260831655 psychiatric nursing notes docx

7/25/2019 260831655 Psychiatric Nursing Notes Docx

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NOTES VI - PSYCHIATRIC NURSING PART 1

IntroductionMENTAL HEALTH balance in a persons internal life andadaptation to reality

Mental ILL Health state of imbalance characterized by adisturbance in a persons thoughts feelings and beha!ior

Psychiatric nursinginterpersonal process "hereby the professional nurse practitionerthrough the therapeutic use of self #art$ and nursing theories#science$ assist clients to achie!e psychosocial "ell being%&ore ' interpersonal process

Relate Ter!sMental hygienemeasures to promote mental health pre!ent mental illness andsuffering and facilitate rehabilitationMain tool' therapeutic use of selfIt re(uires self)a"arenessMethods to increase self)a"areness'Introspection

*iscussionE+perience,ole play

Assess!ent#psychosocial processes $Appearance beha!ior or mood-peech thought content and thought process-ensoriumInsight and .udgment/amily relationships and "or0 habitsLe!el of gro"th and de!elopment

C"!!"n #eha$i"ral Signs an Sy!%t"!s

a&'istur(ances in %erce%ti"nIllusi"nmisinterpretation of an actual e+ternal stimuliHallucinati"nsfalse sensory perception in the absence of e+ternal stimuli

(&'istur(ances in thin)ing an s%eechne"l"gis! coining of "ords that people do not understandCircu!stantiality o!er inclusion of inappropriate thoughts anddetails*"r sala incoherent mi+ture of "ords and phrases "ith nological se(uenceVer(igerati"n meaningless repetition of "ords and phrasesPerse$erati"n persistence of a response to a pre!ious (uestionEch"lalia pathological repetition of "ords of othersA%hasia speech difficulty and disturbance

E+pressi!e recepti!e or global+light ", ieas) shifting of one topic from one sub.ect to another in asome"hat related "ay""seness ", ass"ciati"n)incoherent illogical flo" of thoughts#unrelated "ay$Clang ass"ciati"n sound of "ord gi!es direction to the flo" ofthought'elusi"n persistent false belief rigidly held *elusions of grandeur' special 1important in a "ay2ersecutory' threatened Ideas of reference' situation1e!ents in!ol!e them

-omatic' body reacting in a particular "ay 3ealous' thin0ing that their partner is unfaithful Erotomanic' person usually of high status is in lo!e "ith the client ,eligious' illogical ideas about 4od and religion e+hibited by

e+treme or e+traneous beha!iorMi+ed' combination of abo!e "ithout a predominant theme.agical thin)ing primiti!e thought process thoughts alone canchange e!entsAutistic thin)ing regressi!e thought process5 sub.ecti!einterpretations not !alidated "ith ob.ecti!e reality

'ereis! unorganized thin0ing

c&'istur(ances ", a,,ectIna%%r"%riate disharmony bet"een the stimuli and the emotionalreaction#lunte a,,ect se!ere reduction in emotional reaction+lat a,,ect absence or near absence of emotional reactionA%athy dulled emotional tone'e%ers"nali/ati"n feeling of strangeness from one6s self'ereali/ati"n feeling of strangeness to"ards en!ironmentAgn"sia lac0 of sensory stimuli integration

&'istur(ances in !"t"r acti$ityEch"%ra0ia imitation of posture of others*a0y ,le0i(ility maintaining position for a long period of timeAta0ia loss of balanceA)athesia e+treme restlessness'yst"nia) uncoordinated spastic mo!ements of the bodyTari$e ys)inesia in!oluntary t"itching or muscle mo!ementsA%ra0ia in!oluntary unpurposeful mo!ements

e&'istur(ances in !e!"ryC"n,a(ulati"n filling of memory gaps

'23 $u something unfamiliar seems familiar4a!ais $u) something familiar seems unfamiliarA!nesia memory loss #inability to recall past e!ents$

,etrograde)distant pastAnterograde immediate pastAnomia lac0 of memory of items

,&'yna!ics ", Hu!an #eha$i"r7eha!ior the "ay an indi!idual reacts to a certain stimulus&onflict situation arising from the presence of t"o opposing dri!esNeed ) organismic condition that re(uires a certain acti!ity*ynamics of Human 7eha!ior2ersonality

totality of emotional and beha!ioral traits that characterize theperson in day to day li!ing under ordinary conditions5 it is relati!elystable and predictable%

+OR.ATION O+ PERSONAITYTEM2E,AMENT

biological)genetic template that interacts "ith ouren!ironment%a set of in)built dispositions "e are born "ithmostly unalterableour nature%

