PSYCH

• Highlights of Patient's Bill of Rights


  • To be informed about benefits, qualifications of all providers, available treatment options, and appeals and grievance procedures
  • Least restrictive environment to meet needs
  • Confidentiality
  • Choice of providers
  • Treatment determined by professionals, not third-party payers
  • Parity
  • Nondiscrimination
  • All benefits within scope of benefit plan
  • Treatment that affords greatest protection and benefit
  • Fair and valid treatment review processes
  • Treating professionals and payers held accountable for any injury caused by gross incompetence, negligence, or clinically unjustified decisions
• Rights of Clients and Related Issues

  • Involuntary Hospitalization
  • Release from the Hospital
  • Mandatory Outpatient Treatment
  • Conservatorship and Guardianship
  • Least Restrictive Environment
• Disturbance in Perception


  • Illusion - misperception of an actual external stimuli
  • Hallucination - false sensory perception in the absence of external stimuli
  • Neologism - pathological coining of new words
  • Circumstantiality - over inclusion of details
  • Word salad - incoherent mixture of words and phrases
  • Flight of ideas - shifting of one topic from one subject to another in a completely unrelated way
  • Looseness of Association - shifting of a topic from one subject to another in somewhat related way
  • Verbigeration - meaningless repetition of word or phrases
  • Perseveration - persistence of a response to a previous question
  • Echolalia - pathological repetition of words of others
  • Clang association - the sound of the word gives direction to the flow of thought
  • Delusion - false belief which is inconsistent with one's knowledge and culture
• Types of Delusions


  • Grandeur - is an exaggerated belief of identity
  • Nihilistic - the client denies the existence of self or part of self
  • Persecution - belief that he or she is the object of environmental attention and being singled out for harassment
  • Self-depreciation - worthlessness or hopelessness
  • Somatic - false belief to body function
• Disturbances of Affect


  • Inappropriate affect - 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
• Disturbances in Motor Activity

  • Echopraxia - the pathological imitation of posture/action of others
  • Waxy flexibility - maintaining the desired position for long periods of time without discomfort
  • Akinesia - loss of movement
  • Bradykinesia - slowness of all voluntary movement including speech
  • Ataxia - loss of coordinated movement
• Disturbances in Memory


  • Confabulation - filling in of memory gaps
  • Amnesia - inability to recall past events
  • Anterograde - immediate past
  • Retrograde - distant past
  • Deja vu - feeling of having been to place which one has not yet visited
  • Jamais vu - feeling of not having been to a place which one has visited
  • Dementia - gradual deterioration of intellectual functioning resulting in the decreased of capacity to perform ADL
• Other behavioral signs & symptoms

  • Agitation - severe anxiety associated with motor restlessness
  • Agnosia - inability to recognize and interpret sensory stimuli
  • Akathisia - subjective feeling of muscular tension, restlessness and pacing repeated sitting and standing
  • Ambivalence - presence of two opposing feelings at the same time
  • Aphasia - inability or difficulty to speak or recall words
  • Apraxia - inability to carry out specific task or activity
  • Delirium - acute change or disturbance in a person's: LOC, cognition, emotion, perception
  • Depression - feeling of sadness
  • Derealization - feeling of strangeness towards the environment
  • Dysthymia - persistent state of sadness
  • Elation (euphoria)- a feeling of high degree of confidence, boastfulness and joy with increase motor activity
  • Narcolepsy - sleep disorder characterized by frequent irresistible urge to sleep with episodes of cataplexy (sudden loss of muscle power)
• Interpersonal withdrawal


  Behavior characterized by avoidance of interpersonal contact and a sense of unreality
• Types of interpersonal withdrawal

  • Physical withdrawal
  • Verbal withdrawal
• Nursing Interventions for interpersonal withdrawal

  • Avoid punishment of client
  • Decrease isolation
  • Invite the client to speak
  • State the amount of time you are willing to stay with the client, whether he or she chooses to speak or not
  • Change the context of the contact
  • Encourage the client to share responsibility for the continuance of the relationship
• Regression


  A selective, defensive operation in which the individual resorts to earlier, childish, or less complex patterns of behavior that once brought the client attention or pleasure
• Nursing Interventions for regression


  • Avoid fostering dependency and childlike attitudes
  • Be patient and understanding
  • Confront client directly about his or her plan
  • Compliment client when he or she does something unusually well or assumes more responsibility
  • Promote problem solving, reality orientation, and involvement in social activities
  • Avoid punishment after periods of regression; instead, explore the meaning of the regressive behavior
  • Remember that regression is a normal occurrence in young children who are hospitalized
• Anger


  An unconscious process used to obtain relief from anxiety that is produced by a sense of danger; it involves a sense of powerlessness
• Nursing Interventions for anger

  • Have client acknowledge or name feelings
  • Explore source of personal fear or perceived threat
  • Encourage verbalization of anxiety
  • Explore appropriate external expression of feelings
  • Avoid arguing with client
  • Acting-out behavior is often an indirect expression of anger; it attracts attention and often represents the feelings the person is experiencing
• Hostility/Aggressiveness


  Antagonistic feeling; the client wishes to hurt or humiliate others; the result may be a feeling of inadequacy or self-rejection due to a loss of self-esteem
• Nursing Interventions for hostility/aggressiveness


