1.

Therapeutic Communication Techniques

Designed for dialogue-matching and fill-in-the-blank questions.

Key Therapeutic Techniques

Broad Openings: Allows the patient to introduce the topic.
Example: "What would you like to talk about today?" or "Where would
you like to begin?"
Restating: Repeating the main thoughts expressed by the patient to confirm
understanding.
Dialogue Example:
Patient: "I can't study. My mind keeps wandering and I know I will
fail."
Nurse (Restating): "You are having trouble concentrating and feel
you will fail your exams."
Reflecting: Directing actions, thoughts, or feelings back to the patient so they
can recognize them.
Dialogue Example:
Patient: "My sister doesn't care about me. She never calls."
Nurse (Reflecting): "You feel hurt and abandoned because your
sister doesn't contact you."
Exploring: Delving further into a subject, idea, or experience.
Example: "Tell me more about that particular situation."
Focusing: Taking notice of a single idea or even a single word to avoid
scattering of thoughts.
Example: "This point seems worth looking at more closely."
Offering Self: Making oneself available on an unconditional basis.
Example: "I’ll sit with you here for a while."

Non-Therapeutic Techniques (To Avoid / Identify as Incorrect)

Giving Advice: "If I were you, I would..." (Tells the patient what to do,
decreasing independence).
False Reassurance: "Everything is going to be fine." (Devalues the patient's
real fears).
Requesting an Explanation ("Why" questions): "Why do you feel this way?"
(Forces the patient to defend themselves and increases anxiety).

2. Schizophrenia
Designed for DSM-5 criteria, treatment side effects, and clinical case
interventions.

DSM-5 Diagnostic Criteria

Two or more of the following symptoms must be present for a significant
portion of time during a 1-month period (at least one must be 1, 2, or 3):
1. Delusions: Fixed, false beliefs unchanged by logic (e.g., persecutory,
grandiose).
2. Hallucinations: False sensory perceptions with no external stimulus (e.g.,
Auditory is the most common).
3. Disorganized Speech: Loose associations, word salad, or derailment.
4. Grossly Disorganized or Catatonic Behavior: Extreme psychomotor
agitation or complete immobility/waxy flexibility.
5. Negative Symptoms: Affective flattening, Alogia (poverty of speech),
Avolition (lack of motivation), Anhedonia (inability to feel pleasure).

Medical Treatment & Critical Side Effects

Antipsychotics (Neuroleptics): Used to treat positive symptoms.
Extrapyramidal Symptoms (EPS): Acute dystonia (muscle spasms), Akathisia
(restlessness), Pseudoparkinsonism, and Tardive Dyskinesia
(irreversible involuntary movements of tongue/jaw).
Neuroleptic Malignant Syndrome (NMS): A life-threatening medical
emergency.
 Key Symptoms: Hyperpyrexia (very high fever), severe muscle rigidity,
altered mental status, and autonomic instability.
Action: Discontinue medication immediately and notify the physician.

Nursing Approach & Interventions

Do NOT argue or validate the delusion/hallucination: Never say "I see it too"
or "That's impossible."
Acknowledge feelings and present reality:
Correct response: "I don't see the spiders on the wall, but I understand
that seeing them makes you feel very frightened."
Safety: Maintain a safe environment and monitor for command auditory
hallucinations telling the patient to hurt themselves or others.

3. Bipolar and Depressive Disorders

Designed for lithium calculations/ranges, etiology, and acute mania
management cases.

DSM-5 Criteria & Etiology

Major Depressive Disorder (MDD): Depressed mood or anhedonia for at least
2 weeks, accompanied by sleep disturbances, weight changes, fatigue, or
suicidal ideation.
Bipolar I Disorder: Characterized by at least one full Manic Episode
(persistently elevated, expansive, or irritable mood, inflated self-
esteem/grandiosity, decreased need for sleep, pressured speech, racing
thoughts) lasting at least 1 week.
Etiology: Strongly tied to genetic predisposition, neurobiological imbalances
(norepinephrine, serotonin, and dopamine), and psychosocial stressors.

Lithium Carbonate Treatment (Highly Testable)

Therapeutic Blood Level Window: \bm{0.6 \text{ to } 1.2 \text{ mEq/L}}.
Lithium Toxicity: Occurs when levels exceed \bm{1.5 \text{ mEq/L}}.
 Early Signs: Nausea, vomiting, diarrhea, fine tremors, slurred speech,
muscle weakness.
Advanced/Severe Signs: Coarse hand tremors, ataxia, blurred vision,
seizures, coma.
Crucial Patient Education: Maintain a consistent intake of Sodium and fluids
(\bm{2 \text{ to } 3 \text{ L/day}}). Low sodium levels cause the kidneys to retain
lithium, leading to toxicity.

Nursing Approach
Acute Mania Interventions:
Provide a low-stimulus environment (dim lights, quiet room, away from
crowds).
Offer high-calorie, nutritious finger foods (since manic patients cannot
sit down to eat).
Set clear, firm, and concise boundaries on manipulative behavior.
Depression Interventions: Perform a direct suicide risk assessment ("Are you
thinking of hurting yourself?").

4. Substance Use Disorder (SUD) & Personality Disorder

Clusters
Designed for risk factor identification and cluster differentiation.

SUD Risk Factors & The CAGE Assessment

Risk Factors: Genetic vulnerability, underlying mental health disorders (dual
diagnosis), impulsivity, trauma/adverse childhood experiences, and peer
environment.
CAGE Questionnaire:
Cut down: Have you ever felt you ought to cut down on your
drinking/using?
Annoyed: Have people annoyed you by criticizing your drinking/using?
Guilty: Have you ever felt bad or guilty about your drinking/using?
 Eye-opener: Have you ever had a drink first thing in the morning (eye-
opener) to steady your nerves?