&HA,A&TE,the outcome of the process of socialization the acts and

imprints of our en!ironment and nurture on our psyche during theformati!e years #8)9 years and in adolescence$%

the set of all ac(uired characteristics "e posses often.udged in a cultural)social conte+t%-ometimes the interplay of all these factors results in an abnormalpersonality

THEORIES O+ PERSONAITY 'EVEOP.ENT+reu5sPSYCHOSE6UA THEORY

Libido inner dri!e2arts of body focus of gratification:nsuccessful resolution ) fi+ation

-tructures of personalityId' pleasure principle)instinctEgo' controls action and perception reality principle-uperego' moral beha!ior ) conscience

8);< m8s 5oral mouth trust and discriminating;< mos% = years 5 anal bo"els holding on or letting go

Negati!ism and toilet training age = )9 years phallic 5 genitals e+ploration and disco!ery # inc% se+ualtension$


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4ender identification and genital a"areness>edipus and Electra comple+

&astration an+iety and penis en!y9);? years latency #(uiet stage$ se+ual energy di!erted to play%

Institution of superego' control of instinctual impulses;? young adult genital 5 rea"a0ening of se+ual dri!es relationships

-e+ual maturation-e+ual identity ability to lo!e and "or0

Eric Eric0son6s2-@&H>->&IAL THE>,@

8);?mos T,:-T !s% MI-T,:-T;)=y A:T>N>M@ !s% -HAME *>:7T=)9 IN*:-T,@ !s% IN/E,I>,IT@9);? INITIATIBE !s% 4:ILT;?);< I*ENTIT@ !s% I*ENTIT@ &>N/:-I>N;LATI>N?C)98 E4> INTE4,IT@ !s% -TA4NATI>N98 and abo!e 4ENE,ATIBIT@ !s% *E-2AI,

IN/AN&@

&>N-I-TENT MATE,NAL &HIL* INTE,A&TI>N T,:-TINNE, /EELIN4 >/ -EL/ D>,THH>2E

T>**LE,ALL>D E2L>,ATI>N2,>BI*E />, -A/ET@FN> N>G NE4ATIBI-M>//E, &H>I&E- 1 ,EBE,-E 2-@&H>L>4@T>ILET T,AININ4 ;< M>-%)7>DEL *A@TIME 7LA**E,' ? yo

NI4HTIME 7LA**E,' = yo,EDA,* D1 2,AI-E AN* A//E&TI>N

IN*E2EN*EN&E2,E)-&H>>L

2,>BI*E 2LA@ MATE,IAL--ATI-/@ &:,I>-IT@TEA&H AN* ,EIN/>,&E#H@4IENE->&IAL7EHABI>,$-I7LIN4 ,IBAL,@DILL2>DE,

-&H>>L A4EH>D T> *> THIN4- DELL)-:22>,T E//>,T-&H:M- AN* H>77IE-NEE*- T> E&EL1A&&>M2LI-HNEE* />, 2,IBA&@ AN* 2EE, INTE,A&TI>N&>M2ETEN&E

A*>LE-&EN&EMAE *E&I-I>NEMAN&I2ATI>N /,>M 2A,ENT-7>*@ IMA4E &HAN4E-NEE* T> &>N/>,M 7:T EE2 IN*IBI*:ALIT@-EL/ ) ADA,ENE--

@>:N4 A*:LT&>MMITMENT AN* /I*ELIT@,E-2>N-I7ILIT@A&HIEBEMENT >/ IN*E2EN*EN&E

MI**LE A*:LTH>>*-:22>,T)2E,I>* >/ ,>LE T,AN-ITI>N-MI*LI/E &,I-I-A*3:-TMENT AN* &>M2,>MI-E

M>-T 2,>*:&TIBE AN* &,EATIBEALT,:I-M

LATE A*:LTH>>*-EL/ A&&E2TAN&E-EL/ D>,THDI-*>M

4ean Piaget5sCOGNITIVE THEORY8)? -EN->,IM>T>,

,E/LEE-

IMITATIBE ,E2ETITIBE 7EHABI>,-EN-E >/ >73E&T 2E,MANEN&E AN* -EL/-E2A,ATE /,>M ENBT%T,IAL AN* E,,>, ,E-:LT- IN 2,>7LEM ->LBIN4

?)@ 2,E)>2E,ATI>NAL-EL/)&ENTE,E*E4>&ENT,I&&ANN>T &>N&E2T:ALIJE >THE,6- BIEDANIMI-TI& THININ4IMA4INA,@ 2LA@MATE -@M7>LI& MENTAL,E2,E-ENTATI>N &,EATIBIT@?)K 2,E)&>N&E2T:AL #2,E)L>4I&AL$K) INT:ITIBE #:N*E,-TAN*IN4 >/ ,>LE-$

