Professional Documents
Culture Documents
Mental Hygiene – science which deals with measures employed to promote mental
health, to reduce the incidence of mental illness through prevention and early treatment
and ensure effective management and rehabilitation
GLOSSARY
1. Abreaction – ventilation of feelings that takes place when the patient verbally
recounts emotionally charged areas
2. Aberration – a deviation from what is natural or normal
3. Affect – a subjective feeling state
4. Aggression – a feeling or action that is hostile or self-assertive
5. Ambivalence – coexisting but contrasting, feeling tones
6. Analictic depression – a deprivational reaction in infants separated from their
mothers in the second half of their first years of life
7. Apathy – absence of interest or emotion in a situation which would ordinarily
arouse response
8. Autism – subjective thinking with much introspection, resulting in phantasy,
delusions and hallucinations
9. Blocking – a sudden stopping in the stream of thought
10.Blunting – dullness of emotional response
11. Cathexis – Freud’s term for the attachment of psychic energy to an object or
mental construct
12.Compulsion – an uncontrollable urge to think or act against one’s better judgment
13.Confabulation – the filling in of memory gaps with made –up episodes
14.Conflict – a painful state resulting from existence of opposing desires, emotions
or goals
15. counter-transference – an emotional response of the nurse that is generated by
the qualities of the patient
and is inappropriate to the content and context of the therapeutic relationship
16. Dementia – a deterioration of intellectual capacities
17. Depersonalization – loss of feeling of personal identity with one’s self
18. Dipsomania – a periodic overwhelming desire for alcoholic drinks
19. Dissociation – the detachment of certain aspects or activities of the personality
from the control of the
individual
20. Diurnal mood variation- changes in mood that are related to the time of the day
21. Double bind – simultaneous communication of conflicting messages in the context
of a situation that does not allow escape
22. Echolalia – the pathological repetition of phrases or words of another person
23. Echopraxia – the repetition or imitation of movements the subject is observing
24. Ego – the conscious self which deals with reality
25. Egocentric – self-centered
26. Empathy – the capacity of feeling in communion with others
27. Encopresis – the involuntary passage of feces
28. Euphoria- an exaggerated sense of well-being
29. Flight of ideas – a rapid succession of ideas in which the goal idea is not reached
30. Free association – a psychoanalytical therapeutic that requires the patient to repeat
all his thoughts without censorship, drifting naturally from one thought to another
31. Kleptomania – an uncontrollable impulse to steal petty and often useless articles
32. La belle indifference-term used to describe the patient’s lack of concern or anxiety
regarding his physical illness
33. Mutism – inability to speak
34. Narcissism – unconscious self love
35. Necrophile – sexually aroused by thought of death or having sex with dead person
36. Neologism – literally new words
37. Nihilistic – the delusion of nonexistence of self, the environment or the world
38. Psyche – the mind
39. Remission – temporary period of relief from the symptoms of an illness
40. Soma – the body
41. stereotype- aimless, repetition of verbal, intellectual, emotional or motor activities
42. Synergistic – a reaction between 2 or more substances when introduced into the
body they enhance the physiological effects of each other
43. Ventilation – free verbal expression of feelings, worries, tensions and problems
44. Verbigeration – meaningless repetition of incoherent words or sentences
45. Waxy flexibility – a condition found in catatonic schizophrenia in which the
extremities have a wax-like rigidity and will remain for long periods in any placed
position no matter how uncomfortable
46. word-salad – a mixture of words and phrases which are incomprehensible and
incoherent
Neurotransmitter- are the chemical substances manufactured in the neurons that aid in
the transmission of information throughout the body, these neurotransmitter are
necessary in just the right proportions to relay messages across the synapses
DOPAMINE – located primarily in the brain stem, has been found to be involved in the
control of complex movements, motivation, cognition, and regulation of emotional
responses.
