PSYCHIATRIC- MENTAL HEALTH NURSING

ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED

BY: F.R. CUSTODIO

Mental Health MENTAL HEALTH MENTAL ILLNESS

WHO definition: state of complete physical, mental, 1. Accepts self and 1. Feelings of inadequacy
and social wellness, not merely absence of disease or others 2. Poor self-concept
infirmity 2. Ability to cope or 1. Inability to cope
tolerate stress. Can 2. Maladaptive behavior
return to normal 3. Inability to establish a
"A state of well-being where a person can realize his or functioning if meaningful relationship
her own abilities to cope with the normal stresses temporarily disturbed
of life and work productively.” 3. Ability to form close 1. Inability to establish a
and lasting meaningful relationship
State of emotional, psychological, and social wellness RELATIONSHIP
evidenced by: 4. Uses sound judgment 1. Displays poor judgment
 satisfying interpersonal relationships to make decisions
 effective behavior and coping 5. Accepts responsibility 1. Irresponsibility or inability
 a positive self-concept for actions to accept responsibility for
actions
 emotional stability
6. Optimistic 1. Pessimistic

Factors Influencing a Person's Mental 7. Recognizes limitations 1. Does not recognize

Health (abilities and limitations (abilities and
deficiencies) deficiencies)
 Individual factors:
8. Can function effectively 1. Exhibits dependency
- biologic makeup, autonomy and and independently needs because of feelings
independence, self-esteem, capacity for of inadequacy
growth, vitality, ability to find meaning in life, 9. Able to perceive 1. Inability to perceive
emotional resilience or hardiness, a sense of imagined reality
belonging, reality orientation, and coping or circumstances from
stress management abilities reality
10. Able to develop 1. Does not recognize
 Interpersonal factors: potential and talents to potential and talents due to
fullest extent a poor self-concept
- effective communication, ability to help others,
11. Able to solve problems 1. Avoids problems rather
intimacy, and a balance of separateness and
than handling them or
connectedness attempting to solve them
12. Can delay immediate 1. Desires or demands
 Social/cultural factors: gratification immediate gratification
- A sense of community, access to adequate
resources, intolerance of violence, support of Comparative characteristics of a
diversity among people, mastery of the
environment, and a positive, yet realistic, view
mentally healthy and a mentally ill
of one's world person:

Mental Illness
 Historically viewed as possession by demons, MENTAL HEALTH MENTAL ILLNESS
punishment for religious or social transgressions, Mental health reflects a Mental illness reflects a
weakness of will or spirit, and violation of social person's approach to life by person's inability to cope
communicating emotions, with stress, resulting in
norms
giving and receiving. disruption, disorganization,
 Today seen as a medical problem, although some Working alone as well as inappropriate reactions,
stigma from previous beliefs remains with other, accepting unacceptable behavior and
 Mental disorder is “a clinically significant authority, displaying a the inability to respond
behavioral or psychological syndrome or pattern sense of humor, and according to his
that occurs in an individual and that is associated coping successfully with expectations and the
with distress or disability or with a significantly emotional conflict demands of society.
increased risk of suffering death, pain, disability, or
an important loss of freedom” (American Psychiatric Nursing
Psychological Association [APA])  is the branch of nursing concerned with the
prevention and cure of mental disorders and their
Major criteria for the diagnosis of sequel. It employs theories of human behavior as
mental illness (Psychosis) its scientific frameworks and requires the use of
The criteria for psychosis include: self as its art or expression in nursing practice.
 Bizarre behavior  An interpersonal process
 Abnormal experience  Concerned with all the aspects of care
 Loss of reality contact  Both a Science and an Art
 Lack of insight  Science - uses different theories
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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO


Art - therapeutic use of self 11. Trauma

Clientele: - A severe physical injury to the body from an
 Individual, family and the community Both external source; or a severe psychological
mentally healthy and mentally ill shock.
 Main tool of the nurse: Therapeutic use of self 12. Alcohol dependent
- A person who can not break the habit of
Common Psychiatric Symptoms drinking alcoholic drinks too much, especially
one whose health is damaged because of
and key terms in Psychiatric excessive alcohol intake.
Nursing 13. Schizophrenia
1. Anxiety - A serious mental disorder characterized by
- A state of feeling uncertainty experienced in impaired communication with loss of contact
response to an object or situation. with reality and deterioration from a previous
2. Stress level of functioning in work, social
- A state of extreme difficulty, pressure or strain relationships, or self care
with negative effects on physical and 14. Paranoid disorder
emotional health and well-being. - A psychotic state characterized by moderately,
3. Withdrawal or seriously, impaired reality testing, affect
- A state of habitual quiet and seeming un sociability, accompanied by persecutory,
concerned with other people a focus on one's grandiose, erotic or jealous content delusions.
own thoughts. 15. Manic-depression
4. Depression - A mood disorder involving both mania and
- A mood state characterized by a feeling of depressive episode.
sadness, dejection (self-dislike), despair, 16. Illusion
discouragement, or hopelessness. - A false interpretation or perception of a real
5. Suicide environmental stimulus that may involve any of
- The act of killing oneself (self-distracting the senses.
behavior) 17. Hallucinations
6. Neurosis - Sensory perceptions that occur in the absence
- A condition in which mal adaptive behaviors of an actual external stimulus. They may be
serve as a protection against a source of auditory, visual, olfactory, gustatory or tactile.
unconscious anxiety. 18. Delusion
7. Personality disorder - False belief not true to fact ordinarily accepted
- A non-psychotic illness characterized by by other members of the person's culture
maladaptive behavior that the person uses to
fulfill his or her needs and bring satisfaction to
him or herself. As a result of the inability to  The difficulty which arises in answering these
relate to the environment, the person's actions questions lies in the fact that 'normal' is used in
conflict socially more than one sense. It is sometimes employed
8. Hysteria (conversion disorder) for always or 'most usual' for example when
The loss or impairment of some motor or considering normal height, normal weight and so
sensory function for which there is no organic on. In this sense, with regard to mental health,
cause. normality may be:
- Formerly known as hysteria or hysterical  a sense of well-being.
neurosis.  The use of sublimation as the main
9. Mental retardation defense mechanism
- A disorder characterized by sub average  The ability to postpone present pleasures
intellectual functioning associated with or for future ones
resulting in, the inability or impairment of the  The presence of an intact sense of reality
ability to think abstractly, adapt to new
situation, learn new information, solve problem
or profit from experience. Diagnostic and Statistical Manual
10. Dementia
- A defuse brain dysfunction characterized by a
of
gradual, progressive, and chronic deterioration Mental Disorders, 5 (DSM -5)
of intellectual function. Judgment, orientation, DSM-V Includes significant changes from DSM-IV
memory, affect or emotional stability, and DSM-IV-TR. The most obvious change is the
cognition, and attention all are affected. shift from using Roman numerals to Arabic
numbers in the name (Le, DSM-5, not DSM-V).
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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

 Natal male  Individual assigned

 Perhaps most notably, the DSM-5 eliminated the  Natal female male at birth
multiaxial system. Instead, the DSM-5 lists  Individual assigned
female at birth
categories of disorders along with related
disorders. Example categories in the DSM-5
include anxiety disorders, bipolar and related  The DSM-5-TR also addressed racial and cultural
disorders, depressive disorders, feeding and biases. These revisions include:
eating disorders, obsessive-compulsive and  "Race"' was replaced with "racialized" to
related disorders, and personality disorders. emphasize that race is a social construct.
 "Ethnoracial" now refers to categories such
 A few other changes that came with the DSM-5 as Hispanic, White, and African American.
included:  "Minority" and "non-White" are not used.
 Asperger syndrome was eliminated as a  "Caucasian" is not used because it is based
diagnosis and, instead, incorporated under the on erroneous views about the geographic
category of autism spectrum disorder. origin of people who are Caucasian.
 Disruptive mood dysregulation disorder  Latinx is used instead of Latino/Latina for
was added, in part to decrease the over- gender inclusivity.
diagnosis of childhood bipolar disorders.
 The DSM-5-TR also notes how symptoms of
 Several diagnoses were officially added to the certain conditions manifest differently in people
manual, including binge eating disorder, from varying demographic groups.
hoarding disorder, and premenstrual
dysphoric disorder (PMDD).

 The DSM-5 eliminated the multiaxial system.

Some disorders were eliminated or changed, while
several new conditions were added. HISTORY AND TRENDS IN
Diagnostic and Statistical PSYCHIATRIC NURSING
 Mental illness began in the primitive age as human
Manual of Mental Disorders, existence began: there is evidence that it existed
5TH Edition, Text Revision at the time and attempts were made to treat it. It
(DSM -5 - TR) was thought to be caused by evil spirits entering
and take over the body.
 People attempted to drive these evil spirits from
Changes in the DSM-5-TR the body through the use of incantations and
 DSM-5-TR contains revised criteria for more than magic. Some primitive tribes rejected their
70 disorders, including prolonged grief disorder. mentally ill and drove them from the community.
There are new codes added to the DSM-5-TR that
allow clinicians to document suicidal behavior  In the ancient civilization, Greeks, Romans and
and nonsuicidal self-injury in patients without any Arabs viewed mental deviations as natural
other psychiatric diagnosis. phenomena and treated the mentally ill humanely.
Care consisted of sedation with opium, music,
 The DSM-5-TR uses more specific language to good physical hygiene, nutrition and activity.
avoid reader confusion. For example:  The Greek philosopher Plato (429-348 BC) and
 Criterion A in autism spectrum disorder was the Greek physician Hippocrates (460-377 BC,
changed from "as manifested by the known as the BC, father of medicine), were
following" to "as manifested by all of the concerned about the treatment of the mentally ill.
following” to indicate that all symptoms must Hippocrates described a variety of personalities
be present for this diagnosis. and attempted to classify people according to their
 "Social phobia," which appeared next to behavior
social anxiety disorder, was removed.
 "Intellectual disability" was revised to  In the middle ages (500 - 1450 AD) the Roman
"intellectual development disorder." Empire fell (476 AD) the humanitarian ideas
 Terms surrounding gender dysphoria were concerning the mentally ill were forgotten. People
changed significantly. reverted to mysticism, witchcraft and magic.
Sometimes, patients were humanely cared for by
Used in DSM-5 Used in DSM-5-TR members of religious orders. However, the
 Desired gender  Experienced gender mentally ill were usually locked away in places
 Cross-sex medical  Gender affirming
procedure medical procedure
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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

where flogging, starvation, torture and bloodletting approach in the treatment of mental illness. He is
were common. considered by many to be the father of American
psychiatry.
 During the renaissance (14th. 17th Century), the
belief that mental illness was caused by evil spirit  In 19th Century one of the best known
possessing the body continued to be a menace to reformers was Dorothea Lynde Dix, who
proper care mentally ill people were often put in contributed much to the establishment of American
prison or society protected itself by locking the hospitals for the care of the mentally ill. She
mentally ill in asylums where nonprofessional traveled throughout the country in an effort to have
people were paid to care for them. legislation enacted for improved care for mental
patients. As a result of her efforts, many hospitals
 Mental illness was considered irreversible. The were built in United States, Canada and in other
mentally ill were beaten for disobedience and countries.
confined to cages or closets. Generally, mental
patients were viewed as incompetent, defective,  The first psychiatric training school in United
and potentially dangerous. They had no rights and States was established in 1882 at McLean
were left in social isolation to communicate Hospital in Belmont, Massachusetts. Participation
primarily with other mentally ill patients. Their in psychiatric nursing course becomes a
caretakers were untrained and often punitive. As a requirement for a nursing license in the USA in
result, the mentally ill tended to become more ill 1955. In the 20 Century an Austrian neurologist,
and less able to function. Sigmund Freud made a significant contribution to
the understanding and treatment of mental illness.
 Bethlehem Royal Hospital, the firstmental His belief in the power of unconscious memories
hospital in England, was opened during the 17th and repressed emotions led him to develop the
Century. In this hospital, the public was allowed to theory and practice of psychoanalysis
wander through the hospital and see the patients,
and nurses lacked any interest in improving the  Sigmund Freud and others studied mental
care of mentally ill. disorders scientifically by the 1900s. Because of
his work, he is called the founder of
 Franz Mesmer (1733-1815), an Austrian psychoanalysis.
physician, was interested in a therapeutic
approach to behavior. He believed that the  He studied the dreams, memories, and fantasies
universe was filled with magnetic forces. of his patients in search for unconscious impulses
and conflicts. He identified three major divisions of
 Mesmer professed that the mentally ill could be the self or mind: the Id, superego, and ego. He
cured by having them hold rods filled with iron also presented a theory of psychosexual
filings in water. Although Mesmer's techniques personality development.
were later revealed as false, his idea of suggestive
power has carried over to some modern  Psychotropic drugs first available in 1950
psychiatric techniques.
 Deinstitutionalization began with the Community
 The term mesmerized is from Mesmer; to be Mental Health Centers Act of 1963
mesmerized is to be placed in a hypnotic trance.
Mental Illness in the 21st Century
 A French physician Philip Pineal (1745 - 1826),  56 million Americans have a mental illness
began the movement toward more human (DHHS, 2002)
treatment of the mentally ill when he removed the  Hospital stays shorter, but more numerous:
chains from twelve male patients at Bicker Hospital revolving door
near Paris in 1792. Pineal disavowed punitive  Increased aggression among mentally ill clients
treatment of mental patients. He recognized the  An increased number of people with mental
need for medical care and advocated freedom, illness are incarcerated
useful work, and kindness for patients.  Homeless population of persons with mental
illness, including substance abuse, is growing
 The first hospital in America to admit mental  Most health care dollars still spent on inpatient
patients was the Pennsylvania Hospital located psychiatric care; community services not
in Philadelphia. adequately funded

