week 2

• Psychiatric Disorders


  • Anxiety and Anxiety Disorders
  • Mood Disorders and Suicide
  • Personality Disorders
  • Obsessive Compulsive Disorders
  • Addiction
  • Schizophrenia
• At the end of the session, students will be able to:

  1. Identify common psychiatric disorders and their key symptoms.

  2. Understand therapeutic approaches, including medication and non-drug methods like therapy and communication techniques.

  3. Assess and manage safety risks, including self-harm or harm to others, while following legal and ethical guidelines in psychiatric care.
• Group Activity: Concept Map

  1. Form Six Groups: Divide class into six groups. Each group will select one topic from a list of provided psychiatric disorders to create their concept map.

  2. Brainstorm and Build: Each group will be given 20 minutes to brainstorm and construct their concept maps with clear connections between concepts and to think creatively about their map's structure and presentation.

  3. Group Presentations: After the 20-minute building phase, each group will present its concept map to the entire class.

  4. Grading Criteria: Groups will be graded based on: Content (50%), Delivery (30%), Creativity (20%)
• Psychiatric Disorders for Concept Map

  • Anxiety and Anxiety Disorders
  • Obsessive-Compulsive Disorders
  • Schizophrenia
  • Mood Disorders and Suicide
  • Personality Disorders
  • Addiction
• Psyche Flash Q and A!

  1. Form Groups: Use the same groups from the previous activity.

  2. Answer Questions: Using the set of provided questions, each group will discuss and determine the correct answers.

  3. Awarding Points: The group that provides the correct answer to a question will earn points. Points are cumulative across all questions.
• Anxiety


  • Vague sense of impending doom
  • An unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, resulting from unrecognized intrapsychic conflict
  • Self-awareness about one's anxiety and responses to it greatly improves both personal and professional relationships
  • Positive effects - produce growth and adaptive change
  • Negative effects - produce poor self-esteem, fear, inhibition, and anxiety disorders (in addition to other disorders)
• Stages of Anxiety: General Adaptation Syndrome (GAS)

  1. Alarm Reaction: The initial reaction to a stressor, the body activates its "fight-or-flight" response

  2. Resistance: If the stressor persists beyond the initial alarm reaction, the body attempts to adapt to the ongoing stressor by maintaining physiological arousal

  3. Exhaustion: If the stressor persists for an extended period and the body's resources become depleted, the body's ability to cope with the stressor declines, and physiological resources become severely depleted
• Levels of Anxiety


  • Mild: Helps people learn, grow, and change
  • Moderate: Increases focus on the alarm and learning is still possible
  • Severe: Greatly decreases cognitive function, increases preparation for physical responses, and increases space needs
  • Panic: Fight, flight, or freeze response, no learning is possible, and the person is attempting to free him or herself from the discomfort of this high stage of anxiety
• Nursing Intervention for Anxiety Levels

  • Mild: No direct intervention, the client can learn and solve problems
  • Moderate: Speak in short, simple and easy to understand sentences, Redirect client back to topic
  • Severe: Remain with person, Talk in a low calm and soothing voice, Walk while talking with him, Help them take deep breaths
  • Panic: Person's safety is a priority, Must keep talking in comforting manner, Going to small, quiet and non-stimulating environment, Remain with client at least 5-30 minutes
• Nursing Diagnosis: Ineffective individual coping, Anxiety
• Nursing Intervention for Anxiety (All Levels): Prioritize safety, Encourage the client to verbalize feelings, Administer medications, as ordered, Carefully listen to the client, Environmental stimuli must be controlled
• Incidence and Etiology of Anxiety

  • Incidence: Prevalent in women, Younger than 45 yo, Divorced and/or separated, Lower socioeconomic status
  • Etiology: Genetic predisposition, Traumatic life events, Neurotransmitter imbalances
• Psychopharmacology: Anxiolytics


  • Desired Effects: Decreased anxiety, adequate sleep
  • Have sedative effects
  • For short term use only, no longer than 4-6 weeks
  • High risk for dependence and abuse
  • Examples: Xanax, Librium, Valium, Ativan, Serax, Esquanile, Tranxene
• Nursing Implications for Anxiolytics


  Best taken before meals, Rise slowly, Adequate fluids, Avoid CNS depressants (antihistamines, alcohol), Advise to avoid driving, Administer it separately with any drug, Do not stop abruptly
• Anxiety Disorders


  • Panic Disorder
  • Phobia
  • Generalized Anxiety Disorder (GAD)
  • Post-Traumatic Stress Disorder (PTSD)
• Nursing Intervention for Anxiety Disorders

  Modify environment – safe, Approach: kind-firmness, Nonjudgmental and calm attitude, Allow agreeable time for rituals, Give medications as ordered, Execute therapeutic modalities - biofeedback, change of the scenery, therapeutic touch, hypnosis, massage or relaxation exercises, Desensitization
• Somatoform Disorders (Briquet's Syndrome)


  • Characterized by physical symptoms suggesting a medical condition, not fully explained by medical or mental disorders
  • Presence of multiple physical symptoms with no clear medical cause
  • Significant distress or impairment in social and occupational functioning
  • Psychological factors such as unresolved conflicts or trauma
• Dissociative Disorders


