TO COMMUNITY clients plan social and group interaction token programs , open wards and self medication FAMILY THERAPY A METHOD OF PSYCHOTHERAPY WHICH FOCUSES ON THE TOTAL FAMILY AS AN INTERACTIONAL SYSTEM PROBLEM IS A FAMILY PROBLEM focus on sick members behavior as source of trouble / symptom serve a function for the family members develop sense of identity points out function of the sick member for the rest of the family PSYCHOANALYTIC focuses on the exploration of the unconscious, to facilitate identification of the patients defenses ANXIETY RESULTS BETWEEN CONFLICTS OF ID AND EGO(DEFENSE MECHANISMS FORM TO WARD OFF) BECOMES AWARE OF UNCONSCIOUS THOUGHTS AND FELINGS.UNDERSTAND ANXIETY AND DEFENSES HYPNOTHERAPY VARIOUS METHODS AND TECHNIQUES TO INDUCE A TRANCE STATE WHERE PATIENT BECOMES SUBMISSIVE TO INSTRUCTIONS BEHAVIOR MODIFICATION A THERAPEUTIC INTERVENTION INVOLVOING THE APPLICATION OF LEARNING PRINCIPLES IN ORDER TO CHANGE MAL-ADAPTIVE BEHAVIOR PSYCHOLOGICAL PROBLEMS ARE A RESULT OF LEARNING DEFICIENCIES CAN BE CORRECTED THROUGH LEARNING BEHAVIOR MODIFICATION OPERANT CONDITIONING USE OF REWARDS TO EINFORCE POSITIVE BEHAVIOR PERCEIVED AND SELF REINFORCEMENT BECOMES MORE IMPORTANT THAN EXTERNAL DESENSITIZATION SLOW ADJUSTMENT OR EXPOSURE TO FEARED OBJECTS(USED IN PHOBIAS) PERIODIC EXPOSURE,UNTIL UNDESIRABLE BEHAVIOR DISAPPEARS OR LESSENS AVERSION THERAPY AN EXAMPLE OF BEHAVIOR MODIFICATION IN WHICH PAINFUL STIMULUS IS INTRODUCED TO BRING ABOUT AN AVOIDANCE OF ANOTHER STIMULUS WITH THE END VIEW OF FACILITATING BEHAVIORAL CHANGE TOKEN ECONOMY-REWARDING DESIRED BEHAVIOR COGNITIVE THERAPY SHORT TERM STRUCTURED THERAPY ORIENTED TOWARDS PRESENT PROBLEMS ABD SOLUTIONS AMIN FOCUS OF DEPRESSIVE DISORDERS HUMOR THERAPY TO FACILITATE EXPRESSION AND ENHANCE INTERACTION

 ACTIVITY THERAPY GROUP INTERACTION WHILE WORKING ON A TASK TOGETHER BIOLOGICAL THERAPY ELECTROCONVULSIVE THERAPY mechanism of action unclear voltage 70 150 volts about .5 2 seconds 6 12 treatments intervals of 48 hours indicators of effectiveness occurence of generalized tonic clonic seizures indications depression , mania and catatonic schizophrenia contraindications:fever , IICP, fracture,retinal det.,preg,TB w/ hemm. , cardiac d/o consent needed medications given : AT SO4-decrease secretions anectine ( Succinylcholine )- promote muscle relaxation Methohexital Sodium ( Brevital )- serves as an anesthetic agent common complications: loss of memory headache apnea fracture respiratory depression Psychopharmacology classification , action and indication(complimentary data) contraindications common side/adverse effects considerations , care and client teaching common examples

I.ANTI PSYCHOTIC MEDICATIONS / NEULOLEPTICS formerly called major tranquilizers. used to relieve psychotic symptoms( delusions , hallucinations and looseness of association) blocks activity of the CNS receptors and sympathetic nervous system ALSO ACTS AS ANTI EMETIC , ANTI CHOLINERGIC AND ANTIHISTAMINIC C/I : hypersensitivity , glaucoma , convulsive d/o/ , pregnancy and lactation, elderly clients (CNS)extrapyramidal symptoms PSEUDOPARKINSONISM-tremor , mask like facies drooling , restlesssness AKATHISIA- restlessness DYSTONIA-grimacing , torticoilis , intermittent muscle spasms TARDIVE DYSKINESIA-lip smaking and tongue and mouth movements,disappears during sleep , usually irreversible NEUROLEPTIC MALIGNANT SYNDROME hyperthermia , rigidity ,tremors, automatic hyperactivity SEIZURES leukopenia , agranulocytosis (blood dyscrasia) photosensitivity ands orthostatic hypotension blurred vision , glaucoma

 dry mouth, NAVDA check CBC & BP may cause leukopenia and orthostatic hypotension report elevated temp , muscle rigidity and sore throat, avoid sunlight exposure nay require several weeks of therapy to obtain desired effects take with food or milk to reduce stomach irritation watch out for s and sx of adverse rxns teach the importance of follow up and compliance to medications no activity that requires alertness for 2 weeks from start of therapy common medications: Phenothiazines: Chlorpromazine ( Thorazine ) Prochlorperazine ( Compazine ) Fluphenazine (Prolixin) OTHERS CLOZAPINE (CLOZARIL ) 300 450(SEIZURES) CARBAMAZEPINE (TEGRETOL)50 200 MG / 24 HOURS(SEIZURES) BUTYROPHENONE HALOPERIDOL ( HALDOL ) 2 40 MG/24HRS