 The first American textbook on psychiatry was Psychiatric Nursing Practice

written, during this period by Benjamin Rush
 Psychiatric nursing practice emerged in 1873
(1745-1813) a physician who used a humanistic
when Linda Richards said, "The mentally sick
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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

should be at least as well cared for as the Eriksson, certain developmental tasks must be
physically sick" accomplished during each of stages of the life
 1882 was first formal training of nurses in mental cycle (infancy, childhood, adolescence, adulthood,
health old age). Each step is necessary for self-
 First psychiatric textbook in 1920 development.
 This is a relatively new field in comparison with  An individual personality continues to develop
other areas throughout the life cycle.
 Standards of Psychiatric-Mental Health Clinical  In personality development environment, heredity,
and nurturing play an important role. Joey Luft and
Known to Self Not Known to
Harry Ingham developed the Jo-Hari window
Self
Known to The public self The blind self
others (1) (2)
Not known to The private self The unknown Jo-Hari Window of Self
others (3) self (4)
Nursing Practice developed in 1973, revised in 1. The public self
1982, 1994, 2000 - The first pane indicates knowledge about
 Psychiatric Mental Health Nursing Phenomena of oneself that the person knows and others
Concern: 12 areas of concern that mental health know about him or her.
nurses focus on when caring for clients 2. The blind self
- The second pane indicates knowledge about
one self that the person does not know about
History of Psychiatric him or her self and other people know.
The history of psychiatric nursing in the Philippines has 3. The private self
been influenced by a variety of factors, including - In pane three there are all manner of things
religious beliefs, colonial rule, and the development of that a person knows about him or her self but
psychiatric hospitals: does not choose to share to others.
4. The unknown area
 Pre-Spanish - The last pane represents information about
- Traditional healing practices incorporated oneself that neither the person nor anyone
spiritual beliefs. Mental illness was attributed else knows.
to natural and supernatural phenomena.
 Spanish rule Communication
- Mental illness was viewed as caused by
 Communication is a mutual interaction or
sorcery.
reciprocal action that can occur between or among
 American era
people. ( Shives 1990.)
- A biomedical approach was introduced, and
psychiatric hospitals were established.
 Communication is the giving and receiving of
 Mid-20th century
information. The sender prepares or creates a
- Somatic therapies like ECT became
message when need occurs and sends the
prominent.
message to a receiver or listener, through a proper
 1949
channel: face to face or through electronic or other
- The Philippine Mental Health Association
media. The receiver may then return a message or
(PMHA) was founded to promote mental
feed back to the initiator (sender) of the message.
health activities.
 1951
 Communication is a learned process influenced by
- The PMHA endorsed the first National Mental
attitudes, socio cultural or ethnic background, past
Health Week, which became an annual
experience, knowledge of the subject matter and
celebration.
the ability to relate to others.

Therapeutic Communication
 Therapeutic communication is defined as a special
form communication that has a health-related
GENERAL NURSING purpose and develops as a continuous flow of
TECHNIQUES USED IN interaction between nurse and patient, with input
from both contributing to it is nature and
PSYCHIATRIC NURSING progression. Non-verbal communication is
sometimes considered a more accurate
description of true feelings because one has less
Understanding 'self' control over non-verbal reactions.
 Self is the sum of the attitudes that make up the
personality. According to the psychologist Erik
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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

 Non-verbal communication includes:

- Position or posture
- Facial expressions
- Vocal cues and
- Physical appearance
- Distance or spatial territory
- Touch
- Gesture

Models of Communication
(Elements of communication)
There are four models of communication according to
David and these are:
1. Source (a person who is responsible to
create the message)
2. Message (the idea which is transmitted from
the source to the receiver)
3. Channel (it is a means by which a message
can be transmitted from a source to the
receiver)
4. Receiver (a person who is receiving the
message from the source)

Self-acceptance
 Self-acceptance is a regard for oneself with a
realistic concept of one's strengths and
weaknesses.
Behaviors of the self-accepting person including the
following:
- persevering
- minimizing weaknesses
- increasing strengths seeing reality
- trusting and accepting others

Therapeutic Communication
Techniques

- continuing growth toward self-actualization

- recognizing and accepting one's own behavior
- reaching out to others
- learning from mistakes

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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

Therapeutic Example Rationale

Communication
Accepting ─ indicating "Yes." An accepting response indicates the nurse has
reception "I follow what you said." heard and followed the train of thought. It does
Nodding not indicate agreement but is nonjudgmental.
Facial expression, tone of voice, and so forth
also must convey acceptance or the words lose
their meaning.
Broad openings ─ allowing "Is there something you'd like Broad openings make explicit that the client has
the client to take the initiative in to talk about?” the lead in the interaction. For the client who is
introducing the topic "Where would you like to hesitant about talking, broad openings may
begin?” stimulate him or her to take the initiative
Consensual validation ─ "Tell me whether my For verbal communication to be meaningful, it is
searching for mutual understanding of it agrees essential that the words being used have the
understanding, for accord in the with yours”. same meaning for both (all) participants.
meaning of the words “Are you using this word to Sometimes, words, phrases, or slang terms have
convey that….?” different meanings and can be easily
misunderstood.
Encouraging comparison ─ "Was it something like...?" Comparing ideas, experiences, or relationships
Asking that similarities and “Have you had similar brings out many recurring themes. The client
differences be noted experiences?” benefits from making these comparisons
because he or she might recall past coping
strategies that were effective or remember that
he or she has survived a similar situation
Encouraging description of "tell me when you feel To understand the client, the nurse must see
perceptions ─ Asking the client Anxious” things from his or her perspective. Encouraging
to verbalize what he or she "What is happening?" the client to describe ideas fully may relieve the
perceives “What does the voice seem tension the client is feeling, and he or she might
to be saying?” be less likely to take action on ideas that are
harmful or frightening.
Encouraging expression ─ “What are your feelings in The nurse asks the client to consider people and
asking the client to appraise the regard to...?" events in light of his or her own values. Doing so
quality of his or her experiences “Does this contribute to your encourages the client to make his or her own
distress?” appraisal rather than to accept the opinion of
others
Exploring ─ delving further "Tell me more about that." When clients deal with topics superficially,
into a subject or an idea “Would you describe it more exploring can help them examine the issue more
fully?" fully. Any problem or concern can be better
"What kind of work?" understood if explored in depth. if the client
expresses an unwillingness to explore a subject,
however, the nurse must respect his or her
wishes.
Focusing ─ concentrating on a “This point seems worth The nurse encourages the client to concentrate
single point looking at more closely.” his or her energies on a single point, which may
“Of all the concerns you've prevent a multitude of factors or problems from
mentioned, which is most overwhelming the client, it is also a useful
troublesome?” technique when a client jumps from one topic to
another.

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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO
Therapeutic
Therapeutic Example
Example Rationale
Communication
Communication
Formulating a plan of “What
Client:
could
"I'm
you
really
do to
mad,
let your
I'm ItThis
mayencourages
be helpful for thetheclient
client
to continue
to plan inoradvance
if the
Action ─ asking the client anger
really
out harmlessly?” what
clienthe has orbeen
she might
misunderstood,
do in futurehesimilar
or shesituations.
can
to consider kinds of “Next
upset."
time this comes up, what Making
clarify his definite
or herplans
thoughts.
increases the likelihood that
behavior likely to be might
Nurse:
you do
“You're
to handle
reallyit?”
mad the client will cope more effectively in a similar
appropriate in future and upset.” situation.
situationsinformation ─
Seeking "I'm not sure that I follow." The nurse should seek clarification throughout
Generalto
seeking leads
makegiving
clear that
─ "Go"Have
on." I heard you correctly?" General
interactionsleadswith
indicate that Doing
clients. the nurse
so iscanlistening
help theand
encouragement
which is not meaningful
to continue
or that"And then?" following
nurse to what avoidthe client isassumptions
making saying withoutthat taking away
which is vague "Tell me about it." the initiative for the
understanding hasinteraction.
occurredThey whenalso encourage
it has not. It the
client
helpstothe continue
client iftohe or she is thoughts,
articulate hesitant or feelings,
uncomfortable
and
about the topic.
ideas more clearly
Giving information ─ "My name is……” Informing the client of facts increases his or her
Silence ─ absence of verbal Nurse says nothing but Silence often
knowledge aboutencourages
a topic or letsthethe
client
clienttoknow
verbalize,
what to
making available the facts "Visiting hours are…..”
communication, which continues to maintain eye provided that it is interested and expectant.
expect. The nurse is functioning as a resource person. Silence
that the client needs “My purpose in being here
provides time for the client to contact and conveys interest. gives the
Giving client time
information alsoto organize
builds thoughts,
trust with direct the
the client.
Is…...”
put thoughts or feelings Into topic of interaction, or focus on issues that are most
Giving recognition ─ "Good morning, Mr. S...” Greeting the client by name, indicating awareness of
words, to regain com-posure, important. Much nonverbal behavior takes place
acknowledging, indicating “You've finished your list of change, or noting efforts the client has made all show
or to continue talking during
that the silence, and the the
nurse recognizes nurse needs
client to be aware
as a person, as an of
awareness things to do." the client Suchand his or her own
"I notice that you've combed individual. recognition doesnonverbal
not carry the behavior.
notion of
Suggesting collaboration ─ your"Perhaps value, that is, of being "good"a or "bad."
hair." you and I can The nurse seeks to offer relationship in which the
offering to share, to
Making observations ─ strive, and "You appearand
discuss discover the
tense." client can identify
Sometimes clientsproblems in living or
cannot verbalize with others,
make
to work with the client for
verbalizing what the nurse his or triggers for your
"Are you uncomfortable anxiety.” grow emo-tionally, and improve the ability
themselves understood. Or the client may not to form
be
her benefit
perceives "Let's
when...？” go to your room, and satisfactory re-lationships.
ready to talk. The nurse offers to do
"I notice that you're bitingyou're
I'll help you find what your things with, rather than for, the client.
lip."looking for.”
Summarizing
Offering self ──making
organizing "I'll "Have
sit withI you
got this straight?"
awhile." Summarization
The nurse can offerseeks histoorbring out the important
her presence, interest,
and summing up
oneself available that which “ You've said that.
“I'll stay here with you." points of the discussion and to
and desire to understand. It is important increase the that this
has gone before "I'm"During the in
interested past hour,
what youyou awareness
offer and understanding
is unconditional; that is, the of client
both participants.
does not
and
think." t have discussed....” It omits the irrelevant and organizes
have to respond verbally to get the nurse's the pertinent
aspects of the inter-action. It allows both client and
attention.
nurse to depart with the same ideas and provides a
Placing event in time or “What seemed to lead up to...?” Putting events in proper sequence helps both the
sense of closure at the completion of each
sequence ─ clarifying the “Was this before or after...?” nurse and the client to see them in perspective.
discussion.
relationship of events in “When did this happen?" The client may gain insight into cause-and-effect
Translating
time into feelings Client: "I'm dead" Often what
behavior theconsequences,
and client says, when or thetaken literally,
client may be
─ seeking to verbalize Nurse: "Are you suggesting that able to see that perhaps some things are reality.
seems meaningless or far removed from not To
client's feelings that he or you feel lifeless?" under-stand,
related. the nurse must concentrate on what
she expresses only Client: "I'm way out in the ocean.” the client
When might be
it is obvious feeling
that to express
the client himself or
is misinterpreting
Presenting reality ─ "I see no one else in the room.”
indirectly Nurse: "You seem to feel lonely or herself this way.
reality, the nurse can indicate what is real. The nurse
offering for consideration "That sound was a car
deserted.” does this by calmly and quietly expressing his or her
that which is real backfiring."
Verbalizing the Implied ─ "YourClient:
mother "I can't talk
is not to you
here, I amor a Putting intoorwords
perceptions what
the facts, notthe
by client
way ofhas implied
arguing with or
the
voicing what the client has anyone.
nurse.” It's a waste of time.” said indirectly
client or belittlingtends
his orto make
her the discussion
experience. The intentless
is to
hinted at or suggested Nurse: "Do you feel that no indicate
obscure. anThe
alternative line of thought
nurse should for the as
be as direct client to
possible
one consider,
without being un-feelingly blunt or obtuse. Theis
not to -convince the client that he or she
understands?" wrong.
client may have difficulty communicating directly.
Reflecting ─ directing Client: “Do you think I should Reflection
The nurse encourages
should take thecareclient to recognize
to express andis
only what
client actions, thoughts, tell the doctor.” accept his or her
fairly obvious; own feelings.
otherwise, The may
the nurse nursebeindicates
jumping
and feelings back to client Nurse: "Do you think you that the Client'sorpoint
to conclusions of view has
interpreting value and that the
the client's
should?” client has the
communication right to have opinions, make
Voicing doubt ─ expressing Client: "Isn't“My
thatbrother spends all
unusual?" decisions, and think independently
Another means of responding to distortions of
my money
uncertainty about the reality of "Really?" and then has nerve reality is to express doubt Such expression permits
the client's perceptions to ask for more.”
“That's hard to believe.” the client to become aware that others do not
Nurse: “This causes you to feel necessarily perceive events in the same way or
angry?” draw the same conclusions. This does not mean
Restating ─ repeating the Client: The nursewill
the client repeats what
alter his or the
her client
point has saidbut
of view, in at
main idea expressed “I can't sleep. I stay awake all approximately
least the nurseorwill
nearly the same
encourage the words the client
client to
night. “ has used. This
reconsider restatement
or reevaluate letshas
what thehappened.
client knowThe that
Nurse: "You have difficulty he or she communicated the idea effectively.
nurse neither agreed nor disagreed; however, he or
sleeping.” she has not let the misperceptions and distortions
pass without comment

8
PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

4. Psychological barriers to listening such as day

dreaming, detouring, debating, private
planning.
Reasons for Ineffective communication
1. Barriers caused by reception, need, attitude, Non- Therapeutic Communication
environmental stimuli etc.
2. Barriers caused by a lack of understanding Techniques
language, knowledge etc.
3. Barriers caused acceptance, prejudices,
emotional conflict etc.