  • Prevent aggressive contact by early recognition of increased anxiety
  • Maintain client contact rather than avoid it
  • Encourage verbalization of feelings associated with a threat of frustration (helplessness, inadequacy, anger)
  • Reduce environmental stimuli
  • Avoid reinforcement behavior (e.g., joking, laughing, teasing, and competitive games)
  • Use distraction or remove the client from the immediate environment to reestablish self-control
  • Set limits on unacceptable behavior
  • Protect other clients
• Violence


  Behavior that is physically assaultive and risks injury to the self, others, and the environment
• Nursing Interventions for violence

  • Establish eye contact
  • Avoid asking, "Why?" Instead ask, "What's bothering you?"
  • Speak to the client softly, slowly, and with assurance
  • Give directions clearly and concisely. Tell the client what you want him or her to do
  • Encourage client to verbalize feelings
  • Position yourself near the door
  • Self-protection and protection of other clients are primary concerns
  • Once the client is in control of his or her behavior, review and process the situation in order to alleviate the client's guilt and to discuss alternatives in case the client becomes anxious or angry in the future
• Types of Abuse


  • Physical abuse
  • Physical neglect
  • Emotional abuse
  • Emotional neglect
  • Economic abuse
  • Sexual abuse
  • Incest
• Rape


  Nonconsensual sexual penetration of an individual, obtained by force or threat, or in cases in which the victim is not capable of consent
• Kinds of Rape


  • Power – to prove masculinity
  • Anger – means of retaliation
  • Sadistic – to express erotic feelings
• Silent Rape Syndrome


  A maladaptive reaction to rape where the victim fails to disclose information about the rape or is unable to resolve feelings about the sexual assault, resulting in increased anxiety and may develop a sudden phobic reaction
• Rape Trauma Syndrome (RTS)


  Refers to a group of signs and symptoms experienced by a victim in reaction to rape
• Phases of Rape Trauma Syndrome

  • Acute / Impact – shock, numbness, disbelief
  • Repression / Denial – refusal to discuss the event
  • Heightened Anxiety – fear, tension, nightmares
  • Stage of Resolution
• Battered Wife Syndrome (BWS)


  A form of cyclic domestic violence where the men have low self-esteem and the women have dependent personality disorder
• Characteristics of Abusive Husbands

  • They usually come from violent families
  • They are immature, dependent and non-assertive
  • They have strong feelings of inadequacy
• Components of Child Abuse by Omission

  • Child abandonment
  • Child neglect
• Types of Child Abuse by Commission

  • Physical Abuse
  • Emotional abuse
  • Sexual abuse
• Characteristics of Abusive Parents

  • They come from violent families
  • They were also abused by their parents
  • They have inadequate parenting skills
  • They are socially isolated because they don't trust anyone
  • They are emotionally immature
  • They have negative attitude towards the management of the abused
• Warning signs of Child Abuse / Neglect

  • Child's excessive knowledge on sex and abusive words
  • Hair growth in various lengths
  • Inconsistent stories from the child and parent/s
  • Low self-esteem
  • Depression
  • Apathy
  • Bruised or swollen genitalia; tears or bruising of rectum or vagina
  • Unusual injuries for the child's age and development
  • Serious injuries (fractures, burns, lacerations)
  • Evidence of old injuries not reported
• Mental Retardation (DSM-5: Intellectual Disability)


  A child who is mentally retarded has an IQ of 70 to 75 or below, which is associated with deficits or impairments in adaptive behavior before the age of 18 years
• Levels/Categories of Mental Retardation

  • Mild (Moron) - IQ 51-70, Difficulty adapting to school, Educable – needs assistance
  • Moderate (Imbecile) - IQ 36-50, Poor awareness of needs of others, Trainable – needs moderate supervision
  • Severe (Idiot) - IQ 20-35, Unable to learn academic skills, Poor motor development and minimal speech, Needs complete and close supervision
  • Profound - IQ Below 20, Has minimal capacity for sensorimotor function, Needs custodial care with a totally structured environment
• Nursing Interventions for Mental Retardation

  • Goal: To promote optimum development within a family and community setting
  • Goal: To promote independence by setting realistic goals
• Attention Deficit Hyperactivity Disorder (ADHD)

  Characterized by inattentiveness, overactivity, and impulsiveness, usually diagnosed before age 7
• Problems (Diagnostic Criteria) / Assessment for ADHD

  • Inattention
  • Impulsivity
  • Hyperactivity
• Nursing Interventions for ADHD

  • Goal: To keep child from harming self or others
  • Goal: To encourage age-appropriate, socially acceptable coping skills
  • Goal: To decrease anxiety and increase self-esteem
  • Goal: To administer prescribed medication
• Autism (Autism Spectrum Disorder)


  Characterized by pervasive and usually severe impairment of reciprocal social interaction skills, communication deviance, and restricted stereotypical behavioral patterns
• Signs and Symptoms of Autism

  • Odd play
  • Not cuddly
  • Echolalia
  • Crying tantrums
  • Head towards anything
  • Inanimate object attachment
  • Loves to spin objects / self
  • Difficulty interacting with others
  • Wants blocks
  • Acts as deaf
  • Resists normal teaching method / routine changes
  • No fear of danger
  • Insensitive to pain
  • No eye contact
  • Giggling or silly laughing
• Nursing Interventions for Autism

  • Environment: Encourage the client to participate for self-care, Promote communication, Haloperidol