Clusters of Personality Disorders

Cluster A (Odd or Eccentric)

General Characteristics: Pervasive patterns of strange, odd, or eccentric
behaviors and distrust.
Paranoid Personality Disorder: Severe, unjustified distrust and constant
suspicion of others.
Schizoid Personality Disorder: Complete social detachment, strong
preference for isolation, and a flat emotional affect.
Schizotypal Personality Disorder: Eccentric behavior, magical thinking,
strange beliefs, and odd speech patterns.

Cluster B (Dramatic, Emotional, Erratic)

General Characteristics: Highly dramatic, overly emotional, erratic, and
unpredictable behaviors.
Antisocial Personality Disorder: Total disregard for the law and the rights of
others, complete lack of remorse or guilt, and highly manipulative.
Borderline Personality Disorder: Intense fear of abandonment, unstable
identity, chronic self-harm, and the heavy use of Splitting (viewing
individuals as entirely good or entirely bad).
Histrionic Personality Disorder: Excessive emotionality and constant,
unquenchable attention-seeking behavior.
Narcissistic Personality Disorder: Grandiosity, an intense need for
admiration, and a total lack of empathy for others.

Cluster C (Anxious or Fearful)

General Characteristics: Pervasive patterns of severe anxiety, nervousness, or
fearfulness.
Avoidant Personality Disorder: Extreme social inhibition and withdrawal due
to a profound fear of rejection or disapproval.
Dependent Personality Disorder: Submissive, clinging behavior with an
absolute inability to make independent daily decisions without
reassurance.
Obsessive-Compulsive Personality Disorder (OCPD): Extreme perfectionism,
rigid control, and preoccupation with orderliness.

5. Managing Aggressive Patients, Anxiety, and PTSD

Designed for step-by-step de-escalation protocols and trauma management
cases.

Managing the Aggressive Patient

Early Signs of Escalation: Pacing, clenched fists, loud or rapid speech, glaring.
De-escalation Hierarchy (Step-by-Step Approach):
1. Verbal De-escalation: Maintain a calm, low voice tone, give the patient
physical space (do not trap them), and ask open questions.
2. Chemical Restraints: Offer oral or injectable fast-acting medications
(e.g., Haloperidol, Lorazepam).
3. Seclusion / Physical Restraints: Used only as a last resort if the patient
is an immediate danger to themselves or others and all less
restrictive measures have failed.

Anxiety Levels & Interventions

Mild to Moderate Anxiety: The patient’s perceptual field remains intact. They
can learn and problem-solve.
Intervention: Use active listening and teach coping skills.
Severe to Panic Anxiety: Perceptual field is drastically reduced or shattered.
They cannot process reality or learn.
Intervention: Do not leave the patient alone. Use short, simple, concrete
sentences. Reduce room stimuli.

Post-Traumatic Stress Disorder (PTSD)

Key Symptoms: Intrusive memories/flashbacks, nightmares, hypervigilance,
emotional numbing, and avoidance of trauma reminders.
Nursing Interventions:
During a flashback, reassure the patient immediately of their current
safety: "You are safe in the hospital right now."
Utilize grounding techniques (e.g., "Tell me 5 things you can see in this
room").

6. Child & Adolescent, Neurocognition, Dissociative &

Somatic Disorders
Specifically tailored for the last content units, prioritizing multiple-choice
question profiles.

Child and Adolescent Psychiatric Disorders

Attention-Deficit/Hyperactivity Disorder (ADHD):
Etiology/Risk Factors: Dopamine dysregulation, genetics, prenatal
exposure to toxins.
Nursing Interventions: Provide a highly structured environment with a
predictable daily routine. Break down multi-step tasks into single,
manageable steps. Reward positive behavior immediately.
Autism Spectrum Disorder (ASD):
Clinical Findings: Deficits in social communication, lack of eye contact,
repetitive patterns of behavior/movements.
Nursing Approach: Keep a rigid routine. Introduce changes slowly, as
unexpected alterations to their environment can cause severe
emotional meltdowns

Neurocognitive Disorders (Delirium vs. Dementia)

Delirium
Onset: Acute, sudden, and rapid (occurs over hours to days).
Reversibility: Highly reversible once the underlying physical cause is
identified and treated.
Level of Consciousness: Fluctuating and altered throughout the course of the
day.
Primary Cause: Caused by systemic infections (e.g., UTIs in older adults), drug
toxicity, or severe dehydration.
Nursing Focus: Rapidly diagnose and treat the physiological trigger while
maintaining immediate environmental safety.

Dementia (e.g., Alzheimer's Disease)

Onset: Gradual, progressive, and slow (unfolds over months and years).
Reversibility: Irreversible, resulting in a permanent, progressive decline of
cognitive function.
Level of Consciousness: Stable and clear during the early and middle stages of
the disease.
Primary Cause: Permanent structural brain modifications, such as
neurofibrillary tangles and amyloid plaques.
Nursing Focus: Gently reorient the patient in early stages, utilize validation
therapy in late stages, and maintain a highly familiar environment to
prevent confusion.

Dissociative Disorders and Somatic Symptom Disorders

Somatic Symptom Disorder:
Symptoms: The patient experiences real, distressing physical pain or
symptoms (e.g., severe abdominal pain, paralysis) for which no
physical or organic cause can be found medically. Driven entirely by
repressed anxiety/psychological distress.
Nursing approach: Minimize time spent talking about physical
complaints; redirect focus to feelings and anxiety coping
mechanisms.
Dissociative Disorders (e.g., Dissociative Amnesia, DID):
Symptoms: A sudden disruption of memory, identity, or consciousness
(e.g., forgetting personal identity after a massive psychological
trauma). This serves as an unconscious defense mechanism to
escape extreme emotional pain.