Therapeutic Example Rationale

Communication
Indicating the existence of "What makes you say that?" The nurse can ask, "What happened?" or
an external source ─ "What made you do that?" "What events led you to draw such a
attributing the source of "Who told you that you were a conclusion?" But to question, "What made you
thoughts, feelings, and prophet?" think that?" Implies that the client was made or
behaviors to others or to compelled to think in a certain way. Usually,
outside influences the nurse does not intend to suggest that the
source is external, but that is often what the
client thinks.
Interpreting ─ asking to make "What you really mean is... The client's thoughts and feelings are his or
conscious that which is "Unconsciously you're saying…. her own, not to be interpreted by the nurse for
unconscious; telling the client hidden meaning. Only the client can identify or
the meaning of his or her confirm the presence of feelings.
experience
Introducing an unrelated Client. "I'd like to die " The nurse takes the initiative for the
topic ─ changing the subject Nurse: "Did you have visitors interaction away from the client. This usually
last evening?" happens because the nurse is un-comfortable,
doesn't know how to respond, or has a topic
he or she would rather discuss.
Making stereotyped "It's for your own good." Social conversation contains many dichés and
comments ─ offering "Keep your chin up. " much meaningless chitchat. Such comments
meaningless clichés or trite "Just have a positive attitude are of no value in the nurse client relationship.
comments and you'll be better in no Any automatic responses lack the nurse's
consideration or thoughtfulness
Probing ─ persistent "Now tell me about this problem. Probing tends to make the client feel used or
questioning of the client You know I have to find out.” invaded. Clients have the right not to talk
"Tell me your psychiatric about issues or concerns if they choose.
history." Pushing and probing by the nurse will not
encourage the client to talk.
Reassuring ─ indicating there “I wouldn't worry about that." Attempts to dispel the client's anxiety by
is no reason for anxiety or "Everything will be all right." implying that there is not sufficient reason for
other feelings of discomfort "You're coming along just fine” concern completely devalue the client's
feelings. Vague reassurances without
accompanying facts are meaningless to the
client.
Rejecting ─ refusing to "Let's not discuss... When the nurse rejects any topic, he or she
consider or showing contempt "I don't want to hear about…” closes it off from exploration. In turn, the client
for the client's ideas or may feel personally rejected along with his or
behaviors her ideas.
Requesting an explanation ─ "Why do you think that?" There is a difference between asking the client
asking the client to provide "Why do you feel that way?" to describe what is occurring or has taken
reasons for thoughts, feelings, place and asking him to explain why. Usually,
behaviors, events a "why" question is intimidating. In addition,
the client is unlikely to know "why" and may
become defensive trying to explain himself or
herself.
9
PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

10
PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO
Therapeutic Example Rationale
Communication
Testing ─ appraising the "Do you know what kind of These types of questions force the client to try to
client's degree of insight hospital this is?" * recognize his or her problems. The client's
"Do you still have the idea acknowledgment that he or she doesn't know
that….?" these things may meet the nurse's needs but is not
helpful for the client.
Using denial ─ refusing to Client: "I'm nothing." The nurse denies the client's feelings or the
admit that a problem exists Nurse: "Of course you're seriousness of the situation by dismissing his or
something--everybody's her comments without attempting to discover the
something." feelings or meaning behind them.
Client: "I'm dead."
Nurse: "Don't be silly."
Advising ─ telling the client "I think you should. Giving advice implies that only the nurse knows
what to do "Why don't you….? what is best for the client.
Agreeing ─ indicating accord “That's right’” Approval indicates the client is "right~ rather than
with the client "I agree. "wrong." This gives the client the impression that
he or she is "right" because of agreement with the
nurse. Opinions and conclusions should be
exclusively the clients. When the nurse agrees
with the client, there is no opportunity for the client
to change his or her mind without being wrong."
Belittling feelings expressed Client: "I have nothing to live When the nurse tries to equate the intense and
─ misjudging the degree of the for... I wish I was dead.” overwhelming feelings the client has expressed to
client's discomfort Nurse: "Everybody gets "everybody" or to the nurse's own feelings, the
down in the dumps," or "I've nurse implies that the discomfort is temporary,
felt that way myself. mild, self-limiting, or not very important. The client
is focused on his or her own worries and feelings,
hearing the problems or feelings of others is not
helpful.
Challenging ─ demanding "But how can you be Often the nurse believes that if he or she can
proof from the client president of the United challenge the client to prove unrealistic ideas, the
States? client will realize there is no "proof" and then will
"If you're dead, why is your recognize reality. Actually, challenging causes the
heart beating?" client to defend the delusions or misperceptions
more strongly than before
Defending ─ attempting to "This hospital has a fine Defending what the client has criticized Implies
protect someone or something reputation” that he or she has no right to express impressions,
from verbal attack? "I'm sure your doctor has opinions, or feelings. Telling the client that his or
your best interests in mind.” her criticism is unjust or unfounded does not
change the client's feelings but only serves to
block further communication.
Disagreeing ─ opposing the "That's wrong." Disagreeing implies the client is "wrong."
client's ideas "I definitely disagree with.” Consequently, the
“I don't believe that." client feels defensive about his or her point of view
or ideas.
Disapproving ─ denouncing "That's bad." Disapproval implies that the nurse has the right to
the client's behavior or ideas "I'd rather you wouldn't. pass judgment on the client's thoughts or actions.
It further implies that the client is expected to
please the nurse.
Giving approval ─ "That's good." Saying what the client thinks or feels is "good"
sanctioning the client's "I'm glad that…” implies that the opposite is "bad." Approval, then,
behavior or ideas tends to limit the client's freedom to think, speak,
or act in a certain way. This can lead to the client's
acting in a particular way just to please the nurse.
Giving literal responses ─ Client: "They're looking in my Often the client is at a loss to describe his or her
responding to a figurative head with a television feelings, so such comments are the best he or she
comment as though it were a camera." can do. Usually, it is helpful for the nurse to focus
statement of fact Nurse: "Try not to watch tele on the client's feelings in response to such
vision" or "What channel?" statements.

11
PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

often triggered by work-related stress. Patient

describes difficulty sleeping due to worry and has
NURSE - PATIENT RELATIONSHIP noticed a significant decline in appetite and energy
levels.
PHASE ANXIETY TASKS
1. Pre-Interaction Phase Nurse Major task: develop self-awareness
 begins when the nurse is  includes all of what the nurse thinks and does
assigned/chooses a patient before interacting with the patient
 patient is excluded as an active  data gathering, planning for first Interaction
participant

2. Orientation phase Patient Major task: establish trust and rapport

 when the nurse- patient interacts for  conduct initial interview
the first time  establish contract with the patient
 learn about the patient and his Initial concerns
and needs
 encourage the patient to feel comfortable with
the meeting
 manage present emotions of the patient
 provide support and empathy of the patient's
feelings
3. Working / Exploitation None Major task: identification and resolution of the
"Therapeutic Phase" patients problems
 Patient uses the nurse for emotional  planning and implementation Teach, Learn
support and problem solving. Change
 it is highly individualized Problems
 more structured than the orientation  Transference the development of any
phase emotional attitude towards the nurse positive
 the longest and most productive phase or negative
 limit setting must be employed  Counter transference experienced by the
nurse / therapist
4. Termination Phase / Patient Reinforce and reward change and strength of
 Resolution Patient prepares for patient
discharge and independence.  Encourage expression of feelings about
termination of the relationship
 Summarize the progress
 Terminate the relationship without
Hildegard Peplau
 Interpersonal Relations: Peplau emphasizes the
importance of building a therapeutic relationship Phases of the Nurse-Patient
between the nurse and patient. Relationship: Peplau identifies four phases:

Psychiatric assessment techniques

2. Family and Social history
1. The history-of the present illness
Record briefly accepts of the patient's family history
2. The social and personal history of the patient
such as; Father, Mother, Siblings ,Social position
(supplementary history to be obtained from relative
Home atmosphere and influence.
if possible)
3. A physical examination
3. Record also the patient's personal history,
4. Psychiatric examination/Mental Status
including details of their experience relating to:
Examination
- Date and place of birth - School
5. Further investigations
- Early development - Adolescence
- Occupations - Marriage
1. History of present illness
- Sexual history - Social relations
Record briefly mode of referral/admission reason for
- activities / interest - Children
referral and patients’ complaints (in his own words)
- Sexual history - Medical history
and their duration.
- Mood, Character - Neurotic symptoms in childhood
Example:
4. Physical examination
Patient reports experiencing increasing feelings of
The physical examination should be comprehensive
anxiety and panic attacks over the past 6 months,
and should be carried out within a day of admission.
which began following a job change. These episodes
Special attention should be given to the central
are characterized by rapid heart rate, shortness of
nervous system. Positive and negative findings should
breath, sweating, and a sense of impending doom,
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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

be recorded and a brief summary of abnormalities in mental disorders like addiction, obsessive-compulsive
found should be given. disorder (OCD), and dep when their function is impaired;
essentially acting as a "gatekeeper" for select initiating
5. Psychiatric examination (mental status actions based on cognitive and emotional in Integrates
the emotion into motor body movements
examination)
Record the following aspects of the psychiatric
patient's state General behavior, appearance, word
behavior since admission attitude towards hospital  The prefrontal cortex (PFC) is a part of the brain that
staff etc. regulates thought, emotion, and behavior. It's involved in
- Talk (form of talk), much or little, spontaneous, many complex mental health functions, including
answers to questions etc. decision-making, impulse control, and social behavior
- Mood
 The anterior cingulate gyrus (ACG) is part of the brain that's invo
- Form of thought; Does the patient experience
blocking pressure or poverty in thinking?
- Content of thought
- Insights and Judgement
- Delusions and misinterpretations
- Hallucinations
- Obsessional phenomena

Neurobiologic &
Psychosocial Theories emotions, behavior, and attention. It's also involved in
Therapy decision-making, impulse control, and anticipating
rewards. The ACG is located on the medial surface of
the frontal lobes of the brain
 The Limbic System (LS) is a group of structures in your
brain that regulate your emotions, behavior, motivation
 The temporal lobe is a part of the brain that processes
and memory. While small in size, your limbic system has
sounds, memories, and other information. It's located
a big job to help you interact with the world around you.
behind the ears, near the temples.
Center of emotion specially love happines
FXNS:
 Auditory processing: Receives information from
the ears and processes it so you can understand
what you hear
 Memory: Stores and retrieves memories, including
episodic memory, which is the memory of specific
events
 Language: Helps you understand spoken and
written language
 Emotions: Helps you manage your emotions,
including regulating your mood and interpersonal
interactions
 Visual perception: Helps you understand and
store some aspects of what you see

Damage to the temporal lobe

 The Basal Ganglia (BG), a group of brain structures can cause:
deep within the ce play a crucial role in mental health by  Difficulty understanding speech
regulating functions like motivation, processing, habit  Difficulty learning and retaining new information
formation, and emotional control, which can be disrupted  Difficulty recognizing faces
 Emotional disturbance
 Changes in appetite
 Difficulty planning or coordinating actions
 Difficulty navigating

What are Neurotransmitters?