);?@ &>N&,ETE >2E,ATI>NALL>4I&AL &>N&,ETE TH>:4HTIN*:&TIBE ,EA->NIN4 #-2E&I/I& T> 4ENE,AL$&AN ,ELATE 2,>7LEM ->LBIN4 A7ILIT@,EA->NIN4 AN* -EL/),E4:LATI>N

;?)A7>BE' />,MAL >2E,ATI>NAL TH>:4HTAbstract thin0ing-eparation of fantasy and fact,eality oriented*educti!e reasoningApply scientific method

Ha$ighurst5s'EVEOP.ENTA TAS7S

7aby to early childhood,ight from "rong and &onscience

Late childhood2hysical s0ills "holesome attitude social roles&onscience morality and !alues/undamental s0ills in academics2ersonal independence

Adolescence-e+ual social roles,elationships

Independence and ideologyEarly adulthood

&areer-electing a mate/inding &i!ic or social responsibility

Middle ageAchie!ing &i!ic or social responsibilityAd.usting to changes-atisfactory career performanceAd.usting to aging parentsAd.usting to parental roles

>ld ageAd.usting to changesEstablishing satisfactory li!ing arrangements andaffiliations

7"hl(erg5s.ORA 'EVEOP.ENT8 THIN7ING8 4U'GE.ENT

2,E)&>NBENTI>NAL #8)9$2:NI-HMENT AN* >7E*IEN&E>7E*IEN&E T> ,:LE- T> AB>I* 2:NI-HMENT

&>NBENTI>NAL # 9);? $M:T:AL INTE,2E,->NAL E2E&TATI>N-,ELATI>N-HI2- AN* &>N/>,MIT@->&IAL -@-TEM AN* &>N-&IEN&E MAINTENAN&E7EIN4 4>>* I- IM2>,TANT -EL/ ,E-2E&T >,

&>N-&IEN&E2>-T &>NBENTI>NAL #;? ;< @$

2,I>, ,I4HT >, ->&IAL &>NT,A&T:NIBE,-AL ETHI&AL 2,IN&I2LEA7I*E />, &>MM>N 4>>*,ATI>NAL 2E,->N)BALI*IT@ >/ 2,IN&I2LE-)AN*7E&>ME &>MMITTE* T> THEMINNE, &>NT,>L >/ 7EHABI>, :N*E,-TAN*IN4THE E:ALIT@ >/ H:MAN ,I4HT- AN* *I4NIT@ >/H:MAN 7EIN4- A- IN*IBI*:AL-


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Harry Stac) Sulli$an5sINTERPERSONA THEORY

IN/AN&@NEE* />, -E&:,IT@)IN/ANT LEA,N- T> ,EL@ >N

>THE,- T> 4,ATI/@ NEE*- AN* -ATI-/@ DI-HE-*EBEL>2- A -EN-E >/ 7A-I& T,:-T -E&:,IT@ AN* -EL/D>,TH DHEN THI- >&&:,-

T>**LE,H>>* 1 EA,L@ &HIL*H>>*&HIL* LEA,N- T> &>MM:NI&ATE NEE*- TH,>:4H

:-E >/ D>,*- AN* A&&E2TAN&E >/ *ELA@E*4,ATI/I&ATI>N AN* INTE,/E,EN&E >/ DI-H /:L/ILLMENT

2,E)-&H>>L*EBEL>2MENT >/ 7>*@ IMA4E AN* -EL/)2E,&E2TI>N>,4ANIJE- AN* :-E- E2E,IEN&E- IN TE,M- >/A22,>BAL AN* *I-A22,>BAL ,E&EIBE*7E4IN- :-IN4 -EL&TIBE INATTENTI>N AN**I-A-->&IATE- TH>-E E2E,IEN&E- THAT &A:-E2H@-I&AL >, EM>TI>NAL *I-&>M/>,T AN* 2AIN

-&H>>L A4ETHE 2E,I>* >/ LEA,NIN4 T> />,M -ATI-/@IN4,ELATI>N-HI2- DITH 2EE,-):-E-&>M2ETITI>N&>M2,>MI-E AN* &>>2E,ATI>NTHE 2,E)A*>LE-&ENT LEA,N- T> ,ELATE T>2EE,- >/ THE -AME -E

A*>LE-&EN&ELEA,N- IN*E2EN*EN&E AN* H>D T> E-TA7LI-H-ATI-/A&T>,@ ,ELATI>N-HI2- DITH MEM7E,- >/THE >22>-ITE -E

@>:N4 A*:LTH>>*7E&>ME- E&>N>MI&ALL@ INTELLE&T:ALL@ AN*EM>TI>NALL@ -EL/ -:/I&IENT

LATE, A*:LTH>>*LEA,N- T> 7E INTE,*E2EN*ENT AN* A--:ME-,E-2>N-I7ILIT@ />, >THE,--ENE-&EN&E*EBEL>2- AN A&&E2TAN&E >/ ,E-2>N-I7ILIT@/>, DHAT LI/E I- AN* DA- AN* >/ IT- 2LA&E INTHE /L>D >/ HI-T>,@