  • Involves disruptions in consciousness, memory, identity, or perception
  • Presence of distinct personality states or identities
  • Significant distress or impairment in social, occupational, or other areas of functioning
  • Often associated with trauma or severe stress during childhood
  • Presence of two or more distinct personality states or identities
• Obsessive-Compulsive Disorder


  • Obsessions - recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses
  • Compulsions - ritualistic or repetitive behaviors or mental acts
  • Repetitive behaviors of various types: Self-soothing, Reward-seeking, Disorders of body appearance or function
  • Diagnosed when the obsessions and compulsions interfere life functions
• Incidence and Etiology of OCD: Onset can start in childhood, especially in males. Begins in 20s for females. Genetic factors have a significant influence than environment. An alteration in the frontal-subcortical neural circuitry of the brain.
• Obsessive-Compulsive Disorder (OCD)


  • Obsessions - recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses
  • Compulsions - ritualistic or repetitive behaviors or mental acts
• Types of repetitive behaviors in OCD

  • Self-soothing behaviors: Trichotillomania, Dermatillomania, or Onychophagia
  • Reward-seeking behaviors: Hoarding, Kleptomania, pyromania, or oniomania
  • Disorders of body appearance or function: Body dysmorphic disorder (BDD)
• OCD


  Diagnosed when the obsessions and compulsions interfere life functions
• OCD Related Disorders


  • Dermatillomania
  • Trichotillomania
  • Body Dysmorphic Disorder (BDD)
  • Hoarding
  • Onychophagia
  • Oniomania
  • Kleptomania
  • Body Identity Integrity disorder (BIID)
• Onset and Clinical Course of OCD

  • Can start in childhood, especially in males
  • Begins in 20s for females
  • Early Onset: 11 yo
  • Late Onset: 23 yo
• Etiology of OCD


  • Biological Theories: Genetic factors have significant influence than environment
  • Genome wide: A complex network of several genes may contribute to the genetic risk for OCD - an alteration in the frontal-subcortical neural circuitry of the brain
  • Cognitive Models (Aaron Beck): Describes person's thinking as believing one's thoughts are overly important, perfectionism and intolerance of uncertainty, inflated personal responsibility and overestimation of the threat posed by one's thoughts
• Therapy for OCD


  • Exposure - assisting the client in deliberately confronting the situations and stimuli that he or she usually avoids
  • Response prevention - focuses on delaying or avoiding performance of rituals
• Pharmacological Treatment for OCD


  • SSRI antidepressants: fluvoxamine (Luvox) and sertraline (Zoloft), followed by venlafaxine (Effexor)
  • Second-generation antipsychotics: Risperidone (Risperdal), quetiapine (Seroquel), or olanzapine (Zyprexa) for treatment-resistant OCD
• Nursing Diagnoses for OCD

  • Anxiety
  • Ineffective Coping
  • Fatigue
  • Situational Low Self-esteem
  • Impaired Skin Integrity
• Nursing Interventions for OCD


  • Build trust and a therapeutic relationship
  • Educate about OCD
  • Encourage adherence to treatment
  • Teach coping strategies and relaxation techniques
  • Promote lifestyle modifications
• Schizophrenia


  • A serious psychiatric disorder that causes distorted and bizarre thoughts, perceptions, emotions, movements, and behavior
  • Not a single disease entity but a combination of disorders
  • Characterized by impaired communication, loss of contact into reality, and deterioration from a previous level of functioning
• Positive or Hard Symptoms of Schizophrenia

  • Delusions
  • Hallucinations
  • Ideas of reference
  • Echopraxia
  • Bizarre behavior
  • Associative looseness
  • Perseveration
  • Inattention
• Negative or Soft Symptoms of Schizophrenia

  • Alogia
  • Ambivalence
  • Anhedonia
  • Apathy
  • Asociality
  • Avolition or lack of volition
  • Blunted affect
  • Catatonia
  • Flat affect
• Catatonic Schizophrenia


  Extreme motor disturbances, including maintaining rigid postures or adopting unusual body positions for extended periods
• Paranoid Schizophrenia


  Preoccupation with delusions of persecution and auditory hallucinations, believing that others are plotting against them
• Types of Schizophrenia


  • Disorganized: Poor prognosis, regression, incoherent speech and behavior
  • Paranoid: Fair to good prognosis, projection, hallucinations, ideas of reference, delusion of persecution
  • Catatonic: Good prognosis, repression and isolation, wax flexibility, stupor, agitation, negativism
  • Undifferentiated: Variable prognosis, regression and denial, mixed symptoms
  • Residual: Variable prognosis, intellectualization, presence of negative symptoms
• Neurotransmitters implicated in Schizophrenia

  Dopamine and serotonin
• Schizophreniform Disorder


  Acute psychosis lasting less than 6 months, resembling schizophrenia. May or may not impair social or occupational functioning.
• Intervention for Medication Non-Adherence in Schizophrenia

  Switching to a long-acting injectable (LAI) antipsychotic medication
• Managing Side Effects of Antipsychotic Medications


  Adding a medication to counteract the specific side effects