 Neurotransmitters are chemical messengers that
transmit signals between neurons (nerve cells) in the
brain and nervous system. They play a crucial role in
regulating various physiological and psychological
processes, including mood, appetite, sleep, and
cognitive function.
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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

Neurotransmitters Involved in Mental Psychoanalytic Theories

Health: Pioneered by Sigmund Freud (1856-
1. Serotonin (5-HT): Regulates mood, appetite, and sleep.
Imbalances linked to depression, anxiety, and insomnia.
1939)
in Vienna
2. Dopamine: Involved in reward processing, motivation, • All human behavior is caused and can be explained
and pleasure. Imbalances linked to addiction, • Personality components conceptualized as id, ego, and
schizophrenia, and attention deficit hyperactivity superego
disorder (ADHD). • Behavior motivated by subconscious thoughts and
3. Norepinephrine (NE): Regulates attention, arousal, and feelings; treatment involving analysis of dreams and free
stress response. Imbalances linked to depression, association
anxiety, and post-traumatic stress disorder (PTSD). • Ego defense mechanisms
• Psychosexual stages of development
4. GABA (Gamma-Aminobutyric Acid: Inhibitory
neurotransmitter that regulates calmness and relaxation. • Transference and countertransference
Imbalances linked to anxiety, insomnia, and seizures.
Three main components of Personality
5. Glutamate: Excitatory neurotransmitter involved in 1. ID (Instinctual Needs)
learning and memory. Excessive levels link to - The ID is the primitive, instinctual part of our personality,
excitotoxicity, which can contribute to neurodegenerative present from birth. It seeks immediate gratification of
disorder. basic needs like food, water, and shelter. The ID
operates on the "pleasure principle," avoiding pain and
Implications for Mental Health: seeking pleasure.
1. Mood Disorders: Imbalances in serotonin, dopamine,
2. Ego (Reason and Logic)
and norepinephrine contribute to depression, bipolar
- The Ego develops as we grow and interact with the
disorder, and anxiety disorders.
environment. It's the rational, logical part of our
2. Anxiety Disorders: GABA and serotonin imbalances
personality, responsible for problem-solving and
can contribute to anxiety disorders, such as generalized
decision-making. The Ego operates on the "reality
anxiety disorder and panic disorder.
principle," balancing the demands of the ID with the
3. Psychotic Disorders: Dopamine imbalances are
demands of reality.
implicated in schizophrenia and other psychotic
disorders.
3. Superego (Moral Component)
4. Addiction: Dopamine and serotonin imbalances
- The Superego emerges during childhood, as we
contribute to addiction and substance use disorders.
internalize societal norms, values, and moral principles.
It's the moral component of our personality, guiding our
Nursing Implications: behavior and influencing our sense of right and wrong.
1. Medication Management: Understand the mechanisms
of action and potential side potential side effects of
medications that target neurotransmitter systems. ID SUPEREGO
“I want to do “It’s not right
2. Assessment and Monitoring: Assess patients' mental that now!” to do that”
health symptoms and monitor for changes in
neurotransmitter-related symptoms.
3. Therapeutic Interventions: Implement evidence-based EGO
therapies, such as cognitive-behavioral therapy (CT), “maybe we can
compromise”
that target neurotransmitter systems.
4. Patient Education: Educate patients about the role of
neurotransmitters in mental health and the importance of
adherence to treatment plans.
Ego Defense Mechanisms
Defense
Description Example
Mechanism
Compensation An attempt to overcome a real or imagined A blind woman becomes proficient in playing
short coming, inferiority, inabilities and piano.
weaknesses
Conversion Emotional problems are converted to physical A student unprepared for a report suffered
symptoms headache the day she is supposed to deliver
her report
Denial Failure to acknowledge an intolerable thought, After being admitted to the CCU because of an
feeling, experience or reality AMI, a middle-aged man insists that he is in the
hospital for just a diagnostic work-up
Fantasy Conscious distortion of unconscious feelings A boy who is being bullied by his friends
or wishes wished he had the power of Wolverine
Fixation An unhealthy mechanism which is an arrest of when someone acts out behaviors from an
maturation at certain stages of development earlier stage of development. This can include
crying, sulking, or throwing a tantrum.
Introjection Involves internalizing the ideas or beliefs of Internalizing a parent's values: A child may 14
others. It can be an unconscious process that internalize a parent's values, such as the idea
helps people deal with difficult situations or that "boys don't cry"
feelings.
PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

 These are automatic and usually unconscious  Possible problems:

processes or act by the individuals to: reduce or cope  Compulsive need to be clean and orderly
anxiety or fear o resolve emotional or mental conflict o  Frugality and stinginess
protect one's self-esteem or protect one's sense of  Greed
security  Insistence on doing things at one's own rate at the
 Becomes pathologic when overused expense of others
 Used by both mentally healthy and mentally-ill  Rigid training
individuals  Excessive messiness and disorderly habits

Defense
Description Example
Mechanism
Identification An individual integrates certain aspects of A young school teacher adopts his former
someone else's personality into one's own mentor's teaching style when conducting class
sessions
Repression Unknowingly placing an unpleasant memory or Not remembering a traumatic event such as
thought in the unconscious being sexually abused as a child
Regression Reverting back to an immature behavior from Throwing temper tantrums as an adult when
an earlier stage of development you don't get your way
Displacement Redirecting feelings or actions from the Taking your anger towards your boss out on
intended source to a safer substitute target family members by yelling at them in place of
your boss
Sublimation Replacing socially unacceptable impulses with Channeling aggressiveness into plaving
socially acceptable behavior football
Reaction Formation Overacting in the opposite way to one's true Being overly protective of an unwanted child
feelings
Projection Attributing one's own unacceptable feelings Accusing your boy/girlfriend of cheating on you
and thoughts to others and not yourself because you have thought about cheating on
him/her
Rationalization Justifying actions, thoughts or unwanted Blaming the teaching style of a professor for
outcomes with excuses or faulty logic why you failed
Suppression Permits the individual to store away or A boy walked out from the group and said "I
consciously forget the unpleasant, painful and have to go now", when he was asked what
unacceptable thoughts, desires, experiences happened to their relationship with his
and impulses. "I’ll think it about tomorrow", "I'd girlfriend.
rather go now", "Can we change the topic?"
Substitution Replacing the desired unattainable goal with After failing the board exam 3 times, a woman
one that is attainable worked as a nursing aide just to be in the
hospital.
Symbolization A less threatening object is used to represent Missing her husband, a woman finds comfort in
another hugging her son who looks like his father.
Undoing An attempt to erase an act, thought, feeling, A man gives his wife a bunch of roses after
guilt or desire their argument last night

Nursing Implication:
Psychosexual stages of  Help children achieve bowel and bladder control
without undue emphasis on its importance.
development
1. Oral Stage (0-2 years)
 The area of gratification is the mouth 3. Phallic Stage (4-6 years)
 Pleasures: sucking activities like fingers, toes or nipples  Pleasure: genital region activities associated with
 Dissatisfaction: resurface at a later age overeating, stroking and manipulating their sex organs
smoking, nail-biting  Oedipus complex - During the phallic stage boys
develop the Oedipus complex in which the father is seen
Nursing Implication: as a rival for mother's affection
 Provide oral stimulation by giving pacifiers  Electra complex - a psychological theory that describes
 Breastfeeding may provide more stimulation a girl's sexual and emotional attachment to her father
 Do not discourage thumb sucking and hostility toward her mother.

2. Anal Stage (2-4 years) Concept:

 Children's attention is focused on the anal region. o Onset of "normal homosexuality"
 Pleasure: elimination Nursing implications:
 Covers the ideal age for "toilet training" (2 1/2 years)  Accept child's sexual interest

15
PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

 Help the parents answer child's questions about  Unresolved feelings towards a significant other: A
birth or sexual differences patient, who has unresolved feelings towards a past
romantic partner, redirects those feelings towards
4. Latency Stage (6 to 12 years) - their therapist, becoming overly attached or
Period of calmness / stable period. dependent.
 A client may displace feelings, attitudes, and
 Many of the disturbing behaviors are buried in the
behaviors onto the theranist
subconscious mind
 Countertransference is when a nurse reacts to those
 Their energies are absorbed by the concerns in school,
feelings.
peers, sports and other recreational activities
 Nurse's past experience with a similar patient: A
Nursing Implication:
Nurse, who had a difficult experience with a
 Help the child have positive experiences
previous patient, becomes overly cautious or
guarded when working with a similar patient,
5. Genital Stage (12 years & up) influencing their treatment approach.
 Oedipal feelings are reactivated toward opposite sex
 The person is on his/her way in establishing a satisfying  Nurse's personal values or biases: A therapist, who
life of his/her own has strong personal values or biases, becomes
Nursing Implication: Provide appropriate opportunities for overly invested in a patient's outcome, influencing
the child to relate with opposite sex & Allow child to verbalize their objectivity and treatment decisions.
feelings about new relationships
Transference vs. Countertransference Developmental Theories
 Transference is when a client projects their feelings
 Erik Erikson (1902-1994) - Described eight stages of
onto a nurse
psychosocial development

Primary Positive
Period of Life Negative Resolution
Person Resolution
1. Infant (0-18 months) Maternal person • Reliance on the caregiver • Fear, anxiety and suspicion
(Hope) • Development of trust in the • Lack of care, both physical &
Trust vs. Mistrust environment psychological by caretaker
leads to mistrust of environment
2. Toddler (18 mos. to 3 years) Paternal person  Sense of self-worth or • Loss of self-esteem
(Willpower) Assertion of choice and will • Sense of external control may
Autonomy vs. Shame/Doubt  Environment encourages produce self-doubt in others
independence, leading to • E.g. when a young child is
sense of pride constantly criticized for trying to
perform a basic task, like
dressing themselves or using
the potty, leading them to feel
embarrassed about their
attempts and doubt their ability
to do it independently,
potentially making them
hesitant to try new things in the
future
3. Preschool (3 to 6 years) Family  The ability to learn to initiate • The inability to control newly
(Purpose) activities, to enjoy developed power
Initiative vs. Guilt achievement and  Realization of potential failure
competence leads to fear of punishment and
guilt
4. Schooler (6 to 12 yrs.) Neighbors/ School • Learning the value of work  Repeated frustrations and
(Competence) • Acquiring skills and tools of failures lead to feelings of
Industry vs. Inferiority technology inadequacy and inferiority that
• Competence helps to order may affect their view of life
life and make things work • A feeling of being inadequate or
less than others
5. Adolescent (12 to 18 yrs) Peer group • Experiments with various  Pressures and demands may
(Fidelity) roles in developing mature lead to confusion about self
Identity vs. Role confusion individuality  Failing to commit to an identity,
• Adolescents ask questions like • Committing to an identity which can lead to a weak sense
"Who am that's validated by society of self
I?" and "What do I want to do
with my life?

6. Young Adult (18 to 24 yrs.) Partners in • A commitment to others • Withdrawal from such intimacy,
(Love) friendship • Close heterosexual isolation, self-absorption and
Intimacy vs. Isolation relationship and procreation alienation from others 16
• People explore relationships
and form attachments outside of
their family
PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

 Childhood is very important in personality

development. Three developmental cognitive modes:
 Rejected Freud's attempt to describe personality
solely on the basis of sexuality believed that social prototaxic, parataxic, syntaxic
factors greatly affect felt that personality continued  Prototaxic:
to develop beyond five years of age.  This is the most basic level, where experiences are
purely sensory and cannot be readily put into words
or communicated to others. Think of a newborn
baby's initial sensations without any understanding
Primary Positive Negative
Period of Life
Person Resolution Resolution
Middle Adult (24 to 54 yrs.) Partner • The care and concern for  Self-indulgence and
(Care) the next generation resulting psychological
Generativity vs Stagnation or • Widening interest in work and ideas
Self-absorption impoverishment
- The ability to care for and
contribute to younger and
older generations
Late Adult (54 yrs. to death) Mankind Acceptance of one's life • Disappointment of one's life
(Wisdom)  Realization of the and desperate fear of death
Integrity vs. Despair inevitability of death  A feeling of regret and
 Feeling of dignity and disappointment from reflecting
meaning of existence on one's life
 A sense of fulfillment and
wisdom from reflecting on
one's life

of their meaning.
 Parataxic:
 This mode involves making personal, often illogical
Jean Piaget (1896-1980) connections between experiences based on limited
understanding, leading to biased interpretations and
 Described cognitive and intellectual development in sometimes superstitious thinking. For example,
children in four stages: sensorimotor, preoperational, associating a specific event with bad luck due to a
concrete operations, formal operations coincidental timing.
 Syntaxic:
 This is the most developed cognitive mode, where
experiences can be accurately symbolized, labeled,
and communicated meaningfully with others using
shared language and logic.