TREAT.ENT .O'AITIES,EM>TIBATI>N THE,A2@

T,EATMENT M>*ALIT@ THAT 2,>M>TE-E2,E--I>N >/ /EELIN4- TH,>:4H INTE,A&TI>N/A&ILITATE* 7@ *I-&:--I>N >/ NE:T,AL T>2I&-

-TE2- ' climate of acceptance creating bridge to reality sharing the "orld "e li!e in appreciation of "or0s of the "orld climate of appreciationM:-I& THE,A2@

In!ol!es use of music to facilitate e+pression of feelingsrela+ation and outlet of tension

2LA@ THE,A2@enables patient to e+perience intense emotion in a safeen!ironment "ith the use of playchildren e+press themsel!es more easily in play% re!ealingas reflection of child6s situation in the family

pro!ide toys and materials facilitate interaction obser!e and help child resol!e problems through play

4roup therapyTreatment modality in!ol!ing three or more patients "ith atherapist to relie!e emotional difficulties increase self esteem de!elop insight LEA,N NED A*A2TIBE DA@-T> &>2E DITH -T,E-- and impro!e beha!ior "ithothersI*EAL < ;8 MEM7E,-

MILIE: THE,A2@

&onsists of treatment by means of controlled modificationof the patient6s en!ironment to facilitate positi!e beha!ioralchangeIncrease patient6s

A"areness of feelings-ense of responsibility andHelp return to community

clients plan social and group interactionto0en programs open "ards and self medication aredone

/AMIL@ THE,A2@A METH>* >/ 2-@&H>THE,A2@ DHI&H />&:-E->N THE T>TAL /AMIL@ A- AN INTE,A&TI>NAL-@-TEM2,>7LEM I- A /AMIL@ 2,>7LEMfocus on sic0 members beha!ior as source of trouble 1symptom ser!e a function for the familymembers de!elop sense of identitypoints out function of the sic0 member for the rest of thefamily

2-@&H>ANAL@TI&focuses on the e+ploration of the unconscious to facilitateidentification of the patients defenses

ANIET@ ,E-:LT- 7ETDEEN &>N/LI&T- >/ I* AN*E4>7ecomes a"are of unconscious thoughts and feelings tounderstand an+iety and defenses

H@2N>THE,A2@Barious methods and techni(ues to induce a trance state

"here patient becomes submissi!e to instructions7EHABI>, M>*I/I&ATI>N

Application of learning principles in order to changemaladapti!e beha!ior7elie!es that psychological problems are a result oflearningE!erything learned can be unlearned

7EHABI>, M>*I/I&ATI>N>2E,ANT &>N*ITI>NIN4

:se of re"ards to reinforce positi!e beha!ior2ercei!ed and self)reinforcement becomesmore important than e+ternal reinforcement

*E-EN-ITIJATI>N-lo" ad.ustment or e+posure to feared ob.ects#phobias$2eriodic e+posure until undesirable beha!ior

disappears or lessensABE,-I>N THE,A2@

An e+ample of beha!ior modification2ainful stimulus is introduced to bring about an a!oidanceof another stimulusEnd !ie"' beha!ioral change

>THE, THE,A2IE-H:M>, THE,A2@

To facilitate e+pression and enhance interactionA&TIBIT@ THE,A2@

4roup interaction "hile "or0ing on a tas0 together

7I>L>4I&AL1 ME*I&AL THE>,@EM>TI>NAL 2,>7LEM I- AN ILLNE--cause may be inherited or chemical in origin/>&:- >/ T,EATMENT I- ME*I&ATI>N- AN* E&T

7I>L>4I&AL THE,A2@ELE&T,>&>NB:L-IBE THE,A2@

Artificial induction of a grand mal seizure bypassing a controlled electrical current throughelectrodes applied to one or both templesmechanism of action unclear!oltage' 8 ;C8 !olts*uration' 8%C ?%8 seconds9 to ;? treatmentsinter!als of K< hours

indicators of effecti!eness occurrence of generalizedtonic clonic seizures


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indications depression mania and catatonicschizophrenias1e' confusion disorientation short )term memory lossseizure #=8)98 sec$N2> prior&ontraindications

/e!er pregnancyInc I&2 fractureretinal detachmentT7 "ith hemoptysiscardiac d1o

consent needed,eorient after supporti!e caremedications gi!en '