ANTIPARKINSONIAN MEDICATIONS ADJUNCT TO ANTI-PSYCHOTIC AGENTS. TO BALANCE DOPAMINE /ACETYLCHOLINE IN THE BRAIN GLAUCOMA , TACHYCARDIA , HPN , CARDIAC Dx , ASTHMA, DUODENAL UCER BLURRED VISION,PHOTOSENSITIVITY ,HA DROWSINESS,ORTHOSTATIC HYPOTENSION, CHF, HALLUCINATIONS BEST TAKEN AFTER MEALS AVOID DRIVING BLURRING OF VISION CHECK BP-HYPOTENSION ALCOHOL INCREASES INCREASES SEDATIVE EFFECTS AVOID SUDDEN POSITION CHANGE DRUGS IS NOT WITHDRAWN ABRUPTLY COMMON DRUGS: ANTICHOLINERGICS ARTANE AND COGENTIN ANTIHISTAMINE BENADRYL DOPAMINE RELEASING AGENT SYMMETREL ANTI ANXIETY EXERT A GENERAL DEPRESSSING EFFECT ON TH E CNS.HAVE MUSCLE RELAXANT AND ANTI CONVULSANT EFFECTS.GIVEN FOR INSOMNIA AND AXIETY CALLED MINOR TRANQIULIZER MAY LEAD TO DEPENDENCE IF BP BELOW 20 mmHG SYSTOLIC FROM BASELINE HOLD AND NOTIFY PHYSICAN WITHDRAWAL 8 MONTHS AND IN HIGH DOSES GLAUCOMA , HYPERSENSITIVITY, DYSFUNCTION,HYPERSENSITIVITY, LIVER AND KIDNEY

 PSYCHOSESELDERLY , PREG AND LACT DIZZNESS , DROWSINESS AND CONFUSION(DISORIENTATION)DERMATITIS ,ECG CHANGES AND ORTHOSTATIC HYPOTENSION,TINNITUS AND MYDRIASIS ADMINISTER SEPARATELY INCOMPATIBLE WITH OTHER DRUGS AVOID DRIVING , ALCOHOL AND CAFFEINE . FOOD ALTERS EFFECTS BEST TAKE BEFORE MEALS CAREFUL SUPERVISION OF DOSE AND COMPLIANCE DIAZEPAM (VALIUM) HYDROXYZINE HCL ( ATARAX) ALPRAZOLAM ( XANAX CHLORAZEPATE ( TRANXENE) LORAZEPAM ( ATIVAN) HYDROXYZINE PAMOATE ( VISTARIL0 OXAZEPAM ( SERAX) CHLORDIAZEPOXIDE ( LIBRIUM) ANTIDEPRESSANTS TREATMENT OF MELANCHOLIA,DEPRESSED MOOD ,MOOD SWING . TRICYCLICS PREVENTS REUPTAKE OF NOREPINEPHRINE SSRIS-INHIBITS UPTAKE OF SEROTONIN,STIMULANT COUNTERACTING DEPRESSION ,INCREASING MOTIVATION MAOIS -INTERFERES WITH MONOAMINE OXIDASE ALLOWING INCREASED CONCENTRATION OF NEUROTRANSMITTERS ANTIDEPRESSANTS TRICYCLICS- HYPERSENSITIVITY LIVER DISEASE AND GLAUCOMA SSRIS-SAME MAOS-HYPERTENSION,LIVER DISEASE AND CARDIOVASCULAR DISEASE ANTIDEPRESSANTS MAOIS HYPERTENSIVE CRISIS ,PHOTOSENSITIVITY, WEIGHT GAIN AND SEXUAL DYSFUNCTION SSRIS - NERVOUSNESS,INSOMNIA , DROWSINESS, ANXIETY, TREMOR TRICYCLICS SEDATION , ANTICHOLINERGIC EFFECTS(DRY MOUTH , BLURRED VISION),CONFUSION,PHOTOSENSITIVITY,ORTHOSTATIC HYPOTENSION, BONE MARROW DEP.,URINARY RETENTION ANTIDEPRESSANTS MAOIS INCREASED APPETITE ,ADEQUATE SLEEP AVOID TYRAMINE RICH FOODS:AVOCADO,BANANA,CHEDDAR AND AGED CHEESE,SOYSAUCE AND PRESERVED FOODS TAKES 3-4 WKS TO WORK, 2-3 WEEKS BEFORE INITIAL THERAPEUTIC EFFECTS BECOME NOTICEABLE AVOID STIMULANTS AVOID TRICYCLICS UNTIL 3 WKS AFTER STOPPING MAOI USE SUNBLOCK BEST TAKEN AFTER MEALS REPORT HEADACHE INDICATIVE OF HYPERTENSIVE CRISIS ANTIDEPRESSANTS TRICYCLICS INCREASED APPETITE ,ADEQUATE SLEEP SUICIDE RISK IN 10 14 DAYS SUNBLOCK REQUIRED INCREASE FLUID INTAKE TAKE DOSE AT BEDTIME,BEST GIVEN AFTER MEALS SUGARLESS CANDY/GUM DELAY OF 2-6 WKS (2-3WKS)BEFORE NOTICEABLE EFFECTS CHECK BP HYPOTENSION