- generally excitatory and is synthesized from tyrosine, a dietary amino acid
- implicated in schizophrenia and parkinson’s disease
- antipsychotic meds work by blocking dopamine receptors and reducing
dopamine activity
SEROTONIN- found in the brain, derived from tryptophan, a dietary amino acid
- the function is mostly inhibitory, and is involved in the control of food intake,
sleep and wakefulness, temperature regulation, pain control, sexual behavior,
and regulation of emotions
- plays an important role in anxiety and mood disorders and schizophrenia
- it has been found to contribute to the delusions, hallucinations and withdrawn
behavior seen in schizophrenia
- depressants block serotonin reuptake, thus leaving it available for longer in the
synapse, which results in improved mood
ACETYLCHOLINE- found in the brain, spinal cord and peripheral nervous system
particularly the neuromuscular of skeletal muscle
- excitatory or inhibitory, synthesized from dietary choline found in meat and
vegetables and has been found to affect the sleep / wake and to signals
muscles to become active cycle
- Alzheimer’s and MG– decreased acetylcholine
I. Primitive people –
- believed that mentally ill patients were possessed by demons as punishment for
sins committed
- brutal measures were used like starving and beating, abandoned to the forest to
be devoured by wild animals, some were buried at the stake
1. Preinteraction phase- tasks: self exploration of feelings and fears, gathering data,
info, planning for the first interaction
2. Orientation of introductory phase- task: det why patient sought help, establish
trust, mutually formulate a contract, explore pt’s thoughts, feelings and actions, identify
pt’s problem, define goals
Personality
development next…..
THERAPEUTIC COMMUNICATION
FORMULATING A PLAN OF ACTION- What could you do to let your anger out
harmlessly
SILENCE
REQUESTING AN EXPLANATION
DEFENSE MECHANISMS
DENIAL- failure to acknowledge an intolerable thoughts, feelings, experience,
reality
REACTION FORMATION- acting the opposite of what one thinks or feels, causes
person to act exactly the opposite to the way they feel
Isolation- the separation of unacceptable impulse, act or idea from its memory origin,
thereby removing the motional charge associated with the original memory.
General Characteristics:
1. anxiety- the person attempts to control anxiety by using various coping
mechanisms
2. reality is not grossly distorted and personality not grossly organized
3. the relationship between the subjective symptoms and underlying conflicts is not
recognized by the neurotic
NEUROSIS PSYCHOSIS
Does not usually require hospitalization Requires hospitalization
The condition is considered minor reaction A major reaction to stress
to stress
There is no vague interference with reality Reality testing is greatly impaired
testing, ego remains sound
Neurotic feels his suffering and wants to Does not recognize he is ill
get well
Neurotic does not deny reality, merely Conation is greatly disturbed
ignores it
Conation-impulse toward action-is slightly Psychotic denies reality and substitutes
disturbed something else
Neurotic explains symptoms for secondary No secondary gain derived by the patient
gain
Neurotic patient’s desires and motives are Desires and motives are often projected
never externalized/ no delusion
Patient’s personality usually remains Distortion of personality is great and social
socially organized functioning is greatly disturbed
Incidence:
1. very high, late adolescence, mid 30’s
2. more in women than in men
3. common in higher-income group
ANXIETY –theories: Freud- viewed anxiety as due to the conflict bet the id and the
superego-the ego serves as the battleground as it tries to mediate the demands of these 2
clashing elements-
Sullivan believed that through the close emotional bond between the mother and the
infant, anxiety is first conveyed by the mother to the infant,who respond as if he and his
mothering person were one unit.
Will- believed that a person with low self-esteem or has a poor opinion of himself, has a
high predisposition to anxiety and is easily threatened.Learning theories believe that
individual who have been exposed in early life to intense fears are more likely to
demonstrate a high preposition top anxiety in later life
-is the result of emotional conflict, fear is the result of discrete physical or
psychological entity, the source of fear is identifiable, anxiety is not, anxiety is vague
whereas fear is definite, anxiety is related to anticipated event, fear is related to present
Levels of anxiety
ANXIETY DISORDERS
1. Phobia-chromo, alluro ( cats),bacillo ( germs), myso ( dirt), acro( height),
agora( open), claustro( close),.
-avoid confrontation
-do not focus on getting patient to stop being afraid
-systematic desensitization
-relaxation technique
-antidepressant meds.
2. Obsessive-compulsive disorders
Obsession-repetitive, uncontrollable thoughts
Compulsion- repetitive, uncontrollable acts
-accepts ritualistic behavior
-structure environment
-provide for physical needs
-offer alternative activities
-guide decisions, minimize choices
-encourage socialization
-group therapy
-drug-Anafranil (chlomipramine)
3. Conversion hysteria- physical symptoms with no organic basis
-diagnostic evaluation
-discuss feelings rather than symptoms
-promote therapeutic relationship
-avoid secondary gain
4.DISSOCIATIVE DISORDERS
• Sudden change in the patient’s consciousness, identity or motor behavior
• Loss of memory or knowledge of identity or how the individual came to be in that
particular area
Types
1. dissociative identity disorder – client displays two or more distinct identities or
personalities that recurrently take control of his behavior
2. depersonalization disorder- client has persistent or recurrent feeling of being detached
from his mental processes or body
3. dissociative amnesia – the client cannot remember important personal information
usually of a traumatic or stressful nature
4. dissociative fugue – client has episodes of suddenly leaving the home or place of
work without explanation, traveling to another city, and being unable to remember his
past identity.