Atropine sulfate' decrease secretions-uccinylcholine #Anectine$' promote musclerela+ationMethohe+ital -odium # 7re!ital $' ser!es as ananesthetic agent

common complications'loss of memoryheadacheapnea

fracture)respiratory depression

NOTES VI - PSYCHIATRIC NURSING PART 9

Psych"%har!ac"l"gic Thera%y

#en/"ia/e%inesIndications

An+iety-edation1sleepMuscle spasm

-eizure disorderAlcohol "ithdra"al syndromesAnti-an0iety rugs 4eneric Trade nameAlprazolam ana+&hlordiazepo+ide Librium&lorazepate Tran+ene*iazepam BaliumLorazepam Ati!an>+azepam -era+7usipirone 7u-par

-ide effects*ro"siness1 sedation

Ata+ia/eelings of detachmentIncrease irritability and hostilityAnterograde amnesiaIncreased appetite "eight gainNauseaHeadache confusion

Anti-e%ressantsIndications

*epression7ipolar depression2anic disorder7ulimia

>bsessi!e)compulsi!e d1o2ossibly

Attention deficit1Hyperacti!ity d1o2ost Traumatic -tress *1o&onduct d1o

Tricyclic :TCA& 4eneric Trade nameAmitriptyline Ela!ilImipramine TofranilTrimipramine -urmontilNortriptyline 2amelor

Trazodone *esyrel7upropion Dellbutrin

-ide effects>rthostatic hypertensionAnticholinergic effect

*ry mouth blurred !ision constipation e+cessi!es"eating urinary hesitancy1 retention tachycardiaagitation delirium e+acerbation of glaucoma

Neurologic effectssedation psychomotor slo"ing poor concentrationfatigue ata+ia tremors

*ecrease libido and se+ual performance

."n"a!ine O0iase inhi(it"rs 4eneric Trade nameIsocarbo+azid Marplan2henelzine NardilTranylcypromine 2arnate

-ide effects2ostural lightheadedness&onstipation

*elay e.aculation or orgasmMuscle t"itching*ro"siness*ry mouth

*ietary restrictions&heese esp% aged and matured/ermented or aged protein2ic0led or smo0ed fish7eer red "ine sherry5 li(uor cognac@east/a!a or broad beans7eef or chic0en li!er

-poiled1 o!erripe fruits5 banana peelyogurt

Hy%ertensi$e Crisis-igns

-udden ele!ation of 72E+plosi!e headache occipital may radiate frontallyHead face flushed2alpitations chest pain-"eating fe!erNausea !omiting*ilated pupils photophobiaIntracranial bleeding

TreatmentHold ne+t MA> dose*on6t let pt% lie do"nIM chlorpromazine ;88 mg/e!er' manage by e+ternal cooling techni(ues

Ser"t"nin Reu%ta)e Inhi(it"rs 4eneric Trade name/luo+etine 2rozac-ertraline Joloft2aro+etine 2a+ilBenlafa+ine Effe+or

-ide effectsNausea *iarrhea

Insomnia *ry mouthNer!ousness HeadacheMale se+ual dysfunction *ro"siness*izziness -"eating

."" sta(ili/ing rugsIndications

Acute mania7ipolar prophyla+is

2ossibly


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7ulimiaAlcohol abuseAggressi!e beha!iorschizoaffecti!e

Mode of actionNormalizes the reupta0e of certain neurotransmitters suchas serotonin norepinephrine acetylcholine and dopamine,educes the release of norepinephrine thru competition

"ith calciumEffects intracellularly

Lag period' );8 to ;K days

ithiu! car("nateTrade names

Es0alithLithotabsLithaneLithonate

M>A' unclear5 interfere "ith metabolism of neurotransmitters5 alterNa transport in ner!es and muscle cells2relithium "or0up

:rinalysis #7:N and creatinine$

E&4 /7& &7&-ide effectsEarly

Nausea and diarrheaAnore+ia/ine hand tremor #propranolol$Thirst 2olydipsia #dec% crea inc% albumin$Metallic taste/atigueLethargy

LateDeight gainacne

&ontraindications7rain damage1 &B diseaseEpilepsyElderly1 debilitatedThyroid and renal disease-e!ere dehydration2regnancy #;sttrimester$&an augment the effects of anti)depressants

Nursing considerationsTherapeutic serum le!el' 8%C ;%? me(1LMaintenance le!el' 8%9 );%? me(1LTo+ic

Mild to moderate' ;%C to ? me(1LModerate to se!ere' ? ?%C me(1LNeeds dialysis' = me( and abo!e

Early signs of to+icityLethargy mild nausea !omiting fine hand tremorsanore+ia polyuria polydipsia metallic taste fatigue