CHECK HEARTRATE CAUSES CARDIAC ARRYTHMIAS ANTIDEPRESSANTS SELECTIVE SEROTONIN REUPTAKE INHIBITORS TAKE IN AM TO AVOID INSOMNIA TAKES AT LEAST 4 WEEKS TO WORK CAN POTENTIATE EFFECTS OF DIGOXIN,COUMADIN AND VALIUM USED FOR ANOREXIA, NOT SUICIDAL OR HOMICIDAL COMMON EXAMPLES TRICYCLICS IMIPRAMINE (Tofranil) AMITRIPTYLINE (Elavil) SSRIS Fluoxetine ( Prozac) Paroxetine ( Paxil) Sertraline ( Zoloft) MAOIS Tranylcypromine (Parnate) Phenelizine ( Nardil) Isocarboxazid (Marplan)

ANTI MANIC MOOD STABILIZING DRUG, FOR THE CONTROL OF MANIC EPISODES IN THE SYNDROME OF MANIC DEPRESSIVE PSYCHOSIS- LITHIUM CARBONATE CARDIOVASCULAR DISEASE, RENAL DISEASE, BRAIN DAMAGE, CLIENTS RECEIVING DIURETICS, CLIENTS ON LOW SODIUM DIETS, PREGNANCY AND LACTATION NAVDA (LITHIUM TOXICITY), dizziness , headache, FINE HAND TREMORS, IMPAIRED VISION,MUSCULAR WEAKNESS ANTI - MANIC INCREASE FLUID INTAKE 3LPD AND SODIUM INTAKE 3 GM./DAY BEST TAKEN AFTER MEALS MONITOR FOR TOXICITY AVOID ACTIVITIES THAT INCREASE PERSPIRATION TAKES 10-14 DAYS BEFORE THERAPEUTIC EFFECT BECOMES EVIDENT ANTIPSYCHOTIC GIVEN DURING THE FIRST TWO WEEKS TO MANAGE THE ACUTE SYMPTOMS OF MANIA.UNTIL LITHIUM TAKES EFFECT NORMAL - .5 1.5 mEq /L MONITOR SERUM LEVELS 2-3 TIMES WEEKLY WHEN STARTED AND MONTHLY WHILE ON MAINTENANCE PSYCHIATRIC NURSING LESSON 3- SPECIFIC DISORDERS

ANXIETY AND ANXIETY DISORDERS

FEELING OF DREAD OR FEAR IN THE ABSENCE OF AN EXTERNAL THREAT OR DISPROPORTIONATE TO THE NATURE OF THREAT. PREDISPOSED BY : PROLONGED UNMET NEEDS UNACCEPTABLE THOUGHTS OR FEELINGS STRESS THREATENING SECURITY OR SELF ESTEEM

 CAUSED BY A CONFLICT BETWEEN ID AND SUPEREGOA PRODUCT OF FRUSTRATION priority diagnosis: INEFFECTIVE IDIVIDUAL COPING ANXIETY

LEVELS OF ANXIETY: MILD-HIGH DEGREE OF AWARENESS, MILD UNEASINESS,ALERT MODERATE POOR COMPREHENSION,NARROWED PERCEPTUAL FIELD AND SELECTIVE INATTENTION SEVERE-SIGNS AND Sx becomes the focus of attention, no problem solving technique,impulsive,AMNESIA AND DISSOCIATION PANIC INABILITY TO FUNCTION , SEE OR HEAR, PERSONALITY DISORGANIZED.DEFENSE MECHANISMS FAIL USES EGO DEFENSE MECHANISMS TO MANAGE ANXIETY PRINCIPLES OF CARE CALM ADMINISTER MEDICATIONS LISTEN TO PATIENTS CONCERN MINIMIZE ENVIRONMENTAL STIMULI

ANXIETY DISORDERS THESE ARE EMOTIONAL ILLNESSES CHARACTERIZED BY FEAR, AUTONOMIC NERVOUS SYSTEM SYMPTOMS AND AVOIDANCE BEHAVIOR ASSESS LEVEL OF ANXIETY KEEP ENVIRONMENTAL STRESSES/STIMULATION LOW ASSIST CLIENT TO COPE W/ ANXIETY MAINTAIN ACCEPTING AND HELPFUL ATTITUDE PANIC ATTACKS SUDDEN ATTACKS OF INTENSE ANXIETY INTERVENTION : RELAXATION EXERCISE; ANTI ANXIETY PHOBIA

APPREHENSION , ANXIETY , HELPLESSNESS WHEN CONFRONTED WITH PHOBIC SITUATION OR FEARED OBJECT AVOID CONFRONTATION AND HUMILIATION SIMPLE PHOBIA FEAR OF A SPECIFIC OBJECT OR SITUATION ANTI ANXIETY and antidepressants;SYSTEMATIC DESENSITIZATION and relaxation therapy SOCIAL PHOBIA FEAR OF SOCIAL SITUATIONS,WHEN THERE IS A POSSIBILITY OF EMBARRASSMENT ANTI-ANXIETY, SOCIAL SKILLS TRAINING AGORAPHOBIA FEAR OF BEING ALONE IN THE PUBLIC PLACE ANTI-ANXIETY, SOCIAL SKILLS TRAINING OBSESSIVE- COMPULSIVE DISORDER

OVERWHELMING NEED TO CARRY OUT A STEREOTYPICAL ACT TO RELIEVE ANXIETY PRECIPITATED BY AN OBSESSIVE THOUGHT

obsession repetitive, uncontrollable thoughts compulsion repetitive uncontrollable acts