SOMATOFORM DISORDERS
SITUATIONAL CRISES
GRIEVING PATIENT
Stages of grief- shock and disbelief, awareness of the pain of loss, restitution
*acute grief period- 4-8 weeks
*usual resolution within 1 year
*long term resolution over time
Nursing intervention
-focus on here and now
-provide support to family when loved ones dies
-provide family privacy
-encourage verbalization of feelings
-facilitate expression of anger
-emphasize strengths
-increase ability to cope
-support adjustment to illness, loss of body part
DYING PATIENT
RAPE TRAUMA
Stages of crisis- acute reaction lasts 3-4 weeks, reorganization is long term
Nursing Intervention:
-focus on here and now
-write out treatments and appointments for clients
-record all information in chart
-give clients referrals for legal assistance, support psychotherapy, and rape crisis center
-follow up regularity until client is improved
DISORDERS OF PERCEPTION
1. Illusions- stimulus in the environment is misperceived, maybe visual, auditory.
Nursing Intervention:
-show/explain stimulus to client to promote reality testing
2. Delusion – fixed, false belief that client has power, wealth, status, or is famous
person. (persecutory, grandiose, religious, somatic)
Intervention:
-avoid arguing
-determine client’s need
-reduce anxiety
-accept client’s need for delusion
-present reality, after therapeutic relationship has been established
3. Hallucination-sensory perceptions that have no stimulus in environment.
(auditory/command, visual, olfactory, smells –odors), tactile sensations), gustatory-
taste-sense lingering in the mouth) cenesthetic-fells bodily functions that are
undetectable),Kinesthetic-motionless but reports sensation of bodily movement)
Intervention:
-encourage client to describe hallucination
-accept that this is a real experience for the client
-present reality
4. Ideas of reference – belief that events or behaviors of others relate to self
3. SCHIZOTYPAL PERSONALITY
• BY ACUTE DISCOMFORT WITH AND REDUCED CAPACITY FOR CLOSE
RELATIONSHIP AS WELL AS BY COGNITIVE OR PERSONAL
DISTORTIONS OF BEHAVIOR.BELIEVES IN FAIRIES
-genetic component, problems in thinking, perceiving, communicating
-sensitive to rejection and anger, suspicious of others, blunted and inappropriate affect
-drug-neuroleptics
-care-same as paranoid
7. HISTRIONIC PERSONALITY
- pervasive pattern of excessive emotionality and attention seeking.
-THE CLOWN
-Frequent problem in child parent relationship leads to decrease self-esteem, dramatic
behavior use to gain attention secondary to low self-esteem and belief
-Thrives on being the center of attention, silly, colorful, hurried, restless, overreacts,
somatic complaints, seductive
-Easily influenced by others
• Care:
-positive reinforcement for unselfish or other-centered behaviors
-help clarify feelings
-facilitate appropriate expressions
8. DEPENDENT PERSONALITY
-A pervasive and excessive need to be taken cared of,that leads to submissive and
clinging behavior and fears separation
-FOREVER FOLLOWER
-Anxious and helpless when alone
-Lacks self-confidence
• Care:
-emphasize decision making to increase self responsibility
-teach assertiveness
-assist to clarify feelings, needs and desires
9. AVOIDANT PERSONALITY
A pervasive pattern of social inhibition, feeling of inadequacy, and hypersensitive to
negative evaluation
-THE OLD MAID
-Fixation at the stage where shyness or fear of strangers is common
-Timid, lacks self-confidence, hypersensitive to criticism
-Fears intimate relationship due to fear of ridicule
-Unappealing or inferior
• Care:
-gradually confronts fear
-discuss feelings before and after accomplishing a goal
-teach assertiveness
-increase exposure to small groups
11. Sexual deviations- any aberrant sexual behavior which is preferred to, or takes the
place of, normal heterosexual behavior
-early stages of psychosexual development, intense attachment to their mothers
- homosexuality, pedophilia, pederasty, sodomy, bestiality, fellatio,
cunnilingus,exhibitionism,voyeurism, sadism, masochism, fetishism, transvestism,
trans-sexualism,incest,pyromania
BIPOLAR DISORDER
-involves extreme mood swings from episodes of mania to depression (manic-
depressive)
-Heightened, grandiose, agitated mood
-Flight of ideas, inappropriate dress, excessive make-up and jewelry
-Uses sarcastic, profane and abusive language, talks excessively, jokes, dances, sings,