Late signs of to+icityAta+ia giddiness tinnitus blurred !ision polyuria

Nursing considerationsLithium le!els should be chec0ed ( ?)= mos-erum dra"n in the AM ;?H after last dose&ommon causes of inc% le!els

*ec% Na inta0e

*iuretic therapy*ec% renal functioning/E lossMedical illness>!erdoseN-AI*-

Nursing considerations*iet' ade(uate Na and fluid

=g Na&l1 day9)< glasses of H?>

No caffeineNo dri!ing' "ait for clinical effectManagementModerately se!ere to+icity

>smotic diuresis' urea1 mannitolAminophylline 2L, IBAde(uate Na&l2eritoneal1 hemodialysis

-e!ere to+icityAssess h+ (uic0lyHold ne+t lithium dose&hec0 72 rectal T ,, L>& support >?>btain labsE&4Emetic N4T la!ageHydrate' C)9L1day c 2L,5 /7&)&*:

>ther drugs&arbamazepine #Tegretol$

-ide effects*izzines Ata+ia&lumsiness -edation*ysarthria *iplopiaNausea 4I upset

2reparation' li( tab che"able tab

Nursing considerationsAssess drug le!els ( =)K daysMonitor salt and fluid inta0eA!oid alcohol and non)prescription drugs,efer dec% in :>*on6t stop abruptly&1I' pregnancyTa0e "ith meals

>ther drugsBalproic acid #*epa0ote *epa0ene$

-ide effectsNausea Hepato+icityNeuroto+icity Hematological to+icity2ancreatitis

2rep' tab cap sprin0lesM>A' inc% le!els of 4A7A5 inhibits the kindlingprocess or FsnoballG)li0e effect seen in mania seizures

Nursing considerationsTherapeutic le!el' C8 ;88 ug1mL*ose' ; 888 ;C88 mg1dayMonitor serum le!els ;?H after last doseTo+ic effects

-e!ere diarrhea !omiting dro"siness mm% "ea0nesslac0 of coordination,enal failure coma death

Anti-%sych"tic rugsIndications

2sychotic symptoms of schizophrenia acute mania anddepression4illes de Tourette disorderTreatment)resistant bipolar disorderHuntington6s disease and other mo!ement disorder

2ossibly2aranoid&hildhood psychoses

M>A' bloc0 receptors of dopamine #*? *= *K$If unresponsi!e after 9 "ee0s of therapy another class is tried4eneral considerations

&alms "ithout producing impairment of sleepHigh therapeutic inde+Non addicting no toleranceA!oided in pregnancy

TYPICA; High P"tency/luphenazine #2roli+in$Haloperidol #Haldol$


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Thiothe+ene #Na!ane$Trifluoperazine #-telazine$Moderate 2otencyLo+apine #Lo+itane$Molindone #Moban$2erphenazine #Trilafon$

"< P"tency&hlopromazine #Thorazine$&hlorprothi+ene #Taractan$Mesoridazine #-erentil$Thioridazine #Mellaril$

ATYPICA&lozapine #&lozaril$,esperidone #,isperdal$>lanzapine #Jypre+a$uetiapine #-ero(uel$-ertindole #-erlec6t$Jiprasidone #Jeldo+$

&ontraindications&N- depression' brain damage e+cess alcohol1 narcotics2ar0inson6s diseaseAllergy

7lood dyscrasiasAcute narro" angle glaucoma72H

-ide effectsHypotension-edation*ermal and ocular syndromeNeuroleptic malignant syndromeAnticholinergic syndromeMo!ement syndrome #E+trapyramidal -yndrome$Atropine psychosisAgranulocytosis

-eizures

Neur"le%tic .alignant Synr"!eA potentially fatal idiosyncratic reaction to an antipsychotic drug;8)?8O mortality rate-+'

rigidityhigh fe!erautonomic instability #72 diaphoresis pallor deliriumele!% &2$ confused or mute fluctuate from agitation tostupor

>ccurs in the first ? "ee0s of therapy,is0' high dose of high)potency drugs5 dehydration poor n+concurrent med illness

Mo!ement -yndromesA0athisia*ystoniaTardi!e dys0inesia7rady0inesia2ar0insonism

>ther s1eAtropine psychosis #geriatrics$

Hyperacti!ity agitation confusion flushed s0in sluggishreacti!e pupilsTTT' IM physostigmine

Agranulocytosis #&lozapine$>ccurs =)< "0s afterMedical emergencys1s' fe!er malaise sore throat leu0openiaTTT' d1c re!erse iso antibiotics