INTERVENTIONS: ANTI DEPRESSANTS; (Anafranil) BEHAVIORAL TECHNIQUES SUCH AS stimulus RESPONSE PREVENTION AND THOUGHT STOPPING accept ritulistic behavior provide for physical needs GENERALIZED ANXIETY DISORDER EXCESSIVE ANXIETY FOR AT LEAST 6 MONTHS, INTERFERES WITH A PERSONS LIFE CHARACTERIZED BY ANXIETY, MOTOR TENSION, AUTONOMIC HYPERACTIVITY AND COGNITIVE VIGILANCE ANTI ANXIETY, PSYCHOTHERAPY,COGNITIVE STRUCTURING POST TRAUMATIC STRESS DISORDER REEXPERIENCING THE ORIGINAL TRAUMATIC EVENT( DISTRESSING RECOLECTIONS, DREAMS OR NIGHTMARES,FLASHBACKS,HYPERVIGILANCE,NUMBING) DURATION AT LEAST A MONTH,BUT CAN EMERGE MONTHS TO YEARS ANTI-ANXIETY , ANTI-DEPRESSANT , GROUP THERAPY,FLOODING, ASSIST CLIENT TO CHALLENGE EXISTING IDEAS TEACH STRESS MANAGEMENT TECHNIQUES,ENHANCE SUPPORT SYSTEMS ANOREXIA NERVOSA MOST COMMON IN ADOLESCENT FEMALES-CHARACTERIZED BY FEAR OF OBESITY, DRAMATIC WEIGHT LOSS AND DISTORTED BODY IMAGE, ANEMIA , AMENORRHEA, PURGING AND INDUCED VOMITING,EXECISIVE EXERCISE ANOREXIA NERVOSA MONITOR WEIGHT , MIO , ELECTROLYTE BALANCE AND V.S. PROVIDE ADEQUATE FLUIDS AND ELECTROLYTE AND NUTRITION BEHAVIOR MODIFICATION AND FAMILY THERAPY SUPPORT EFFORTS TO TAKE RESPONSIBILITY FOR SELF AMENORRHEA NO ORGANIC FACTOR WEIGHT LOSS OBVIOUSLY THIN BUT FEELS FAT REFUSAL TO MAINTAIN BODY WEIGHT EPIGASTRIC DISCOMFORT X SYMPTOMS HIDING FOOD INTENSE FEAR OF GAINING WEIGHT ALWAYS PREOCCUPIED WITH FOOD

BULIMIA CHARACTERISTICS OF ANOREXIA AND BINGE EATING( HIGH CALORIE SHORT PERIOD) NORMAL WEIGHT OR OVERWEIGHT MANAGED COUNSELING WITH ANTI-DEPRESSANTS, NUTRITIONAL ASSESMENTS AND

BINGE EATING UNDER STRICT DIETING/VIGOROUS EXERCISE LACKS CONTROL OVER BINGES

 INDUCED VOMITING 2 BINGE EATING PER WEEK FOR 3 MNTHS INCREASED CONCERN OVER BODY SIZE ABUSE OF DIURETICS AND LAXATIVES INTERVENTIONS REMAIN IN PUBLIC/ STAY W/ PNT. FOR TWO HOURS AFTER MEALS MONITOR WEIGHT FREQUENT ORAL HYGIENE BEHAVIOR MODICATION THERAPY CRISIS AND CRISIS INTERVENTION SITUATION THAT OCCURS WHEN AN INDIVIDAULS HABITUAL COPING ABILITY BECOMES INEFFECTIVE TO MEET THE DEMANDS OF THE SITUATION TYPES : CRISIS STATE INDIVIDUALIZED , AFFECTING SUPPORT SYSTEM LAST 4-6 WKS,SELF LIMITING CAN PROMOTE GROWTH AND NEW BEHAVIORS PERSONS BECOMES PASSIVE AND SUBMISSIVE STAGES OF CRISIS DENIAL INCREASED TENSION AND ANXIETY DISORGANIZATION ATTEMPTS TO REORGANIZE ATTEMPTS TO ESCAPE GENERAL REORGANIZATION TYPES OF CRISIS MATURATIONAL / DEVELOPMENTAL CRISIS SITUATIONAL / ACCIDENTAL SOCIAL CRISIS GOAL N- TO ENABLE THE PATIENT TO ATTAIN OLOF. INTERVENTIONS GOAL DIRECTED, FOCUS ON HERE AND NOW FOCUS ON CLIENTS IMMEDIATE PROBLEM ACTIVE AND DIRECTIVE EXPLORE UNDERSTANDING OF PROBLEM HELP CLIENT BECOME AWARE OF FEELINGS AND VALIDATE THEM DEVELOP A PLAN FIND NEW COPING SKILLS AND MANAGE FEELINGS SITUATIONAL CRISIS GRIEVING-4-8 WEEKS TO 1 YEAR FOCUS ON HERE AND NOW PROVIDE SUPPORT AND ENCOURAGE VERBALIZATION AND EXPRESSION DYING DABDA KEEP COMMUNICATION OPENGIVE SENSE OF CONTROL AND DIGNITY RAPE TRAUMA-3-4 WKS REORGANIZATION LONG TEM SELF BLAME , PHOBIAS , ANXIETY AND PSYCHOSOMATIC TENDENCIES PROVIDE FOR PHYSIOLOGICAL NEEDS FIRST AND REFER FOR MEDICOLEGAL