hyperactive
-Can’t stop moving to eat, easily stimulated by environment, no appetite, hypersexual,
sexually indiscreet, insomia
-Elation or grandiosity –defense to underlying depression or feeling of low self-esteem
• Care:
-simplify the environment and decrease environmental stimuli
-limit people, anticipate situations that will provoke or over stimulate client
-Distract and redirect energy
-assign one staff to provide control, set limit, refuse unreasonable demands, explain
restrictions on behavior
-do not encourage client when telling jokes or performing, avoid laughing
-guard vigilantly against suicide, remain non-judgmental
-avoid long, complicated discussions, avoid giving advices when solicited, use short
sentences
-meet physical needs, give high calorie finger foods and drinks to be carried while
moving
-encourage rest, sedate PRN
-help decrease denial and increase client’s awareness of feelings
-help client acknowledge the need for help when denying
-have patient verbalize needs directly
-drug- lithium
SCHIZOPHRENIA
- split mind- lack of integration of patient’s function
- cause is unknown
• Causes distorted and bizarre thoughts, perceptions, emotions, movements, and
behavior.
• Characterized by disorganized thinking, delusion, hallucination,
depersonalization, impaired reality testing
• Incidence-15-25/25-35 years old, genetic, organic, psychological
• Interpersonal theorists suggested that schizophrenia resulted from dysfunctional
relationships in early life and adolescence
• 4 A’s-autism, association (disorganized) ambivalence (can’t choose between
conflicting emotions), affect (flat, blunted)
• Withdrawal from relationship, neologism ( rhyming that others can’t understand),
magical thinking, suspiciousness, short attention span, hallucination,regression
• TYPES
1. disorganized-silly laughing and regression, transient hallucination
2. catatonic – sudden onset of mutism, bizarre mannerisms, stereotyped
position and waxy flexibility, catalepsy( pathologic limb rigidity)
3. paranoid- suspicion and ideas of persecution and delusion
4. undifferentiated-more than one symptom
5. residual – no longer present overt symptoms, recovered to return to the community,
still manifest recognizable, residual disturbances of thinking, feeling and behavior
Implementation:
1. Maintain patient safety- decreased sensory stimuli, remove from the areas of
tension, validate reality, do not argue, with patient
2. Protect from erratic and inappropriate behavior- communicate in calm,
authoritative tone, address client by name, observe for s/s of escalating behavior
3. Meet physical needs of severely depressed type/catatonic- ask pt to pick up fork,
if unable to make decision, then feeding is necessary, when ready encourage
patient to eat in the dining room with others
4. Establish a therapeutic relationship-be consistent and reliable in keeping all
scheduled appointments, avoid direct questions, accept client’s indifference,
discuss all staff changes, tolerate silences, encourage client’s affect by verbalizing
what you observe
5. Engage in family therapy
6. Engage in socialization or activity group therapy
7. Provide simple activities- finger painting, clay,avoid competitive situations
8. DOC – Prolixin( Fluphenazine decanoate )- oily, IM or SQ Q 2 weeks
DEPRESSION
Response to real or imagined loss
Anger and aggression toward self results from feelings of guilt about negative or
ambivalent feelings
Low self-esteem, feelings of helplessness, hopelessness, obsessive thoughts and fears
Unkempt, depressed appearance, multiple physical complaints, prone to injury,
accidents and infections, loss of appetite, no sexual desire, insomia, constipation
Decreased attention span, slowed speech, impaired reality testing, withdrawn
Care:
- Be alert for signs of self destructive behavior, report all changes to the team
- Meet physical needs, companionship during mealtime, frequent feedings, favorite
food
- Promote rest, medicate PRN, stay with client if necessary
- Avoid pep talks, no promises, keep encouragement
- Avoid presenting choices, be brief and simple, avoid long explanations, brief
orientation, simple language, written schedules
- Provide consistent daily care, avoid task at which the client will fail
- Sit with client during long quiet times, touch to promote acceptance
