PSYCHOTIC DISORDERS ASPECT OF PSYCHIATRIC MEDICAL

CARE REHABILITATION REHABILITATION

MENTAL ILLNESS FOCUS Wellness and Disease, illness,
 A state of imbalance characterized by a health NOT and symptoms
disturbance in a person’s thoughts, feelings symptoms
and behavior BASIS Person’s abilities Person’s
 A mental disorder or condition manifested by and functional disabilities and
disorganization and impairment of a function behavior intra-psychic
that arises from various causes such as functioning
psychological, neurobiological, genetic and SETTING Caregiving in Treatment in
organic factors. natural setting institutional setting
RELATIONSIP Adult to Adult Expert to Patient
CRITERIA OF MENTAL ILLNESS relationship relationship
1) Dissatisfaction with one’s characteristics, MEDICATION Medicate as Medicate until
abilities, and accomplishments appropriate and symptoms are
2) Ineffective or unsatisfying interpersonal tolerate some controlled
relationships illness
3) Dissatisfaction with one’s place in the world DECISION Case management Physician makes
4) Ineffective coping or adaptation MAKING in partnership with decisions and
client prescribes
PERSONITY CHARACTERISTICS treatment
1) Unaccepting of self and dislikes self EMPHASIS Strengths, Dependence and
2) Has unrealistic perception of strengths and Self-help, and Compliance
weaknesses Interdependence
3) Thoughts and perceptions may not be reality
based SCHIZOPHRENIA
4) Unable to find meaning and purpose in life  A group of psychotic reactions that affect
5) Lacks direction and productivity in life multiple areas of an individual’s functioning
6) Has difficulty in meeting own needs that includes:
7) Depends on others for thoughts and actions a) Thinking and communicating
b) Perceiving and interpreting reality
MISCONCEPTIONS ABOUT MENTAL ILLNESS c) Feeling and demonstrating emotions
1) Abnormal behavior is different or odd and d) Behaving in a socially acceptable
easily recognized manner
2) Abnormal behavior can be predicted and
evaluated BLEULER 4 A’S OF SCHIZOPHRENIA
3) Internal forces are responsible for abnormal a) ASSOCIATIVE LOOSENESS
behavior  Lack of logical thought leading to
4) People who exhibit abnormal behavior are chaotic and disorganized thinking
dangerous b) AFFECTIVE DISTURBANCES
5) Maladaptive behavior is always inherited  Flat, blunted and socially
6) Mental illness is incurable inappropriate affect or feeling tone
c) AMBIVALENCE
POPULATION AT RISK FOR MENTAL ILLNESS  Presence of strong conflicting feelings
1) Familial or Genetic predisposition to mental leading to psychic immobility
illness d) AUTISTIC BEHAVIOR
2) Poor access to health care  Extreme retreat from reality leading to
3) Disadvantaged (homeless and poor) psychotic though processes
4) Misusing substances
5) Undergoing lifestyle changes ETIOLOGY:
6) Victims of violence  UNKOWN
7) Elderly poor  No single etiologic factor
THEORIES OF CAUSATION
a) Genetic Theory
b) Psychodynamic Theory
 c) Neurobiological Theory d) Disorganized Behavior
d) Organic Theory
BASIC NURSING INTERVENTION FOR AGITATION
OTHER POSSIBLE REASONS WHY ONE DEVELOPS 1) Remove cause of stimulation
SCHIZOPHRENIA 2) Eliminate stimulants
a) Persistent faulty reaction to the environment; 3) Set limits
use of faulty coping mechanisms (A. Meyer) 4) Monitor physical discomforts
b) Ego is weak, unable to integrate (S. Freud) 5) Administer drugs as ordered.
c) Poor mother-child relationship (H. Sullivan) 6) Do not display anger and frustration
7) Do not discourage
PRE-PSYCHOTIC PERSONALITY 8) Do not criticize
 SCHIZOID PERSONALITY DISORDER 9) Do not argue