DOMESTIC VIOLENCE BATTERED WIFE SYNDROME-HUMILIATION , BEATING AND OTHER FORMS OF AGGRESSION

ABUSIVE MEN LOW SELF-ESTEEM ABUSED WOMEN DEPENDENT PERSONALITY THEY COME FROM ABUSIVE FAMILIES IMMATURE DEPENDENT AND NONASSERTIVE STRONG FEELINGS OF INADEQUACY DOMESTIC VIOLENCE PRIORITY OF CARE PROVISION OF SHELTER STAGES tension building acute battering aftermath honeymoon

CHILD ABUSE INTENTIONAL PHYSICAL , EMOTIONAL , SEXUAL MISUSE /TRAUMA, OR INTENTIONAL OMISSION OF BASIC NEEDS (NEGLECT) (ABANDONMENT). USUALLY RELATED TO DIMINISHED/LIMITED ABILITY OF PARENTS TO COPE WITH, PROVIDE FOR OR RELATE TO CHILD INDICATORS S ERIOUS INJURIES IN VARIOUS STAGES OF HEALING ( INCONSISTENCIES) HEALTHY HAIR IN VARIOUS LENGTH AND CNSORABDML. INJURIESSEVERE A PATHY , NO REACTION D EPRESSION/DISTURBANCE IN PARENT CHILD INTERACTION E EXCESSIVE KNOWWLEDGE OF SEX EMOTIONAL NEGLECT-FAILURE TO THRIVE S ELF ESTEEM LOW

CHILD ABUSE INTERVENTIONS PROVIDE FOR PHYSICAL NEEDS FIRST MANDATORY REPORTING TO APPROPRIATE AGENCY NON JUDGEMENTAL Tx OF PARENTS.TEACH G AND D PROVIDE EMOTIONAL SUPPORT FOR THE CHILD(PLAY THERAPY) INITIATE PROSPECTIVE PLACEMENT PROPER DOCUMENTATION SOMATOFORM DISORDERS PRESENCE OF PHYSICAL SYMPTOMS BUT WITHOUT EVIDENCE OF PHYSIOLOGIC DISORDER.LINKED TO PSYCHOLOGIC FACTOR OR EMOTIONAL CONFLICT SOMATIZATION DISORDER RECURRENT AND MULTIPLE SOMATIC COMPLAINTS OF SEVERAL YEARS DURATION AND SEEMINGLY WITHOUT PHYSIOLOGIC CAUSES, USUALLY BEGINS BEFORE 30 TEARS OF AGE, CHRNIC ACCOMPANIED BY ANXIETY AND DEPRESSED MOOD CONVERSION DISORDER LOSS OR ALTERATION OF PHYSICAL FUNCTION THAT SUGGESTS A PHYSICAL DISORDER RELATED TO EXPRESSION OF A PSYCHOLOGICAL CONFLICT. PRIMARY GAIN- KEEP CONFLICT OUT OF AWARENESS SECONDARY GAIN AVOID DISTRESSING/UNCOMFORTABLE ACTIVITY WHILE RECEIVING SUPPORT FROM OTHERS. CONVERSION DISORDER CONVERSION HYSTERIA

 PHYSICAL SYMPTOMS WITH NO ORGANIC BASIS- blindness , paralysis, convulsions without LOC, stocking nad glove anesthesia , la belle indefference discuss FEELINGS RATHER THAN SYMPTOMS. avoid secondary gain DIAGNOSTIC EVALUATION AND ESTABLISH THER. RELATIONSHIP HYPOCHONDRIASIS PREOCCUPATION WITH FEAR OR BELIEF THAT THEY WILL HAVE A SERIOUS DISEASE WHICH IS NEGATIVE ON PHYSICAL EVALUATION. BODY DYSMORPHIC DISORDER IMAGINED DEFECT ON APPEARANCE WHICH IS OUT OF PROPORTION TO ANY ACTUAL ABNORMALITY UNDIFFERENTIATED SOMATOFORM MULTIPLE PHYSICAL COMPLAINTS AT LEAST 6 MONTHS W/O ANY ORGANIC PROBLEM SOMATOFORM PAIN DISORDER PAIN IN ABSENCE OF PHYSIOLOGIC FINDINGS DISSOCIATIVE DISORDERS SUDDEN TEMPORARY CHANGE OF CONSCIOUSNESS, IDENTITY OR MOTOR BEHAVIOR SO THAT SOME PART OF THE FUNCTIONS ARE LOST. THE REPRESSION OF IDEAS THAT LEADS TO AMNESIA AND OTHER FORMS OF DISSOCIATION IS CONCEIVED AS A WAY OF PROTECTING THE INDIVIDUAL FROM EMOTIONAL PAIN ARISING FROM EITHER DISTURBING EXTERNAL CIRCUMSTANCES OR INTERNAL PSYCHOLOGIC CONFLICTS MULTIPLE PERSONALITY DISORDER TWO OR MORE DISTINCT PERSONALITIES , TRANSITION FROM OE PERSONALITY TO ANOTHER IS SUDDEN AND DRAMATIC PSYCHOGENIC FUGUE WANDERS FAR - FORGETS PAST LIFE AND ASSOCIATIONS, IS UNAWARE OF HAVING FORGOTTEN ANYTHING. WHEN HE RETURNS DOES NOT REMEMBER THE PERIOD OF FUGUE. GENERALLY RECLESIVE AND QUIET PSYCHOGENIC AMNESIA AWARE TOTAL LOSS OF MEMORY FOR EVENTS THAT OCCURRED DURING A PERIOD RANGE FROM FEW HOURS TO A WHOLE LIFETIME MOOD DISORDERS DISTURBANCES IN EMOTIONAL AND BEHAVIORAL RESPONSE PATTERNS. RANGES FROM ELATION AND AGITATION TO SEVERE DEPRESSION AND SERIOUS POTENTIAL OFR SUICIDE BIPOLAR DISORDERS MOOD DISORDERS WHICH MAYBE OBSERVED AT ANY GIVEN TIME, BOTH OF WHICH MAYBE PRESENT SIMULTANEOUSLY( Bipolar , mixed) or symptoms of one may alternate with the other(Cyclothymia) . characterized by episodes of: mania-hyperactivity , excitement,agitation, decresaed need for sleep, impaired ability to concentrate depression ubderactivity,apathy,profound sadness,guilt and low slef esteem depression- psychodynamics response to real or imagined loss anger and aggression towards self result from feelings of guilt about negative or ambivalent feelings introjection occurs(incorporation of a loved or hated object or person into ones own ego) types:

MAJOR DEPRESSIONSEVERE LASTS 2 WKS. DYSTHYMIA- LESS SEVERE 2YEARS OR > DEPRESSION NOT OTHERWISE SPECIFIED 2 DAYS 2WEEKS MAINTAIN THERAPEUTICALLY SAFE ENVIRONMENT SUPPORTIVE PROF. ATTITUDE ONGOING ASSESSMENT ENCOURAGING AND REASSURING ECT AS ORDERED ADMINISTER MEDICATIONS- ANTI DEPRESSANTS / ESKALITH SHOW CONFIDENCE AND WORK WITH PATIENT

BIPOLAR DISORDERS heredity important factor AS WELL AS BIOCHEMICAL failure of individual to function successfully in preserving internal emotional equilibrium between unconscious wishes and impulses vs moral conscience precipitated by deep, emotionally traumatizing loss inconsistent or abusive parenting withdrawal of physical nurturance BIPOLAR DISORDERS mania flight from reality to escape inner conflict, depression is the result of failing to deal adequately with conflict mania and depression to gain attention , approval and emotional support oral, greedy and demanding repression and suppression rationalization , projection and introjection grandiosity and fantasizing a nurturing parent SUBTYPES OF BIPOLAR D/O MANIC SEVERE , LASTS 1 WK HYPOMANIC LESS SEVERE ,4 DAYS BIPOLAR 1 WITH HISTORY OF MANIA BIPOLAR 2 NO HISTORY OF MANIA CYCLOTHYMIA- EPISODES OF HYPOMANIA AND DEP. LAST 2 YEARS MANIC TYPE EUPHORIA 1ST SIGN ELATED BEHAVIOR MOOD INCREASE, DELUSIONS OF GRANDEUR AND SELFIMPORTANCE. IRRITABITY W/ DELUSION OF PERSECUTION EASY DISTRACTIBILITY AND FLIGHT OF IDEAS DECREASED SLEEP AND FOOD DEPRESSED TYPE IN TEREST LOW SELF ESTEEM - LOW DEPENDENCY ENERGY LOW FATIGUE ELATION - MANIA SUICIDAL

BIPOLAR DISORDER AFFECTIVE DISORDER , ELATION AND GRANDIOSITY DEFENSE AGAINST UNDERLYING DEPRESSION/LOW SELF ESTEEM TESTING AND MANIPULATIVE BEHAVIOR INDICATIVE OF LOW SELF- ESTEEM STRONG TENDENCY TO RECUR

TESTING , MANIPULATIVE , DEMANDING BEHAVIOR INTERVENTIONS PSYCHOTHERAPY NOT EFFECTIVE PATIENT UNREACHEABLE EMPHASIZE BEINGRATHER THAN DOING RELATE FROM A NON COMPETITIVE FRAME OF REFERRENCE DEVELOP REALISTIC ADULT RELATIONSHIPS AND CONTRACTS FOR CHANGE PROVIDE FOR SAFETY AND UNDERSTANDING INTERVENTRIONS SIMPLIFY ENVT. SET LIMITS COMMUNICATE FIRM UNAMBIVALENT CONSISTENT APPROACH. MEE MEET PHYSICAL NEEDS FIRST ENCOURAGE REST ADMINISTER LITHIUM EAT NA RICH FOOS AND INCREASE FLUIDS SPECIFIC INTERVENTION TECHNIQUES PROVIDE UNDERSTANDING PACING AND LEADING-GEN . INTERVENTION PROVIDE FOR SAFETY PROVIDE EMOTIONAL CONFRANTATION AND COGNITIVE RESTRUCTURING DIFFERENTIATION: MANIA COLORFUL AGGRESSION OUTWARDS LITHIUM NON-STIMULATING MILLIEU QUIET ACT./AVOID COMPETITIVE MATTER OF FACT DEPRESSION SAD AGGRESION INWARDS ECT STIMULATING MILLEU MONOTONOUS ACT. COUNTING KIND FIRMNESS