Humanistic Theories
 Abraham Maslow (1921-1970)
 Hierarchy of needs: basic physiologic needs, and
safety and security needs, love and belonging
needs, esteem needs, self-actualization
 Carl Rogers (1902-1987)
 Client-centered therapy
 Concepts of unconditional positive regard,
genuineness, and empathetic understanding
 also known as person-centered therapy or Rogerian
therapy. It's a non-directive form of therapy that
encourages clients to make their own choices and
change their lives.
Interpersonal Theories
Harry Stack Sullivan (1892-1949)
 Established five life stages of personality development
that included the significanee of interpersonal
relationships
 Described three developmental cognitive modes:
prototaxic, parataxic, syntaxic
 Believed that unsatisfying relationships were the basis
for all emotional problems
 Described the concept of therapeutic milieu or
community

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BY: F.R. CUSTODIO

 involves a therapist or leader and a group of clients

sharing a common purpose; members contribute to the
group and expect to benefit from it.
 Minimum number : 3
 Ideal number :8-10
 Stages of group development
 Pre-group stage
 Initial/Forming stage
 Orientation
 Working stage
 Termination stage/ Consolidation
 Transition

Behavioral Theories
 Ivan Pavlov (1849-1936) -It's also known as Pavlovian
conditioning.
Classical conditioning theory
 B. F. Skinner (1904-1990) - operant conditioning theory
 Behaviorism focuses on behaviors and behavior
changes rather than on explaining how the mind
works
 All behavior is learned -learned and retained by
positive reinforcement (reward or praise)
 Behavior has consequences (reward or
punishment) 1. Remotivation Therapy: Promotes expression of feeling
 Rewarded behavior tends to recur through interaction facilitated by discussion of neutral
 Positive reinforcement increases the frequency of topics
behavior - Remotivation therapy activities include asking questions,
 Removal of negative reinforcers increases the sharing experiences, and using visual aids. The goal is
frequency of behavior to help clients feel safe and acknowledged, and to
 Continuous reinforcement is the fastest way to stimulate interest in life.
increase behavior; random intermittent
reinforcement increases behavior more slowly but 2. Family therapy: A method in which family members
with longer-lasting effect gain:
 Treatment modalities based on behaviorism  insight into the problems o improve communication
include behavior modification, token economy, and  improve functioning of individual members as well
systematic desensitization as the family as a whole.
 It focuses on the total family as an interactional
system
PSYCHOTHERAPY
 A process in which a person enters into a contract to 3. Milieu Therapy - A therapeutic environment is
interact with a therapist to relieve symptoms, resolve organized to:
problems in living and seek personal growth  encourage and assist the client to control
problematic behavior
Individual Psychotherapy  function within the range of social norms
 A method of bringing about change in a person by
exploring his or her feelings, attitudes, thinking, and Dance Therapy
behavior  also known as dance movement therapy, is a form of
 It involves a one-to-one relationship between the psychotherapy that uses movement and dance to
therapist and the client promote emotional, cognitive, and physical well-being. It
 The therapist's theoretical beliefs strongly influence his combines elements of dance, movement, and
or her style of therapy psychology to help individuals express and process their
emotions, develop self-awareness, and improve their
1. Hypnotherapy: Involves various methods and overall mental health.
techniques to induce a trance state where the
patient becomes submissive to instructions  Mental Health Implications:
2. Humor therapy: Use of humor to facilitate 1. Reduces stress and anxiety
expression of feelings and to enhance interaction 2. Improves mood and self-esteem
3. Psychoanalysis: Focuses on the exploration of the 3. Enhances cognitive function and memory
unconscious, to facilitate identification of the 4. Supports addiction recovery
patient's defenses
 Nursing Student Implications:
Group Therapy 1. Understand the therapeutic benefits of dance for patients
with mental health conditions.

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ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

2. Learn to incorporate dance therapy into care plans. 3. Develop observation and assessment skills to evaluate
3. Develop observation and assessment skills to evaluate patients' responses to biblio therapy.
patients' responses to dance the Navigatep
Types of Psychotropic Drugs:
Art Therapy 1. Antipsychotics: Schizophrenia, bipolar
Art therapy is a form of psychotherapy that uses creative
activities like drawing, painting, sculpting, or other art forms
disorder, major depressive disorder with
to promote emotional, cognitive, and physical well-being. It psychotic features
provides an outlet for individuals to express and process
their emotions, develop self-awareness, and improve their  Mechanism of Action:
overall mental health. Art therapy can be adapted to meet Antipsychotic drugs work by blocking or reducing the activity
the needs of individuals with diverse backgrounds, ages, and of certain neurotransmitters, such as:
abilities  Dopamine: Antipsychotics block dopamine
receptors, particularly D2 receptors, to reduce
 Mental Health Implications: psychotic symptoms.
1. Expresses and processes emotions  Serotonin: Some antipsychotics, such as
2. Enhances self-awareness and self-esteem clozapine, also block serotonin receptors, which can
3. Reduces stress and anxiety help reduce symptoms of anxiety and depression.
4. Supports trauma recovery
 Types of Antipsychotics:
 Nursing Student Implications: 1. First-generation (typical) antipsychotics:
1. Understand the therapeutic benefits of art for patients with Haloperidol, chlorpromazine
mental health conditions. 2. Second-generation (atypical) antipsychotics:
2. Learn to incorporate art therapy into care plans. Risperidone, olanzapine, quetiapine, clozapine
3. Develop observation and assessment skills to evaluate
patients' responses to art therapy.  Food to Avoid:
1. Grapefruit and grapefruit juice: May increase
Music Therapy levels of certain antipsychotics, such as quetiapine.
Music therapy is a form of therapy that uses music to 2. High-fat meals: May increase absorption of
promote emotional, cognitive, and physical well-being. It can certain antipsychotics, such as olanzapine.
involve creating, singing, moving, or listening to music, and is
often used to help individuals manage stress, anxiety, and  Nursing Responsibilities Prior to Administration:
other mental health conditions. Music therapy can be 1. Assess patient's medical history: Review patient's
adapted to meet the needs of individuals with diverse medical history, including allergies, medications, and
backgrounds, ages, and abilities. medical conditions.
2. Assess patient's mental status: Evaluate patient's
 Mental Health Implications: mental status, including symptoms of psychosis, anxiety,
1. Reduces stress and anxiety and depression.
2. Improves mood and cognitive function 3. Monitor vital signs: Check patient's vital signs, including
3. Enhances memory and language skills blood pressure, pulse, and temperature.
4. Supports pain management 4. Check laboratory results: Review patient's laboratory
results, including complete blood count (CBC),
 Nursing Student Implications: electrolyte levels, and liver function tests.
1. Understand the therapeutic benefits of music for patients 5. Verify medication order: Confirm the medication order,
with mental health conditions. including the dose, frequency, and route of
2. Learn to incorporate music therapy into care plans. administration.
3. Develop observation and assessment skills to evaluate 6. Educate patient and family: Provide patient and family
patients' responses to music therapy. with information about the medication, including its
purpose, potential side effects, and importance of
adherence.
Bibliotherapy 7. Administer medication safely: Follow safe medication
Is a form of therapy that uses books, reading, and writing to administration practices, including using the "five rights"
promote emotional, cognitive, and physical well-being. It can of medication administration: right patient, right
involve reading self-help books, fiction, or non-fiction, and medication, right dose, right route, and right time.
writing in a journal or diary. Biblio therapy can help
individuals develop coping skills, manage stress and anxiety,  Nursing Considerations
and improve their overall mental health. 1. Monitor for extrapyramidal symptoms (EPS): Watch for
signs of EPS, such as dystonia, akathisia, and
 Mental Health Implications: parkinsonism.
1. Reduces stress and anxiety 2. Monitor for metabolic changes: Monitor patient's
2. Improves mood and self-esteem weight, blood glucose, and lipid profiles, as
3. Enhances cognitive function and memory antipsychotics can increase the risk of metabolic
4. Supports personal growth and development syndrome.
3. Monitor for orthostatic hypotension: Watch for signs of
 Nursing Student Implications: orthostatic hypotension, such as dizziness or
1. Understand the therapeutic benefits of reading and writing lightheadedness, especially when administering
for patients with mental health conditions. medications that can cause hypotension.
2. Learn to incorporate biblio therapy into care plans.

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ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

2. Antidepressants - Major depressive and changes in vital signs, especially when

disorder, anxiety disorders, obsessive- administering SSRIs.
2. Monitor for orthostatic hypotension: Watch for
compulsive disorder signs of orthostatic hypotension, such as dizziness
or lightheadedness, especially when administering
 Mechanism of Action: Antidepressant drugs work by TCAs.
increasing the levels of certain neurotransmitters, such 3. Monitor for weight changes: Monitor patient's
as: weight, as some antidepressants can cause weight
5. Serotonin (5-HT): Selective serotonin reuptake gain or loss
inhibitors (SSRIs) block the reabsorption of
serotonin, increasing its levels in the synaptic
3. Mood Stabilizers: Bipolar disorder,
cleft.
6. Norepinephrine (NE): Tricyclic antidepressants seizure disorders
(TCAs) and monoamine oxidase inhibitors  Mechanism of Action: Mood stabilizer drugs work by:
(MAOIs) increase the levels of norepinephrine by 1. Inhibiting the release of excitatory
blocking its reabsorption or degradation. neurotransmitters, such as glutamate
7. Dopamine: Some antidepressants, such as 2. Enhancing the activity of inhibitory
bupropion, increase the levels of dopamine. neurotransmitters, such as GABA
3. Stabilizing ion channels and neuronal membranes
 Types of Antidepressants:
1. Selective Serotonin Reuptake Inhibitors  Types of Mood Stabilizers:
(SSRIs): Fluoxetine, sertraline, paroxetine 1. Lithium (Lithobid)
2. Tricyclic Antidepressants (TCAs): 2. Valproate (Depakote)
Amitriptyline, imipramine, nortriptyline 3. Carbamazepine (Tegretol)
3. Monoamine Oxidase Inhibitors (MAOls): 4. Lamotrigine (Lamictal)
Phenelzine, tranylcypromine
4. Atypical Antidepressants: Bupropion,  Food to Avoid:
venlafaxine, duloxetine 1. Grapefruit and grapefruit juice: May interact with
carbamazepine and valproate
 Food to Avoid: 2. High-sodium foods: May increase lithium levels
1. Tyramine-rich foods: Avoid foods high in 3. Caffeine: May interact with lithium and valproate
tyramine, such as aged cheese, wine, and
fermented meats, when taking MAOIs.  Nursing Responsibilities Prior to Administration
2. Grapefruit and grapefruit juice: May interact 1. Assess patient's medical history: Review patient's
with certain antidepressants, such as fluoxetine medical history, including allergies, medications,
and sertraline. and medical conditions
3. Caffeine: May interact with certain 2. Assess patient's mental status: Evaluate patient's
antidepressants, such as MAOIs and SSRIs mental status, including symptoms of bipolar
disorder, mania, and depression
 Nursing Responsibilities Prior to Administration: 3. Monitor vital signs: Check patient's vital signs,
1. Assess patient's medical history: Review including blood pressure, pulse, and temperature
patient's medical history, including allergies, 4. Check laboratory results: Review patient's
medications, and medical conditions. laboratory results, including complete blood count
2. Assess patient's mental status: Evaluate patient's (CBC), electrolyte levels, and liver function tests
mental status, including symptoms of depression, 5. Verify medication order: Confirm the medication
anxiety, and suicidal ideation. order, including the dose, frequency, and route of
3. Monitor vital signs: Check patient's vital signs, administration
including blood pressure, pulse, and 6. Educate patient and family: Provide patient and
temperature. family with information about the medication,
4. Check laboratory results: Review patient's including its purpose, potential side effects, and
laboratory results, including complete blood importance of adherence
count (CBC), electrolyte levels, and liver function 7. Monitor for toxicity: Monitor patient for signs of
tests. toxicity, such as lithium toxicity (confusion, tremors,
5. Verify medication order: Confirm the medication seizures)
order, including the dose, frequency, and route of
administration.  Nursing Considerations
6. Educate patient and family: Provide patient and 1. Monitor for renal function: Monitor patient's renal
family with information about the medication, function, as mood stabilizers can affect kidney
including its purpose, potential side effects, and function
importance of adherence. 2. Monitor for thyroid function: Monitor patient's thyroid
7. Monitor for suicidal ideation: Assess patient's risk function, as lithium can affect thyroid function
for suicidal ideation and develor a plan to ensure 3. Monitor for blood dyscrasias: Monitor patient for
patient safety. signs of blood dyscrasias, such as anemia,
leukopenia, dyscrasias, Or thrombocytopenia
 Nursing Considerations 4. Monitor for teratogenic effects: Monitor patient for
1. Monitor for serotonin syndrome: Watch for signs signs of teratogenic effects, as some mood
of serotonin syndrome, such as agitation, confusion, stabilizers can affect fetal development during
pregnancy.

