PSYCHIATRIC NURSING

• Somatoform disorders


  Disorders characterized by physical symptoms with no identified physical etiology
• Dissociative disorders


  Disorders characterized by a disruption in the integrated fixations of consciousness, identity, memory, or perception of the environment
• Free floating anxiety


  • Emotional stress may exacerbate or precipitate an illness
• Defense mechanisms

  • Repression
  • Projection
  • Conversion
  • Introjection
• Conversion disorder


  Presence of physical symptoms with no identified physical etiology
• La belle indifference


  Lack of concern about the physical symptoms
• Gains in conversion disorder

  • Primary gain
  • Secondary gain
• Primary gain


  • Repression: Keeps internal need or conflict out of awareness
  • Symbolism: Symptom has symbolic value to client
• Secondary gain


  • Additional advantages
  • Reinforces maladjusted behavior
• Nursing management for conversion disorder

  • Divert attention from symptom
  • Provide social and recreational activities
  • Reduce pressure on client
  • Control environment
• Nursing management for conversion disorder (don'ts)

  • Confront client with his illness
  • Feed into secondary gains through anticipating client needs
• Hypochondriasis


  Preoccupation with an imagined illness with no observable symptoms and no organic changes
• "Doctor shopping"


  Seeking multiple medical opinions for an imagined illness
• Assess for in hypochondriasis

  • Preoccupation with body functions or fear of serious disease
  • Misinterpretation and exaggeration of physical symptoms
  • Adoption of sick role and invalid life-style
  • Lack of interest in environment history
• Malingering


  Feigning or exaggerating physical or psychological symptoms for a secondary gain
• Nursing management for hypochondriasis

  • Show acceptance
  • Prepare for, assist in complete medical workup
  • Give accurate information and correcting misconception
  • Do NOT focus on the illness
  • Provide diversion
• Dissociative disorders

  • Blocking- certain areas out of the mind
  • Repressing- traumatic events
  • Psychological retreat- from reality
• Depersonalization


  Sense of detachment from self, as if self is NOT REAL
• Dissociative identity disorder


  Multiple personality: Two or more personalities, each of which controls the behavior while in the consciousness
• Nursing management for dissociative disorders

  • Reduce anxiety
  • Redirect client's attention away from self
  • Increase socialization/ diversional activities
• Modalities of treatment for dissociative disorders

  • Abreaction
  • Hypnosis- cognitive restricting
  • Behavioral therapy
  • Anti-anxiety, antidepressant
• Personality Disorders

  • Nonpsychotic illness
  • Maladaptive behavior is used to fulfill needs and bring satisfaction.
  • Stats in the adolescence- less obvious in middle or old age.
• General characteristics of personality disorders includes denial, maladaptive behavior that leads to inflexible (worst case), minor stress that leads to poor tolerance and mood disturbance, has contact with reality but having difficult to accept it and lastly, lack of awareness.
• Personality disorders is divided into 3 cluster, the cluster A (ODD and ECCENTRIC) which includes paranoid, schizotypal, and schizoid. The cluster B (DRAMATIC and ERRATIC)which includes antisocial, borderline, histrionic and narcissistic. Lastly Cluster C ( ANXIOUS and FEARFUL) which includes OCPD, dependent, avoidant and passive aggressive.
• paranoid personality - Oral fixation and Projection
• Manifestation of paranoid personality

  • Lonely
  • Pathologic jealous
  • Hypersensitive
  • Unemotional
  • Hyper vigilance
  • Common in MEN
• Intervention of paranoid personality includes;

  • Passive friendliness
  • Consistency
  • Proxemics
• Characteristic of schizoid personality;

  • Socially distant
  • Low IQ
  • Introvert
  • Flat affect
  • Functional when alone, more interested on objects
  • Fair contact with reality
  • Autistic thinking
  • Cold and detached
• Schizotypal personality also consider as mild schizophrenia. They are magical thinking, ideas of reference, coid/aloof, inappropriate affect and peculiarity in speech but looseness of association and excess social anxiety.
• Antisocial a.k.a Sociopathic, Psychopathic, Semantic d/o

  • Usual: 15-40 years
  • SET LIMITS
  • CONSISTENCY
• ANTISOCIAL PERSONALITY THEORIES OF CAUSATION

  • Genetic hereditary
  • Brain damage of trauma
  • Low socioeconomic status
  • Faulty family relationship
  • Any behavior that result in secondary gain of attention , security , or love
  • Aggressive , manipulative
  • Coprolalia
  • Lack of guilt , conscience , and remorse
  • Conflict with laws and customs
  • Unable to postpone gratification
  • Disregard for right of others
  • Appears charming , Intellectual , smooth talker
• Borderline personality

  • Latent , ambulatory , abortive schizophrenics
  • Symptoms fall between moderate neurosis and frank pyschosis yet stable DSM – IV – TR
  • COMMON : WOMEN
• Manifestation of borderline personality

  • Impulsive, unpredictable behavior (gambling, shoplifting, sex, and substance abuse )
  • Inappropriate, intense anger
  • Unstable, intense personal relationships
  • Disturbance in self–concept identity
  • Defense mechanism splitting
  • Identity disturbance with chornic feelins of emptiness (adhenia)
  • Projective identification - Ability to project uncomfortable or aggressive aspects into external objects
  • Manipulate the objects
• Histrionic personality

  • Emotional , dramatic theatrical
  • Center of attention
  • Manipulative
  • Sexually seductive or provocative
  • Exaggeratio of emotion
  • Impression style of speech
  • Labile emotion
  • Creative , imaginative
  • Extrovert
  • Uses somatic complaints to avoid responsibility
  • Common : WOMEN - 2-3% of population
  • Lacks father figure ( Electra complex)
• Narcissistic personality

  • Vanity
  • Grandiose self importance
  • Superiority complex
  • Preoccupied with fantasies : power , success , beauty
  • Strong need for admiration from others
  • Arrogant
• Dependent personality

  • Cardinal sign : ENABLING
  • Submissive, clinging
  • Low esteem, helpless
  • Preoccupied with fear of being alone
  • Fails to make decisions and accept responsibility
• Obsessive compulsive personality Disorder

  • Obsession – irresistible thought
  • Compulsion – irresistible action
  • Cardinal sign : RITUALISTIC Defense mechanism
  • Undoing
  • Repression
  • Symbolization
• Avoidant personality

  • Sensitive to rejection , criticism
  • Inferiority complex
  • Avoids open forum
  • Social withdrawal
  • Depression, anxiety , anger are common
  • Lacks self-confidence
  • Feelings of discomfort /timidity when with others
• Passive-aggressive personality

  • Backbiters
  • Loves to procrastinate, can’t finish a task
  • Express anger through passivity
  • Defense mechanism : Reaction formation
  • Goal – verbalization of anger when needed
• ANTISOCIAL – impulsive, aggressive,manipulative