SUICIDE VIOLENCE , SELF DIRECTED ; RISK FOR SELF DESTRUCTIVE BEHAVIOR(INTROJECTION)ANFER AND RAGE TURNED INWARDS OR INTO AN ATTEMPT TO PUNISH OTHERS MOST COMMON AS DEPRESSION IS LIFTING 10-14 DAYS AFTER ANTI DEPRESSANT MEDICATIONS/ NEW SIGNS OF ENERGY OR IMPROVEMENT INDIVIDUAL FEELS GUILTY AND OVERWHELMED SUICIDE SEEN AS RELIEF AMBIVALENCE MAY LEAD TO CRY FOR HELP OR ATTENTION ATTEMPTS TO COPE FAIL-HOPELESSNESS AND HELPLESSNESS RISK FACTORS: SEX WHITE MALE DIVORCED CAUCASIAN UNSUCCESSFUL PREVIOUS ATTEMPT IDENTIFICATION WITH SOMEONE WHO COMMITED SUICIDE CHRONIC

ILLNESS DEPRESSION/DEPENDENT PERSONALITY AGE (18-25 AND >40) , ALCOHOLISM LETHALITY OF PREVIOUS ATTEMPTS/LOSSES

KEY POINTS ONE ON ONE MONITORING FREQUENT UNSCHEDULED ROUNDS SAFE ENVIRONMENT(REMOVE ALL POTENTIALLY DANGEROUS ITEMS MONITOR FOR SIGNS DISCUSS ALL BEHAVIOR WITH TEAM MEMBERS INTERVENE QUICKLY AND CALMLY DURING ATTEMPTS PROVIDE AFMILY THERAPY / GIVE CLIENT SENSE OF CONTROL OTHER RHAN SUICIDE(PROB.SOLVING ,DECISION MAKING,SUICIDE CONTRACT) SCHIZOPHRENIA SPLITING OF THE MIND DELUSIONS HALLUCINATIONS, DISORGANIZED SPEECH, GROSSLY DISORGANIZED BEHAVIOR AND APATHY ALTERED THOUGHT PROCESS AUTISM ASSOCIATIVE LOOSENESS APATHY AMBIVALENCE BIOLOGIC THEORY DECREASED IN DOPAMINE SOCIAL ISOLATION CATATONIA HALLUCINATIONS INCOHERENCE ZERO INTEREST OBVIOUS FAILURE TO ATTAINDEV.LEVEL PECULIAR BEHAVIOR HYGIENE IMPAIRED RECURRENT ILLUSIONS/UNUSUAL PERCEP. NO ORGANIC FACTOR INABILITY TO RETURN AFFECT IS INAPPROPRIATE

DISHARMONY BETWEEN THE PATIENTS THINKING FEELIN AND ACTING UTILIZES MECHANISMS OF DENIAL AND WITHDRAW FROM REALITY, USING FANTASY CANNOT CONCEPTUALIZE OR FORM LOGICAL CONCLUSIONS DELUSIONS AND HALLUCINATIONS TEND TO FULFILL DENIED WISHES DEFECT IN FAMILY INTERACTION HIGHLY CRITICAL , HOSTILE OR OVERINVOLVED PSYCHOLOGIC INFORMATION PROCESSING DEFICIT BIOLOGIC-METABOLIC IMBALANCE GENETICS BIOCHEMICAL DOPAMINE HYPOTHESIS BRAIN STRUCTURE ALTERATIONS =- > VENTRICLES DISORGANIZED INAPPROPRIATE BEHAVIOR , AFFECT AND TRANSIENT HALLUCINATIONS INCOHERENCE, MARKEDLY LOOSENING OF ASSOCIATIONS

REGRESSION IMPAIRED SOCIAL FUNCTIONING ASSISTANCE W/ ADL OR AUDITORY

PARANOID PREOCCUPATION WITH SYSTEMATIZED DELUSIONS HALLUCINATIONS RELATED TO A SINGLE THEME SUSPICION , IDEAS OF PERSECUTION AND DELUSIONS MISTRUST AND FEELINGS OF REJECTION PROJECTION POTENTIAL FOR INJURY NUTRITION AND SAFETY

CATATONIC SUDDEN ONSET MUTISM , BIZARRE MANNERISMS, REMAINS IN STEREOTYPED POSITION WITH AWXY FLEXIBILITY. MAY HAVE DANGEROUS PERIODS OF AGITATION / EXPLOSIVITY STUPOR, NEGATIVISM, RIGIDITY ,EXCITEMENT, POSTURING REPRESSION AND IMPAIRED MOTOR ACTIVITY CIRCULATION AND NUTRITION UNDIFFERENTIATED ONE OR MORE TYPES OF SCHIZOPHRENIA DOES NOT MEET THE REQUIREMENTS OF OTHER TYPES PROMINENT SYMPTOMS RESIDUAL ABSENCE OF PROMINENT DELUSION, HALLUCINATIONS, INCOHERENCE OR GROSSLY DISORGANIZED BEHAVIOR. NO LONGER EXHIBITS OVERT SYMPTOMS OTHER DELUSIONAL NO HALLUCINATIONS SCHIZOPHRENIFORM - < 6 MONTHS NORMAL FUNCTIONING POSSIBLE SCHIZOAFFECTIVE D/O DOMINANT SYMPTOMS- MOOD D/O