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ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

2. Interacting with GABA receptors in the brain

4. Anxiolytics: Anxiety disorders, insomnia 3. Reducing the activity of excitatory
 Mechanism of Action Anxiolytic drugs work by: neurotransmitters, such as glutamate
1. Enhancing the activity of the neurotransmitter
GABA (gamma-aminobutyric acid)  Types of Hypnotics:
2. Reducing the activity of the neurotransmitter 1. Benzodiazepines (e.g., triazolam, temazepam)
glutamate 2. Non-benzodiazepines (e.g., zolpidem, eszopiclone)
3. Interacting with benzodiazepine receptors in the 3. Melatonin receptor agonists (e.g., rameleon)
brain
 Food to Avoid:
 Types of Anxiolytics 1. Grapefruit and grapefruit juice: May interact with
1. Benzodiazepines (e.g., alprazolam, clonazepam, certain hypnotics, such as triazolam
diazepam) 2. Caffeine: May interfere with sleep and reduce the
2. Non-benzodiazepines (e.g., buspirone, zolpidem) effectiveness of hypnotics
3. Barbiturates (e.g., phenobarbital) 3. High-fat meals: May increase absorption of certain
hypnotics, such as zolpidem
 Food to Avoid:
1. Grapefruit and grapefruit juice: May interact with  Nursing Responsibilities Prior to Administration
certain anxiolytics, such as alprazolam and 1. Assess patient's medical history: Review patient's
clonazepam medical history, including allergies, medications,
2. Caffeine: May interact with certain anxiolytics, such and medical conditions
as benzodiazepines 2. Assess patient's sleep patterns: Evaluate patient's
3. High-fat meals: May increase absorption of certain sleep patterns, including duration, quality, and
anxiolytics, such as diazepam timing
3. Monitor vital signs: Check patient's vital signs,
 Nursing Responsibilities Prior to Administration including blood pressure, pulse, and temperature
1. Assess patient's medical history: Review patient's 4. Check laboratory results: Review patient's
medical history, including allergies, medications, laboratory results, including complete blood count
and medical conditions (CBC), electrolyte levels, and liver function tests
2. Assess patient's mental status: Evaluate patient's 5. Verify medication order: Confirm the medication
mental status, including symptoms of anxiety and order, including the dose, frequency, and route of
insomnia administration
3. Monitor vital signs: Check patient's vital signs, 6. Educate patient and family: Provide patient and
including blood pressure, pulse, and temperature family with information about the medication,
4. Check laboratory results: Review patient's including its purpose, potential side effects, and
laboratory results, including complete blood count importance of adherence
(CBC), electrolyte levels, and liver function tests 7. Monitor for dependence and withdrawal: Monitor
5. Verify medication order: Confirm the medication patient for signs of dependence and withdrawal, as
order, including the dose, frequency, and route of hypnotics can be habit-forming.
administration
6. Educate patient and family: Provide patient and  Nursing Considerations
family with information about the medication, 1. Monitor for respiratory depression: Monitor patient
including its purpose, potential side effects, and for signs of respiratory depression, especially when
importance of adherence administering benzodiazepines
7. Monitor for dependence and withdrawal: Monitor 2. Monitor for cognitive impairment: Monitor patient for
patient for signs of dependence and withdrawal, as signs of cognitive impairment, especially in older
anxiolytics can be habit-forming. adults
3. Monitor for falls: Monitor patient for risk of falls,
 Nursing Considerations especially in older adults
1. Monitor for renal function: Monitor patient's renal 4. Monitor for interactions with other medications:
function, as mood stabilizers can affect kidney Monitor patient for potential interactions with other
function medications, such as sedatives or antidepressants.
2. Monitor for thyroid function: Monitor patient's thyroid
function, as lithium can affect thyroid function
3. Monitor for blood dyscrasias: Monitor patient for
signs of blood dyscrasias, such as anemia,
leukopenia,
Trauma and Stressor - Related
4. dyscrasias, Or thrombocytopenia Disorder
5. Monitor for teratogenic effects: Monitor patient for  Trauma and stressor related disorders are a group of
signs of teratogenic effects, as some mood mental health conditions that are triggered by
stabilizers can affect fetal development during experiencing or witnessing a traumatic event.
pregnancy.  The types of trauma and stressor related disorders
include:
5. Hypnotics 1. Acute Stress Disorder,
 Mechanism of Action -Hypnotic drugs work by: 2. Post-traumatic stress disorder (PTSD)
1. Enhancing the activity of the neurotransmitter 3. Adjustment disorder
GABA (gamma-aminobutyric acid) 4. Reactive attachment disorder.

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ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

Acute stress Disorder (ASD)

- is a mental health condition that can occur after PTSD is characterized by four main symptom groups:
experiencing a traumatic event. It is similar to post- 1. Intrusion: Flashbacks, nightmares, or intrusive
traumatic stress disorder (PTSD), but occurs within one memories of the event.
month of the event and lasts for a shorter period of time. 2. Avoidance: Efforts to avoid thoughts, feelings, or
external reminders (e.g., places or people)
 The clinical course of acute stress disorder typically associated with the trauma.
involves three phases: 3. Negative Alterations in Cognition and Mood:
1. The immediate reaction phase - individuals may Persistent negative emotions, detachment from
experience intense fear, helplessness, and others, or an inability to experience positive
dissociation. feelings.
2. The acute phase - symptoms such as re- 4. Hyperarousal: Irritability, exaggerated startle
experiencing the trauma, avoidance, and response, difficulty sleeping, or hypervigilance.
hyperarousal can persist for up to four weeks.
3. The recovery phase - is when symptoms begin to  Duration:
decrease and the individual starts to cope with the For a diagnosis, symptoms must persist for at least one
trauma. month and cause significant distress or functional
impairment. Some recover within months with treatment,
 The etiology of acute stress disorder is complex and while others may struggle lifelong without intervention.
can be influenced by a combination of genetic, The course isn't linear-stressors like anniversaries of the
environmental, and psychological factors. In some trauma or new life challenges can exacerbate symptoms,
cases, individuals may have a predisposition to making ongoing management essential.
developing the disorder due to a family history of mental
illness. Environmental factors such as exposure to Etiology of PTSD
violence or natural disasters can also play a role. 1. Traumatic Event: The triggering event is the
Additionally, the way an individual copes with stress and cornerstone. This could be combat exposure, sexual
their ability to process and manage traumatic events can assault, natural disasters, serious accidents, or
contribute to the development of acute stress disorder. witnessing violence. The severity, duration, and
proximity to the trauma influence risk.
 When caring for clients with acute stress disorder, it is 2. Biological Factors: Brain regions like the amygdala
important to: (fear processing) and prefrontal cortex (emotional
1. Provide a safe and supportive environment - regulation) show altered activity in PTSD patients.
This can include validating their experiences, 3. Dysregulation of stress hormones, particularly cortisol
helping them to identify and manage triggers and norepinephrine, contributes to hyperarousal and
2. Providing resources for coping and self-care - It memory intrusion.
is Important for clients to have a atrong support 4. Psychological Factors: Pre-existing mental health
system and to practice self-care techniques, such conditions (e.g. anxiety or depression), a history of
as relaxation exercises, to aid in their recovery childhood trauma, or poor coping skills increase
3. Cognitive-behavioral therapy, can also be vulnerability.
beneficial in helping clients process and cope with 5. Social and Environmental Factors: Lack of social
their trauma. Cognitive-behavioral therapy (CBT) support post-trauma, ongoing stress (e.g., poverty or
has been found to be particularly effective in helping discrimination), or cultural attitudes toward trauma can
clients process their traumatic experience and worsen outcomes.
develop coping strategies.
4. Medication such as antidepressants or anti-anxiety Risk Factors:
medication may be prescribed to help manage
Women are statistically more likely to develop PTSD than
symptoms.
men, possibly due to higher rates of interpersonal trauma like
sexual violence. Genetics also play a role-family history of
Post-Traumatic Stress Disorder (PTSD) mental illness can heighten susceptibility.
PTSD is a psychiatric disorder that can develop after an In short, PTSD isn't just about the event itself but how the
individual experiences or witnesses a traumatic event. The individual's mind, body, and environment respond to it.
clinical course varies widely between individuals, but there
are some common patterns: Treatment of PTSD
Effective treatment aims to reduce symptoms, improve
1. Onset: Symptoms typically emerge within three quality of life, and help individuals regain control. It's typically
months of the trauma, though in some cases, they a combination of psychotherapy, medication, and support.
may be delayed for months or even years. This is
known as delayed-onset PTSD. A. Psychotherapy
2. Acute Phase: In the initial weeks following a traumatic 1. Cognitive Behavioral Therapy (CBT): The gold
event, individuals might experience intense fear, standard. It helps patients reframe negative
helplessness, or horror. Many will naturally recover thoughts and manage triggers.
during this time with support, but for those who 2. Prolonged Exposure Therapy: Patients gradually
develop PTSD, symptoms persist beyond one month. confront trauma-related memories and situations in
3. Chronic Phase: If untreated, PTSD can become a safe setting to reduce avoidance.
chronic, lasting for years. Symptoms may wax and 3. Eye Movement Desensitization and
wane, often triggered by reminders of the trauma. Reprocessing (EMDR): This involves guided eye
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ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

movements while recalling the trauma, helping the

brain reprocess it less distressingly.  Reactive Attachment Disorder (RAD), is a disorder
4. Trauma-Focused Therapy: Tailored to address the that occurs in children who have not formed healthy
specific trauma, often incorporating narrative attachments with their primary caregivers, often due to
techniques. neglect or abuse.

B. Medications  The etiology of adjustment disorder is not fully

1. SSRIs (e.g., Sertraline, Paroxetine): First-line understood, but it is believed to be a combination of
treatment to alleviate depression and anxiety genetic, biological, psychological, and environmental
symptoms. factors. RAD is typically caused by early trauma or
2. Prazosin: Often used for nightmares and sleep neglect, which disrupts a child's ability to form healthy
disturbances. attachments and can lead to long-term emotional and
3. Anti-anxiety meds or mood stabilizers: behavioral issues.
Occasionally prescribed, though sparingly due to
dependency risks.  Treatment for adjustment disorder often involves
therapy, medication, and support from loved ones. RAD,
C. Complementary Approaches however, requires a more specialized and intensive
- Mindfulness, yoga, and support groups can enhance approach, including attachment-focused therapy and
resilience and emotional regulation. working with the child's caregivers to establish a secure
and nurturing environment.
D. Personalized Care
- Treatment must be tailored - some respond better to talk Nursing responsibilities in treating these disorders
therapy, others to medication, and many need both. Co- include:
occurring conditions like substance abuse or depression 1. Providing emotional support
must also be addressed. 2. Administering medication as prescribed
- Recovery isn't about "curing" PTSD but empowering 3. Assisting with therapy sessions
individuals to manage it effectively. 4. Nurses also play a, crucial role in educating
caregivers about the importance of attachment and
Nursing Responsibilities in PTSD Care how to provide a safe and nurturing environment for
1. Assessment: Nurses conduct thorough screenings to children with RAD.
identify PTSD symptoms, often using tools like the
PTSD Checklist (PCL-5). They assess triggers, coping  IMPORTANT: With the right treatment and support,
mechanisms, and co-morbidities like substance use or individuals with adjustment disorder and RAD can learn
suicidal ideation. healthy coping mechanisms and improve their overall
2. Education: Nurses teach patients and families about mental well-being.
PTSD — what it is, how it manifests, and what to expect
from treatment. Normalizing symptoms reduces stigma ANXIETY DISORDERS
and encourages help-seeking.  Introduction to Anxiety Disorders
3. Therapeutic Communication: Building trust is key. Anxiety is a normal human emotion-think of it as the body's
Nurses listen without judgment, validate feelings, and alarm system, kicking in during stressful or threatening
provide a safe space for patients to express trauma- situations. But when that alarm gets stuck in the "on"
related emotions. position, interfering with daily life, that's when we're talking
4. Monitoring and Support: Observe for medication side about an anxiety disorder. These disorders are among the
effects, track symptom changes, and reinforce coping most common mental health conditions globally, affecting
strategies like deep breathing or grounding techniques millions of people with a spectrum of severity.
during distress.
5. Advocacy: Nurses connect patients to resources-
therapists, support groups, or social services-and
advocate for their needs within the healthcare system. Levels of Anxiety
6. Crisis Intervention: If a patient experiences a flashback  Level 1: Mild Anxiety
or suicidal thoughts, nurses intervene swiftly, ensuring  Picture this: you're about to give a presentation,
safety and de-escalating the situation. and your stomach's doing a little flip. That's mild
7. Self-Care Promotion: They encourage healthy anxiety— a low hum of unease that's actually kind
routines-sleep hygiene, nutrition, exercise-and help of helpful. At this level, your senses sharpen. You're
patients avoid triggers when possible. more alert, focused, and ready to tackle what's
ahead. Maybe your heart beats a tad faster, or your
 SELF AWARENESS: Nurses also face emotional palms get sweaty, but it's manageable. Your brain's
challenges in this work. Vicarious trauma is a risk, so saying, "Heads up, something's coming," and it's
self-care and debriefing are vital to sustain OUR ability motivating rather than paralyzing.
to care for others.  Signs: Restlessness, slight irritability, or a bit of
fidgeting-like tapping a pen. You're still thinking
clearly, and your attention's wide open.
 Impact: This level boosts problem-solving. You
Adjustment Disorder & Reactive might even feel energized to prep more or double-
Attachment Disorder (RAD), check your work.
 Adjustment Disorder is a psychological response to a  What to Do: Not much intervention needed here. A
stressful event or change in one's life, such as a divorce deep breath, a quick pep talk, or a moment to
or job loss. regroup usually does the trick. Nurses might notice
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ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