-eizures #&lozapine$>ccurs in CO of patients5 TTT' *1c drug

Antich"linergics7enztropine #&ogentin$

Trihe+yphenidyl #Artane$7iperiden #A0ineton$2rocyclidine #emadrin$

Not "ithdra"n abruptly2ro!ide cool en!ironment

ANTIPAR7INSONIAN .E'ICATIONSAd.unct to anti)psychotic agents to balance dopamine1 acetylcholinein the brains1e' glaucoma tachycardia H2N cardiac d+ asthma duodenalulcerA1e' blurred !ision photosensiti!ity dro"siness orthostatichypotension &H/ hallucinations&>MM>N *,:4-'Trihe+yphenidyl #Artane$benztropine #&ogentin$7iperiden #&ogentin$-elegiline #Eldepryl$2ergolide #2erma+$ANTIHI-TAMINE*iphenhydramine H&l #7ENA*,@L$*>2AMINE ,ELEA-IN4 A4ENT

Amantadine #-@MMET,EL$

Nursing considerations7est ta0en after mealsA!oid dri!ing&hec0 72Alcohol increases sedati!e effectsA!oid sudden position change*rug is not "ithdra"n abruptly

N>TE- BI ) 2-@&HIAT,I& N:,-IN4 2A,T =

PSYCHIATRIC 'ISOR'ERS

AN6IETY 'ISOR'ERS

PANIC DISORDERS SPECIFIC PHOBIA SOCIAL PHOBIA OCD PTSD ACUTE STRESS DISORDER GENERALIZED ANXIETY DISORDER

2ANI& ATTA&-

*I-&,ETE 2E,I>* >/ INTEN-E /EA, >, *I-&>M/>,T INDHI&H AT LEA-T K I/ THE // - *EBEL>2 A7,:2TL@ AN*

2EA DITHIN ;8 MIN-'

2alpitations pounding heart or accelerated H,

-"eating

Trembling or sha0ing

-ensations of ->7 and smothering

/eeling of cho0ing

&hest pain or discomfort

Nausea or abd% 2ain

/eeling dizzy unsteady lightheaded or faint

*erealization or depersonalization


7/18

/ear of losing control or going crazy

/ear of dying

2aresthesias

&hills or hot flashes

SPECIFIC PHOBIA SOCIAL EXCESSIVE AND UNREASONABLE CUED BY

THE PRESENCE OR ANTICIPATION OF ASPECIFIC OBJECT OR SITUATION DEFENSE MECH COMMONLY USEDINCLUDE REPRESSION AND DISPLACEMENT FEAR OF SOCIAL PERFORMANCESITUATIONS IN WHICH THE PERSON ISEXPOSED TO UNFAMILIAR PEOPLE OR TOPOSSIBLE SCRUTINY BY OTHERSOBSESSION COMPULSION

RECURRENT AND PERSISTENT THOUGHTS,IMPULSES, OR IMAGES ARE EXPERIENCEDDURING THE DISTURBANCE AS INTRUSIVEAND INAPPROPRIATE CAUSE ANXIETY OR DISTRESS PX KNOWS THAT THESE ARE JUSTPRODUCT OF ONES OWN MIND PX FEELS DRIVEN TO PERFORMREPETITIVE BEHAVIORS OR MENTAL ACTS INRESPONSE TO OBSESSION OR ACCORDING

TO THE RULES THAT ONE DEEMS MUST BEAPPLIED RIGIDLY

AIMED AT REDUCING ANXIETY OBSESSION COMPULSION FEAR OF DIRT ! GERMS FEAR OF BURGLARY OR ROBBERY WORRIES ABOUT DISCARDINGSOMETHING IMPORTANT CONCERNS ABOUT CONTRACTING ASERIOUS ILLNESS WORRIES THAT THINGS MUST BESYMMETRICAL OR MATCHING EXCESSIVE HAND WASHING REPEATED CHECKING OF DOOR AND

WINDOW LOCKS COUNTING AND RECOUNTING OFOBJECTS IN EVERYDAY LIFE HOARDING OF OBJECTS EXCESSIVE STRAIGHTENING, ORDERING,OR OF ARRANGING THINGS REPEATING WORDS OR PRAYERSSILENTLY