OBJECTIVE BEHAVIORAL DISORDERS IN BASIC NURSING INTERVENTION FOR DELUSIONS

SHIZOPHRENIA 1) Explain all procedures
a) Alterations in personal relationships 2) Provide personal space
b) Alterations of activity 3) Maintain eye contact
4) Provide consistency (cornerstone of TRUST)
SUBJECTIVE BEHAVIORAL DISORDERS IN 5) Set realistic goals
SHIZOPHRENIA 6) Do not touch without warning
a) Alterations in perception 7) Do not whisper or laugh in the presence of
b) Alteration of thought the client (e.g. Idea of Reference)
c) Alteration of consciousness 8) Do not argue, disprove delusions
d) Alteration of affect 9) DO not reinforce delusions
10) Present logical argument
CLASSIFICATION
1) CATATONIC BASIC NURSING INTERVENTION FOR
 Rigid or stupor posture HALLUCINATIONS
 Waxy flexibility 1) Decrease environmental stimuli
 Mute 2) Identify contributory factors
 Echolalia 3) Monitor command hallucinations
2) DISORGANIZED (HEBEPHRENIA) 4) Be alert to non-verbal stimulation
 Chronic schizophrenia 5) Present reality
 Severely depressed 6) Do not participate in the hallucination
3) PARANOID process
 Dangerous; cannot determine what the
person is thinking (-) NEGATIVE SYMPTOMS
 Delusions of persecution  Absence of those that normal people exhibit
 NURSING CONSIDERATION:  CHRONIC onset
 Have passive friendliness  Prognosis is POOR
4) UNDIFFERENTIATED  Effective: ATYPICAL antipsychotics (e.g.
 Manifestations are combination of other Clozapine, Resperidone)
classifications of schizophrenia  MANIFESTATIONS:
a) Flat affect
(+) POSITIVE SYMPTOMS b) Avolition (decreased motivation)
 Present symptoms that normal people do not c) Anhedonia (lack of pleasure)
exhibit d) Attention impairment
 ACUTE onset e) Anergia (no energy)
 Prognosis is GOOD f) Alogia (lack of spontaneity and flow of
 Effective on TYPICAL antipsychotics (e.g. conversation)
Haloperidol) g) Poor eye contact
 MANIFESTATIONS:
a) Delusion
b) Hallucination
c) Pressured Speech
MANAGEMENT d) Exaggerated sense of importance and
 GENERAL CONSIDERATIONS invincibility
1) Continuity of care is important
2) Level of care depends on the severity of IMPACT OF MOOD DISORDERS
symptoms, availability of family and 1) May become CHRONIC and
social support INCAPACITATING without appropriate
3) Case management approach is important intervention
because client care is generally long term. 2) Client may not seek treatment
4) Brief psychiatric hospitalization
(Management of acute symptoms) NURSING PRIORITY: ALTERATION IN NUTRITION
a) Pharmacologic treatment LESS THAN BODY REQUIREMENTS
b) Milieu Management 1) Meet physiologic needs (#1 Priority)
c) Supportive therapy 2) High caloric, high vitamins diet
d) Psycho-education for client and 3) Finger foods and fluids
family a) Sandwich
e) Discharge planning b) French fries
5) LONG TERM psychiatric hospitalization 4) Non-stimulating environment
a) Used for client with persistent 5) Non-competitive solitary activities
symptoms a) Hiking
b) May pose a danger to self or b) Camping
others c) Gardening
6) Community-based treatment d) Outdoor yoga
a) Supportive housing e) Walking
b) Day treatment programs
c) Supportive therapy NURSING PRIORITY: IMPAIRED SOCIAL
d) Psycho-education programs INTERACTION
e) Outreach services 1) Promote adaptive coping
2) Set limits
MOOD DISORDERS 3) Provide meaningful interaction
 Affects a person’s emotional state 4) Avoid judgment
 A disorder in which a person experiences long
periods of extreme happiness, extreme sadness, NURSING PRIORITY: INEFFECTIVE COPING
or both. 1) Therapeutic nurse-client relationship by kind,
firm consistent, honest approach
DEPRESSION
 Grief or sadness is a typical response SYMPTOMS OF MAJOR DEPRESSION
 Death of a spouse or family member 1) Feeling sad most of the time r nearly every
 Loss of a job day
 Major Illness 2) Lack of energy or feeling sluggish
3) Feeling worthless or hopeless
DIAGNOSTIC CRITERIA FOR DEPRESSION 4) Loss of appetite or overeating
 Is an emotional state characterized by: 5) Weight gain or weight loss
a) Sadness 6) Loss of interest in activities that formerly
b) Discouragement brought enjoyment
c) Guilt 7) Hypersomnia or Insomnia
d) Decreased Self-esteem 8) Frequent thoughts about death or suicide
e) Helplessness 9) Difficulty of concentrating or focusing
f) Hopelessness
OTHER FORMS OF DEPRESSION
DIAGNOSTIC CRITERIA FOR MANIA 1) Post-Partum Depression
 Is an emotional state characterized by: 2) Seasonal Affective Disorder (common in
a) Elation winter season)
b) High Optimism 3) Psychotic Depression
c) Increased Energy 4) Depression related to medical condition,
medication or substance abuse
BIPOLAR DISORDER DYSTHYMIA
 Defined by swings in mood from periods of  PERSISTENT depressive disorder
depression to mania  CHRONIC form of depression (can last for at
 Depressive episodes with manic episodes or least 2 years)
mania  Symptoms may occasionally lessen in severity
 During a manic episode, a person may feel during this time.
elated or can also feel irritable or have  RISK FACTORS:
increased levels of activity. a) Family history
b) Previous diagnosis of mood disorder
BIPOLAR I c) Trauma, stress or major life changes in
 MOST SEVERE form the case of depression
 Manic episodes last at least 7 days or maybe d) Physical illness or use of certain
severe enough to require hospitalization medications
 Depressive episodes will also occur, often e) Brain structure and function in the case
lasting for at least 2 weeks. of bipolar disorder
 MANAGEMENT:
BIPOLAR II a) Antidepressants
 Causes cycles of depression similar to those of 1. SSRIs
Bipolar I 2. TCAs
 Experiences HYPOMANIA (less severe form of 3. MAOIs
mania) b) Mood stabilizers
 Able to handle daily responsibilities and does 1. Lithium
not require hospitalization c) Antipsychotics
d) Psychotherapy
SYMPTOMS OF BIPOLAR DISORDER 1. Talk Therapy
1) Feeling extremely energized or elated 2. Cognitive Behavioral Therapy
2) Rapid speech or movement 3. Interpersonal Therapy
3) Agitation, restlessness, or irritability 4. Problem-Solving
4) Risk-taking behavior, such as spending too
much money or driving recklessly
5) Unusual increase in activity or trying to do
too many things at once
6) Racing thoughts
7) Insomnia or Troubled sleeping
8) Feeling jumpy or on edge for no apparent
reason

CYCLOTHYMIA
 A MILDER FORM of bipolar disorder
 Experience continuous irregular mood swings
 From mild to moderate emotional “highs” to
mild to moderate “lows”
 Changes is mood can occur quickly and at any
time
 Only short periods of normal mood
 For an adult to be diagnosed with cyclothymic,
symptoms have to be experienced for at least 2
years.
 For children and adolescents, symptoms must
be persisting for at least 1 year.