- Introduce to others when ready
- Group, individual, family therapy
- Imply confidence in client’s capabilities, give assistance when needed
- Drug- anti-depressant
suicide
CARE:
-be alert for signs of destructive behavior, remove all potentially dangerous items
-one to one relationship, stay with the client
-discuss all behavior with health team, note for clues as cry for help, increase energy
-intervene quickly and calmly during actual destructiveness, stay with client
-avoid judgmental remarks or interpretations
-no suicide, no harm, no self injury contract
1 -prepare patient by explaining procedure and telling him about temporary memory
loss and confusion
2-informed consent, physical exam, labwork
3 -NPO after MN
4 -have patient void before the ECT
5-remove dentures, jewelries, glasses
6 -usually a muscle relaxants and short acting anesthesia and barbiturates are given
7 -give atropine 30 min before treatment
8 -oxygen on hand
9 -after procedure, take vital signs, orient patient
10 -observe patient’s reaction and stay with him
11 -observe for sudden improvement and indications of suicidal threats after ECT
EATING DISORDERS
1. Anorexia Nervosa
-most common in females 12-18 years old
-characterized by fear of obesity, dramatic weight loss, distorted body image
-amenorrhea, anemia, excessive exercise, electrolyte imbalance
2. Bulimia
-characterized by all of the characteristics of anorexia and binge eating
-may be of normal weight or overweight
Care:
-monitor clinical status, hydration and electrolytes
-behavior modification
-family therapy
-support efforts to take responsibility for self
-explore issues regarding sexuality
-drug- antidepressant
-nutritional assessment
-weigh patient 3x a week, at the same time
-sets limit on time allotted for eating
-stay with the client during meals, accompany client to bathroom
-record amount eaten
ABUSE
1. Child Abuse
-inconsistency of type/location of injury with the history of the incident
-severe CNS or abdominal injuries, obvious disturbance in parent/child interaction
-sexual abuse-genital laceration, STD’s, emotionally neglect, failure to thrive
2. Elder Abuse
-battering, fractures, bruises, over/undermedicated, absence of needed dentures
-physical evidence of sexual abuse, urine burns, pressure sores
3. Domestic Violence
-frequent visits to physician’s office for unexplained trauma
Care
-provide for physical needs first, safety
-mandatory reporting of identified/suspected cases to appropriate agency
-nonjudgmental treatment of parents, encourage expression of feelings
-provide role model and encourage parents to involved in acre
-teach growth and development concepts
-provide emotional support for child, play therapy initiate protective placement or
appropriate referrals
-documentation
ANTIDEPRESSANT MEDICATIONS
1. MONOAMINE OXIDASE INHIBITORS ( Isocarboxazid/Marplan,
Tranylcypromine/Parnate, Phenelzine Sulfate/Nardil)
Precaution: if foods with Tyramine ingested, life threatening-can have hypertensive
crisis ( headache, sweating, palpitations, stiff neck), foods high in Tyramine- aged
meats,pepperoni, salami, summer sausage, beef logs, lasagna, tap beers
-potentially fatal drug interactions-no CNS depressants, Demerol,
antihypertensive and general anesthetics(sweating, fever, agitation, rigidity, coma death)
-potentially lethal in overdose-potential risk, suicide
Implications
-assist client to rise slowly from sitting position
-administer in the morning
-administer with food
-ensure adequate fluids
-avoid foods with Tyramine
-takes 3-4 weeks to work
-avoid tricyclics until 3 weeks after stopping MAO
-monitor vital signs
-sunblock
Care:
-if with NMS ( neuroleptic malignant syndrome-idiosyncratic reaction)- rigidity, high
fever, unstable BP, diaphoresis,pallor, stop the medication, administer drugs as ordered,
( Cogentine, Artane,Valium, Ativan)
-increase fluid intake
-caution about sun exposure
-ice chips
-rise slowly
-do not mix with beverages that contain caffeine or apple juice
- May cause false positive pregnancy test
- Monitor bowel function
- Monitor vital signs, watch out infection
- Change positions slowly, weekly blood monitoring
CARE:
-CNS depressant
-long duration
-renal and hepatic function
-withdraw drug gradually( over 2 weeks)
- give with meals
-monitor therapeutic level
- avoid alcohol