this in a patient waiting for test results- offer a smile  Impact: Total shutdown. No reasoning, no focus-
and some info, and they're usually good. just raw terror. You're not processing anything
beyond the immediate threat (real or not).
 Level 2: Moderate Anxiety  What to Do: This is emergency territory. Nurses
 Moderate anxiety is like a storm cloud rolling in— need to stay calm and in control-think firm but
you can still function, but it's harder to ignore. That gentle. "You're safe, I'm here" can anchor them.
presentation? Suddenly you're obsessing over Guide breathing-slowly, in through the nose, out
every slide, and your mind's racing a bit. Your through the mouth. If it's a patient, check vitals (rule
body's more involved: maybe your chest feels tight, out a real medical crisis), and get help if it's
your muscles tense up, or your voice gets shaky. spiraling. Meds might be fast-tracked, and
Your focus narrows-you're zeroing in on the worry, afterward, therapy's a must to unpack what
and it's tougher to see the big picture. triggered it.
 Signs: Pacing, talking faster, or feeling distracted.
You might snap at someone unintentionally or Types of Anxiety Disorder
struggle to concentrate on anything unrelated to the 1. Generalized Anxiety Disorder (GAD) - Chronic,
stressor. excessive worry about everyday things, often without a
 Impact: You're still in the game, but it's taxing. clear trigger.
Decision-making gets shaky, and you might miss 2. Panic Disorder - Sudden, intense panic attacks with
details outside your tunnel vision. physical symptoms like heart palpitations or shortness of
 What to Do: This is where support kicks in. Nurses breath.
can step up with calm reassurance - "Hey, let's 3. Social Anxiety Disorder - Intense fear of social
break this down together." Techniques like slow situations or being judged by others.
breathing, grounding (name five things you see), or 4. Specific Phobias - Extreme fear of a particular object or
a quick distraction (chat about something neutral) situation like heights or spiders.
can help. For a patient, say, pre-surgery, explaining 5. Obsessive-Compulsive Disorder (OCD) - Persistent,
what's next in simple terms can ease that mounting intrusive thoughts (obsessions) and repetitive behaviors
tension. (compulsions).
6. Post-Traumatic Stress Disorder (PTSD) - Anxiety
 Level 3: Severe Anxiety triggered by a traumatic event, with symptoms like
 Here's where it gets rough. Severe anxiety feels like flashbacks or hypervigilance.
the storm's hit — you're drenched, and it's hard to  Each has unique features, but they share a core theme:
see straight. Your body's screaming: heart anxiety that's disproportionate to the situation and tough
pounding, breathing fast, maybe even nausea or to control.
dizziness. Your mind's a mess, jumping from one
worry to another, and rational thinking? Out the Causes and Risk Factors
window. You might feel doomed, like whatever's
So, what flips the switch from normal worry to a disorder? It's
happening is too big to handle.
a mix of factors:
 Signs: Full-on agitation-shaking, crying, or pacing
1. Biological: Imbalances in neurotransmitters like
like a caged animal. Speech might be disjointed,
serotonin, dopamine, or GABA can play a role.
and you're hyper-focused on escaping the feeling.
Genetics also matter-family history increases risk.
 Impact: Functioning's shot. You can't problem-
2. Psychological: Personality traits like perfectionism
solve; you're just trying to survive the moment.
or a tendency to overthink can predispose
Relationships or tasks? Forget it-everything's
someone.
filtered through that overwhelming fear.
3. Environmental: Trauma, chronic stress, or major
 What to Do: This needs active intervention. Nurses
life changes-like losing a job or a loved one— can
might use a quiet space, a steady voice, and clear
be the spark.
directions - "Look at me, breathe with me." Meds
4. Medical: Conditions like thyroid issues or
like a short-acting anti-anxiety drug (prescribed, of
substance use (caffeine, drugs) can mimic or
course) might come into play if it's unbearable. For
worsen anxiety.
a patient in this state-maybe freaking out post-
trauma-safety's priority one, alongside de-
Understanding this helps us see anxiety as a puzzle with
escalation. No complex explanations; keep it simple
multiple pieces, which is key for effective management.
and present.
Signs and Symptoms
 Level 4: Panic Anxiety Anxiety isn't just "feeling nervous." It's a full-body experience.
 This is the top of the scale— panic. It's like the Symptoms fall into three buckets:
storm's a tornado, and you're caught in it. Full- 1. Emotional: Excessive worry, irritability, or a
blown fight-or-flight kicks in: you might feel like sense of impending door.
you're dying, losing control, or going crazy. Your 2. Physical: Racing heart, sweating, trembling,
heart's racing so fast you think it'll burst, you're fatigue, muscle tension, or GI issues like nausea.
hyperventilating, and reality feels warped. Time 3. Cognitive: Trouble concentrating, racing
slows down, and you're convinced the end is near. thoughts, or blanking out.
 Signs: Wild eyes, sweating buckets, trembling, or For nurses, spotting these signs is step one. A patient might
even freezing in place. Some people bolt, others not say, "I have anxiety"-they might show up with chest pain
collapse. You might hear "I can't breathe!" or "I'm or insomnia instead. Our job is to connect the dots.
having a heart attack!" — classic panic attack stuff.
Management of Anxiety Disorders

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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

Management is about reducing symptoms and improving  Education: Break down what anxiety is, how
quality of life. It's a team effort involving patients, healthcare treatment works. Knowledge reduces fear of the
providers, and often therapists. Her unknown.
1. Psychotherapy
 Cognitive Behavioral Therapy (CBT): The gold 3. Acute Management
standard. It helps patients identify and reframe  Panic Attack Care: Stay calm, guide them to
negative thought patterns. For example, changing breathe slowly-inhale 4 seconds, hold 4, exhale 4.
"I'II fail this test" to "I've prepared, and I'll do my Dim overstimulation (lights, noise).
best."  Safety: If they're hyperventilating or dissociating,
 Exposure Therapy: Great for phobias or PTSD- keep them grounded —focus on senses: "Feel your
gradually facing the fear in a safe way desensitizes feet on the floor."
the response.
 Mindfulness-Based Approaches: Techniques like 4. Long-Term Support
meditation teach patients to stay present, reducing  Teach Coping Skills: Practice deep breathing or
runaway thoughts. visualization with them. Role-play CBT techniques.
 Monitor Meds: Watch for side effects, ensure
2. Medications they're taking it right— e.B., "Take it with food to
 SSRIs (e.g., Sertraline, Escitalopram): First-line avoid nausea."
for long-term management-boost serotonin, fewer  Encourage Goals: Small wins, like "Try one
side effects. relaxation exercise today," build confidence.
 Benzodiazepines (e.g., Lorazepam): Fast-acting
for acute panic, but short-term only due to 5. Collaboration - Work with psychiatrists, therapists,
dependency risk. and families. Advocate for the patient-maybe they
 Beta-Blockers: Handy for physical symptoms like a need a med tweak or a referral.
racing heart, especially in performance anxiety.  Challenges and Considerations
 Buspirone: A milder option for GAD, less sedating  Stigma: Some patients avoid help, thinking anxiety
than benzos. is "weakness." Normalize it-it's biology, not a flaw.
ALERT: Docs tailor thesè based on the patient's needs, and  Comorbidities: Depression or substance abuse
nurses monitor for side effects-like drowsiness or nausea- often tag along. Treat the whole picture.
and educate patients on adherence.  Cultural Lens: Anxiety looks different across
cultures-somatic complaints (headaches) might
3. Lifestyle Changes dominate over emotional ones.
 Exercise: Boosts endorphins, reduces stress
hormones. Even a 20-minute walk can help. Obsessive-Compulsive and Related
 Sleep: Poor sleep fuels anxiety; good sleep calms
it. Consistent routines matter. Disorders (OCRDs)
 Diet: Cut back on caffeine and sugar-those can rev OCRDs are a group of mental health conditions where
up the nervous system. people get stuck in loops of thoughts or behaviors that feel
 Social Support: Connection with friends or family impossible to shake. OCD itself is the headliner: it's about
acts like a buffer. obsessions (intrusive, unwanted thoughts) and compulsions
(repetitive actions to ease the anxiety those thoughts cause).
4. Complementary Therapies
 Relaxation Techniques: Deep breathing, Think of it as the brain's alarm system going haywire-ringing
progressive muscle relaxation-these hit the brakes when there's no real fire. Related disorders, like
on the fight-or-flight response. trichotillomania (hair-pulling) or hoarding, share that
 Herbal Options: Some swear by chamomile or compulsive vibe but branch out in their own ways.
lavender, though evidence is mixed-always check
with a provider. Causes
So, why does this happen? It's not one thing it's a mix of
Nursing Interventions factors crashing together:
Nurses are on the front lines, bridging medical care and  Biological: Brain wiring's a biggie. Studies show
emotional support. Here's how we step in: funky activity in areas like the orbitofrontal cortex and
1. Assessment basal ganglia parts that handle decision-making and
 Screening: Use tools like the GAD-7 questionnaire habits. Serotonin, a mood-regulating chemical, is
to gauge severity. Ask open-ended questions: often out of whack too. Genetics play a role if your
"What's been weighing on your mind lately?* mom or uncle has OCD, your odds tick up.
 Physical Check: Rule out mimics-hyperthyroidism  Environmental: Stressful life events can flip the
or heart issues can look like anxiety. switch. Trauma, abuse, or even a nasty infection
 History: Dig into triggers, past trauma, or (like strep in kids, linked to PANDAS) might kick
substance use. Build trust so they open up. things off. Learned behaviors -like watching a parent
obsess over germs can seed it too.
2. Therapeutic Communication  Psychological: Perfectionism or a need for control
 Active Listening: Nod, reflect back— "It sounds can fuel the fire. If someone's already anxious or
like you're feeling overwhelmed." No judgment. rigid in their thinking, they're more prone.
 Reassurance: "You're not alone in this, and we're
here to help." Normalize their experience without REMEMBER: No single cause hands you OCD on a platter-
dismissing It. -it's more like a recipe with a dash of each.

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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

Signs and Symptoms REMEMBER: Its not a quick fix - progress takes weeks or
OCD has two main stars: Obsessions and Compulsions. months-but it works for most.
 Obsessions: These are intrusive thoughts that barge in
and won't leave. They're distressing_-like "What if I hurt Nursing Interventions
someone?" or "Did I leave the stove on?" They spark You're the boots on the ground, so here's how you step up:
anxiety, guilt, or fear.  Assessment: Dig in. Ask about thoughts they can't
 Compulsions: These are the rituals to quiet that noise shake or habits they repeat. "How much time do you
washing hands until they're raw, checking locks 20 spend on this?" or "Does it bother you?" Watch for
times, counting steps in threes. They're not fun; they're a clues-chapped hands, nervous glances. Screen for
desperate attempt to feel okay. depression or anxiety too -OCD loves company.
 Education: Demystify it. "This is your brain getting
Related disorders tweak this pattern: stuck-it's not you being weak." Explain treatments so
 Hoarding Disorder: Can't throw stuff out, even they know what's coming-Exposure and Response
trash, because it feels essential. Prevention (ERP) sounds scary, but it's a game-
 Body Dysmorphic Disorder (BDD): Obsessed with changer.
a "flaw" (like a nose they think is crooked), leading to  Support: Be their rock. Validate the struggle-" see
mirror-checking or hiding behaviors. how hard this is"-but don't feed the compulsion. If
 Trichotillomania: Pulling out hair, often they ask you to check the lock, gently redirect: "Let's
unconsciously, to relieve tension. try sitting with that worry instead."
 Common threads: Time-consuming habits (over an  Therapy Backup: Don't do ERP yourself--that's for
hour a day), distress, and a hit to daily Iife—work. specialists-but reinforce it. "How'd it go not washing
relationships after touching the bin?" Encourage sticking with it,
even when it's rough.
Examples of OCD  Med Management: If they're on SSRIs, watch for
Let's paint some pictures: side effects-nausea, sleep issues and report back to
1. Contamination OCD: A guy washes his hands 50 the prescriber. Teach them it's not instant -results
times a day because he's terrified of germs. He kick in after 8-12 weeks.
avoids doorknobs and won't shake hands-his skin's  Safety Check: Severe OCD can spark suicidal
cracked, but stopping feels worse. thoughts (e.g., "| can't live like this"). Ask straight up:
2. Checking OCD: A woman checks her stove 10 "Are you thinking of hurting yourself?" Escalate if
times before bed, convinced it's on. She's late for needed.
everything because the ritual eats her time.  Holistic Care: Push sleep, nutrition, and routine. A
3. Symmetry OCD: Someone arranges their desk tired, hungry brain fights harder against compulsions.
perfectly -pens aligned, books at right angles. If it's
off, they're anxious until it's fixed. Related example: Panic Disorder
In BDD, imagine a teen who spends hours hiding a Panic disorder is when someone has recurrent, unexpected
"huge" forehead with makeup, missing school panic attacks -sudden surges of intense fear or dread that
because they can't face the mirror's "truth.' peak fast, usually within minutes -and then spends a lot of
time dreading the next one. A panic attack itself isn't the
Management and Treatment disorder; it's the pattern plus the fallout that defines it.
Good news: OCRDs are treatable. The aim is to cut the Think of it like a fire alarm that keeps blaring out of nowhere,
cycle and reclaim life. even when there's no smoke. Over time, that fear of another
1. Therapy: "alarm" can shrink someone's world--they avoid places or
 Cognitive-Behavioral Therapy (CBT): The gold situations, just in case.
standard. Specifically, Exposure and Response
Prevention (ERP) -facing the fear (touching a "dirty" Causes
doorknob) without the ritual (no hand-washing). It's What sets this off? It's a cocktail of factors -no single villain
tough but rewires the brain over time. here:
 Cognitive Therapy: Challenges distorted thoughts-  Biological: Brain chemistry's a big player. Overactive
like "If I don't check, the house will burn down." fear circuits like the amygdala (your brain's panic
button)-can misfire. Imbalances in neurotransmitters
2. Medication: (serotonin, norepinephrine) might prime the pump.
 SSRIs (like sertraline or fluoxetine) boost Genetics? If a parent had it, the risk jumps-about 40% of
serotonin and dampen obsessions. Higher doses cases have a family link.
than for depression are common.  Psychological: A history of anxiety or trauma can lay
o If SSRIs flop, docs might try antipsychotics the groundwork. Someone who's naturally high-strung or
(like risperidone) as a backup. prone to "catastrophizing" (thinking every twinge is a
heart attack) is more vulnerable.
3. Lifestyle Support:  Environmental: Stressful triggers- like losing a loved
 Stress management -think mindfulness or exercise one, a car accident, or even too much caffeine -can
-helps. Support groups can ease the isolation too. spark that first attack. Once it happens, the memory of it
becomes its own fuel.
4. For Related Disorders: Hoarding might need  Random Kickoff: Sometimes there's no clear "why" -
specialized CBT; trichotillomania might lean on habit- the first attack just hits, maybe during a quiet movie
reversal training (swapping hair-pulling for squeezing a night, and the cycle starts.
stress ball).
Signs and Symptoms
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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