NURSING CARE PROMOTE ADEQUATE COMMUNICATION PROMOTE COMPLIANCE WITH MEDICAL REGIMEN AND PROVIDE PHYSIOLOGICAL NEEDS (FLUID AND NUTRITION) ASSIST WITH GROOMING , HYGIENE AND ADLS PROMOTE ORGANIZED BEHAVIOR PROMOTE SOCIAL INTERACTION AND ACTIVITY SOCIAL SKILLS TRAINING\PROMOTE REALITY BASED PERCEPTIONS INTERVENE WITH DELUSIONS PROMOTE CONGRUENT EMOTIONAL RESPONSES, FAMILY UNDERSTANDING AND INVOLVEMENT, AND COMMUNITY CONTACTS. PERSONALITY DISORDERS RIGID MALADAPTIVE PATTERNS OF FUNCTIONING THAT ARE STABLE THROUGH TIME AND LEAD TO UNHAPPINESS GENETICS, TEMPERAMENTAL BIOLOGIC, PSYCHOANALYTICAL FIXATION PARANOID SUSPICIOUSNESS, HYPERSENSITIVE AND HUMORLESS

 INTERPRETS ACTIONS OF OTHERS AS PERSONAL THREAT USES PROJECTION AND HOLDS GRUDGES SCHIZOID SHY,INTROVERTED LITTLE VERBAL COMM. , COLD AND DETACHED USES INTELLECTUALIZATION, DESCRIBES EMOTIONAL RESPONSES IN MATTER OF FACT DAY DREAMING CARE SAME SCHIZOTYPAL ECCENTRIC AND ODD,SENSITIVE TO REJECTION AND ANGER VAGUE STEREOTYPICAL SPECH SUSPICIOUS , BLUNTED OR INAPPROPRIATE AFFECT RELATIVES OF SCHIZ., PROBLEMS IN THINGKING , PERCEIVING COMMUNICATING LOW DOSE NEUROLEPTICS AND SAME

AND

ANTI SOCIAL DISREGARD FOR RIGHTS OF OTHERS. CHARMING INTELLECTUAL AND SMOOTH TALKING, UNLAWFUL , RECKLESS AND AGGRESSIVE BEHAVIORS LACK OF GUILT AND REMORSE.IMMATURE AND IRRESPONSIBLE GENETICS,ASSOC. W/ SUBS.ABUSE AND DEPENDENCY PROB..RATIONALIZES AND DENIES OWN BEHAVIOR FIRM LIMIT SETTING, CONFRONT BEHAVIORS CONSISTENTLY, ENFORCE CONSEQUENCES, GROUP THERAPY BORDERLINE REPETITIVE SELF DESTRUCTIVENESS, TEMPER TANTRUMS AND FIGHTS.BLAMES OTHERS FOR OWN PROBLEMS,LABILE MOOD, BOREDOM,IMPULSIVE , FEARS SEPARATION,UNSTABLE BUT INTENS RELATIONSHIP.HYPOCHONDRIAL PROJECTIVE IDENTIFICATION, SEROTONIN ABN., PROBLEMS WITH IDENTITY SELF IMAGE,HINKING AND MOOD BORDERLINE HELP IDENTIFY , VERBALIZE AND CONTROL NEGATIVE BEHAVIORS EMPATHY BEHAVIORAL CONTRACTS TO DECREASE MUTILATION CONSISTENT LIMIT SETTING SUPPORTIVE CONFRONTATION PSYCHOPHARMACOLOGY AND THERAPY

GROUP

NARCISSISTIC ARROGANT, GRANDIOSITY , LACK OF ABILITY TO FEEL SHALLOW RELATION SHIPS,VIEWS OTHERS AS INFERIOR. NEEDS TO BE ADMIRED.USES RATIONALIZATION TO BLAME OTHERS SUPPORTIVE CONFRONTATION TO INCREASE SENSE OF SELF RESPONSIBILITY LIMIT SETTING AND CONSISTENTLY FOCUS ON HERE AND NOW, TEACH THAT MISTAKES ARE ACCEPTABLE , IMPERFECTIONS DO NO DECREASE WORTH HISTRIONIC DRAWS ATTENTION TO SELF OVERLY CONCERNED WITH PHYSICAL APPEARANCE, ATTENTION SEEKING BEHAVIOR, EXTROVERT EASLY INFLUENCED, CANNOT DEAL WITH FEEKINGS

POSITIVE REINFORCEMENT FOR UNSELFISH BEHAVIOR FACILITATE EXPRESSION

DEPENDENT PASSIVE , INCESSANT DEMANDS FOR ATTENTION FROM OTHERS, LACKS SELF CONFIDENCE, NEED EXCESSIVE REASSURANCE AND ADVISE. ANXIOUS OR HELPLESS WHEN ALONE. FEAR OF LOSS OF SUPPORT AND WITHDRAWAL,SELF CONFIDENCE AVOIDANT WITHDRAWN , TIMID, , HYPERSENSITIVIVE TO CRITICISM AVOID SITUATIONS WHERE THERE IS REJECTION POSSIBILITY FEARS INTIMACY-RIDICULE VIEWS SELF TO BE SOCIALLY INEPT,INFERIOR ,UNAPPEALING GRADUALLY CONFRONT FEARS, DISCUSS FEELINGS BEFORE AND AFTER ACCOMPLISHING A GOAL , TEACH ASSERTIVENESS, INCREASE EXPOSURE TO SMALL GROUPS OBSESSIVE COMPULSIVE SETS HIGH PERSONAL STANDARDS FOR SELF OR OTHERS, PREOCCUPIED WITH RULES /DETAILSRIGID, STUBBORN , OVERCONSCIENCIOUS AND INFLEXIBLE,COLD AND INDECIISIVE PERFECTIONISM INTERFERES TASK FULFILLMENT EXPLORE FEELINGS, HELP WITH DECISION MAKING, TEACH THAT MISTAKES ARE ACCEPTABLE