Panic attacks are the core, and they're intense. Imagine your mimics -thyroid issues, heart problems -with vitals and
body and mind slamming into overdrive: history.
 Physical: Heart racing (palpitations), sweating,  During an Attack: Stay calm-you're their anchor.
shaking, shortness of breath, chest pain, nausea, "You're safe, this will pass." Guide breathing: "In slow
dizziness, chills, or hot flashes. It can mimic a heart through your nose, out through your mouth." Keep it
attack- patients often land in the ER thinking they're simple--no long lectures mid-panic. If it's their first, get
dying. them checked-chest pain could be cardiac.
 Mental: A sense of doom-"'m losing control" or "I'm  Education: Break it down post-attack. "Your body's in
going crazy." Some feel detached, like they're fight-or-flight, but there's no real threat. It's awful, but not
floating outside themselves (depersonalization). fatal." Prep them for treatment options CBT, meds-so
 Duration: Peaks in 10 minutes, fades in 20-30, but they're not lost.
leaves you wiped out.  Support: Validate, don't dismiss. "I see how scary this is
let's tackle it together." Encourage small wins-like
The disorder part? After the attack, they're haunted: staying in a "trigger" spot for five minutes.
o Persistent worry about another  Med Oversight: If they're on benzos, watch for overuse-
one-"When's it coming? What if I'm slurred speech, drowsiness. SSRIs? Check for early
driving?" side effects (jitteriness, nausea) and nudge them to stick
o Avoidance -skipping crowds, elevators, or it out.
anything tied to past attacks.  Safety Net: Panic can spark despair-"I can't keep living
One attack doesn't equal panic disorder. It's the repeat like this." Screen for suicidal thoughts: "Are you feeling
episodes plus that gripping tear ot recurrence that clinches it. hopeless?" Escalate if red flags pop up.
 Follow-Up: Track progress. "Fewer attacks? Less
Examples avoidance?" Reinforce therapy homework- breathing
 A 30-year-old woman feels her heart pound in a grocery drills, exposure steps.
store, can't breathe, and bolts outside, convinced she's
dying. Weeks later, she's dodging stores, terrified it'll Panic disorder's a beast-sudden, brutal, and relentless until
happen again. you break its grip. It's rooted in biology, stress, and fear of
 A college kid wakes up gasping, chest tight, thinking it's fear itself. Attacks hit hard, but with CBT, meds, and support,
the end. Now he avoids sleep, chugging coffee, which- people can fight back. You, as nurses, are clutch -calming
yep-makes it worse. the storm, ruling out emergencies, and guiding them to help.
It's not just about surviving attacks; it's about giving patients
their freedom back, one steady breath at a time.
Management and Treatment
Panic disorder's disruptive, but it's treatable. The goal? Stop
attacks, cut the fear, and get life back. Here's the playbook: Phobias
1. Therapy: A phobia is an intense, irrational fear of a specific object,
 Cognitive-Behavioral Therapy (CBT): King here. situation, or activity that poses little or no actual danger.
It teaches patients to reframe the panic-like "My Unlike general anxiety, phobias are typically triggered by a
heart's racing, but it's not a heart attack, it's just particular stimulus and lead to avoidance behavior. They are
adrenaline." Interceptive exposure (deliberately classified as a type of anxiety disorder in the Diagnostic and
speeding your heart with exercise) proves the Statistical Manual of Mental Disorders (DSM-5) and can
sensations aren't deadly. significantly impair an individual's daily functioning if severe.
 Exposure Therapy: If they avoid malls, you
gradually take them there-first the parking lot, then  The development of phobias is multifactorial,
inside -until the fear fades. involving biological, psychological, and
2. Medication: environmental influences. Below are the primarv
 SSRIs (like sertraline or escitalopram): First-line, etiological factors:
long-term fix. Boosts serotonin, calms the brain. 1. Biological Factors:
Takes weeks to kick in.  Genetics: Research suggests a hereditary
 Benzodiazepines (like lorazepam): Fast relief for predisposition to anxiety disorders, including
acute attacks, but short-term only-addiction's a phobias. Individuals with a family history of
risk. anxiety are more likely to develop phobias.
 Beta-blockers: Occasionally used to blunt  Neurochemical Imbalance: Dysregulation in
physical symptoms (racing heart), though less neurotransmitters like serotonin, dopamine, or
common. gamma-aminobutyric acid (GABA) may heighten
fear responses.
3. Lifestyle: Cut caffeine, nicotine-stimulants that mimic  Amygdala Overactivity: The amygdala, a brain
panic. Exercise and sleep stabilize the system. structure involved in fear processing, may be
Relaxation tricks-deep breathing, progressive muscle hyperactive in individuals with phobias, amplifying
relaxation -can nip attacks in the bud. their response to perceived threats.
4. Education: Knowledge is power. "This is panic, not
danger" shifts the mindset. 2. Psychological Factors:
 Classical Conditioning: A phobia may develop after
a traumatic event paired with a neutral stimulus (e.g.,
Nursing Interventions
being bitten by a dog leading to a fear of dogs).
 Assessment: Catch it early. Ask: "Ever feel sudden
 Observational Learning: Witnessing others exhibit
terror out of nowhere? Heart racing, can't breathe?" Dig
fear (e.g., a parent afraid of spiders) can contribute to
into frequency, triggers, avoidance. Rule out medical
phobia development.

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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

 Cognitive Factors: Negative thought patterns or

overestimation of danger can reinforce phobic 2. Pharmacological Treatment: Medication is typically
responses. reserved for severe cases or when therapy alone is
insufficient.
3. Environmental Factors:  Anxiolytics: Benzodiazepines (e.g., lorazepam) for
 Traumatic Experiences: Direct exposure to a short-term relief during acute exposure.
frightening event (e.g., a car accident) can trigger a  Antidepressants: SSRIs (e.g., sertraline) for social
phobia. phobia or agoraphobia with co-occurring depression.
 Cultural Influences: Societal norms or beliefs may  Beta-Blockers: (e.g., propranolol) to manage
shape what is feared (e.g., fear of the number 13 in physical symptoms like rapid heartbeat in
some cultures). performance-based social phobia.
 Early Life Stress: Childhood experiences, such as Note: Medication is not curative and is often combined with
overprotective parenting or lack of exposure to therapy.
diverse stimuli, may increase vulnerability.
3. Self-Help Strategies: Education about the phobia to
Types of Phobias reduce mystery and fear.
Phobias are categorized into three main types according to  Mindfulness and stress management techniques.
the DSM-5:  Support groups for shared experiences and
1. Specific Phobias: Involve fear of a distinct object or encouragement.
situation.
 Subtypes include: 4. Alternative Therapies:
 Animal Type: Fear of spiders (arachnophobia),  Hypnotherapy to address subconscious triggers.
dogs (cynophobia), etc.  Eye Movement Desensitization and Reprocessing
 Natural Environment Type: Fear of heights (EMDR) for phobias linked to trauma.
(acrophobia), water (aquaphobia), or storms.
 Blood-Injection-Injury Type: Fear of needles Nursing Responsibilities in Managing
(trypanophobia), blood (hematophobia), or Phobias
medical procedures(tomophobia). Nurses play a critical role in the care of individuals with
 Situational Type: Fear of enclosed spaces phobias, from assessment to intervention and education. Key
(claustrophobia), flying, or driving. responsibilities include:
 Other: Fear of clowns (coulrophobia), choking, 1. Assessment:
or vomiting.  Conduct a thorough history to identify the phobia's
2. Social Phobia (Social Anxiety Disorder): trigger, onset, and impact on daily life. Assess for
 Fear of social situations where one might be physical symptoms (e.g., tachycardia, sweating)
scrutinized or embarrassed, such as public and psychological distress (e.g., panic attacks).
speaking or meeting new people.  Screen for co-occurring conditions like depression
 Often linked to low self-esteem or fear of rejection. or substance use.
3. Agoraphobia: 2. Patient Education:
 Fear of situations where escape might be difficult or  Explain the nature of phobias and treatment options
help unavailable, such as crowded places, public in simple, reassuring terms.
transportätion, or being alone outside the home.  Teach coping strategies like deep breathing or
 Often develops secondary to panic disorder. grounding techniques for acute anxiety.
3. Support During Treatment:
 Assist with exposure therapy by providing a safe
Management and Treatment of Phobias environment and emotional support.
 Treatment aims to reduce fear, improve coping  Monitor for adverse reactions to medications and
mechanisms, and enhance quality of life. educate patients on proper use.
 Approaches vary based on the phobia's severity and 4. Emotional Support:
type.  Use therapeutic communication to validate the
1. Psychological Therapies: patient's fears without reinforcing irrational beliefs.
 Cognitive Behavioral Therapy (CBT):The gold  Encourage small steps toward facing the phobia,
standard for phobia treatment. celebrating progress.
 Involves identifying and challenging irrational 5. Collaboration:
thoughts and replacing them with rational ones.  Work with psychologists, psychiatrists, and
 + Includes exposure therapy, where patients therapists to ensure a holistic care plan.
are gradually exposed to the feared stimulus in 6. Monitoring and Follow-Up:
a controlled manner (e.g., systematic  Evaluate treatment effectiveness and adiust care
desensitization). plans accordingly.
 Behavioral Techniques:  Watch for signs of worsening anxiety or avoidance
 Relaxation training (e.g., deep breathing, behavior that may require intervention.
progressive muscle relaxation) paired with 7. Advocacy:
exposure.  Advocate for the patient's needs in healthcare
 Modeling, where the patient observes someone settings, ensuring they feel understood and
else safely interacting with the feared object. supported.
 Virtual Reality Therapy: Uses simulated  GAD is characterized by excessive, persistent, and
environments for exposure (e.g., virtual heights for uncontrollable worry about a variety of everyday
acrophobia). situations, lasting for at least 6 months. The worry is

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PSYCHIATRIC- MENTAL HEALTH NURSING
ADRIAN M. CHOG-AP, MAN,RN, LPT TRANSCRIBED
BY: F.R. CUSTODIO

disproportionate to the actual likelihood or impact of the

feared event.
 Core Symptoms (DSM-5 Criteria):
 Excessive anxiety and worry occurring more days
than not.
 Difficulty controlling the worry.
 Associated with at least three of the following (in
adults):
- Restlessness or feeling keyed up.
- Easily fatigued.
- Difficulty concentrating.
- Irritability.
- Muscle tension.
- Sleep disturbances (e.g., difficulty falling or
staying asleep).

 GAD often coexists with physical symptoms like

headaches, gastrointestinal distress, or palpitations, and
it can significantly impair daily functioning.

 SAD, also known as social phobia, involves an intense

fear of social situations where an individual might be
scrutinized or judged by others. This fear leads to
avoidance behaviors or significant distress when
enduring such situations.
 Core Symptoms (DSM-5 Criteria):
 Marked fear or anxiety about one or more social
situations (e.g., conversations, public speaking,
meeting new people).
 Fear of acting in a way that will lead to
embarrassment or rejection.
 Social situations almost always provoke anxiety,
often out of proportion to the actual threat.
 Avoidance of social situations or enduring them with
intense distress.
 Symptoms persist for 6 months or more and cause
significant impairment.

 Physical symptoms may include blushing, sweating,

trembling, or a racing heart, particularly in triggering
situations.

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