POST TRAU.ATIC STRESS SYN'RO.E

2E,->N HA- E2E,IEN&E* DITNE--E* >, 7EEN

&>N/,>NTE* DITH AN EBENT THAT INB>LBE* A&T:AL >,

TH,EATENE* *EATH >, -E,I>:- IN3:,@ >, A TH,EAT T>

2H@-I&AL INTE4,IT@

2E,->N ,EE2E,IEN&E- THE-E IN THE MIN*

INB>LBE- INTEN-E /EA, HEL2LE--NE-- >, H>,,>,AN* N:M7IN4 >/ 4ENE,AL ,E-2>N-IBENE-- #2-@&HI&

N:M7IN4$

A&:TE 4ENE,ALIJE*

-T,E-- ANIET@

MEET- THE &,ITE,IA />, E2>-:,E T> A T,A:MATI&

EBENT AN* 2E,->N E2E,IEN&E- = >/ THE // -'

sense of detachment

reduced a"areness of one6s surroundings

derealization

depersonalization

dissociated amnesia

E&E--IBE ANIET@ >, D>,,@ >&&:,,IN4 IN M>,E

*A@- THAN N>T />, AT LEA-T 9 M>- A7>:T A N:M7E, >/

EBENT- >, A&TIBITIE-

/IN*- IT *I//I&:LT T> &>NT,>L THE D>,,@

.OO'8 A++ECTIVE 'ISOR'ERS

7I2>LA, *1>

7I2>LA, I' current or past e+perience of manic episode lasting

at least a "ee0 that is se!ere enough to cause e+treme impairment

in social or occupational functioning%

MANIA: hyperactivity

DEPRESSED: extreme sadness or ithdraal

MIXED

7I2>LA, II' h+ of ; or more m. depressi!e episodes at least ;

hypomanic episode5 no mania

= .A4OR 'EPRESSIVE '8O

P least C s+ of same ?) "0 period "ith one being either

depressed mood or loss of interest or pleasure%

-ingle episode or recurrent

>ther s+' "t loss insomnia fatigue recurrent thoughts of death

diminished ability to thin0 psychomotor agitation or retardationfeelings of "orthlessness%

= CYCOTHY.IC '8O

H+ of ? yrs of hypomania "ith numerous periods of abnormally

ele!ated e+pansi!e or irritable moods%

*oes not meet the criteria of mania or depression%


8/18

= 'YSTHY.IC '8O

P least ? yrs of usually depressed mood and at least ; of the s+

of m. depression "ithout meeting the criteria for it

= SEASONA A++ECTIVE '8O

*epression that comes "ith shortened daylight in fall and "inter

that disappears during spring and summer%

*ealing "ith Inappropriate 7eha!iors

A44,E--IBE 7EHABI>,

A--I-T THE &LIENT IN I*ENTI/@IN4 /EELIN4- >/

/,:-T,ATI>N AN* A44,E--I>N

EN&>:,A4E THE &LIENT T> TAL >:T IN-TEA* >/ A&TIN4

>:T /EELIN4- >/ /,:-T,ATI>N

A--I-T THE &LIENT IN I*ENTI/@IN4 2,E&I2ITATIN4

EBENT- >, -IT:ATI>N- THAT LEA* T> A44,E--IBE

7EHABI>,

*E-&,I7E THE &>N-E:EN&E- >/ THE 7EHABI>, >N

-EL/ AN* >THE,-

A--I-T IN I*ENTI/@IN4 2,EBI>:- &>2IN4 ME&HANI-M-

A--I-T THE &LIENT IN THE 2,>7LEM)->LBIN4

TE&HNI:E- T> &>2E DITH /,:-T,ATI>N >, A44,E--I>N

*EE-&ALATI>N TE&HNI:E-

MAINTAIN -A/ET@

MAINTAIN LA,4E 2E,->NAL -2A&E AN* :-E

N>NA44,E--IBE 2>-T:,E

:-E &ALM A22,>A&H AN* &>MM:NI&ATE DITH A &ALM

&LEA, T>NE >/ B>I&E #7E A--E,TIBE N>T A44,E--IBE

*ETE,MINE DHAT THE &LIENT &>N-I*E,- T> 7E HI- >,

HE, NEE*

AB>I* BE,7AL -T,:44LE-

2,>BI*E &LEA, >2TI>N- THAT *EAL DITH 7EHABI>,

A--I-T DITH 2,>7LEM)->LBIN4 AN* *E&I-I>N MAIN4

,E4A,*IN4 THE >2TI>N-

.ANIPUATIVE #EHAVIORS

-ET &LEA, &>N-I-TENT ,EALI-TI& AN* EN/>,&EA7LELIMIT- AN* &>MM:NI&ATE E2E&TE* 7EHABI>,- 7E &LEA, A7>:T &>N-E:EN&E- A-->&IATE* DITHE&EE*IN4 -ET LIMIT- *I-&:-- 7EHABI>, IN N>N3:*4MENTAL AN*N>NTH,EATENIN4 MANNE, AB>I* 2>DE, -T,:44LE-

A--I-T IN *EBEL>2IN4 MEAN- >/ -ETTIN4 LIMIT- >N>DN 7EHABI>,

SCHI>OPHRENIA

&HA,A&TE,IJE* 7@ IM2AI,MENT- IN THE 2E,&E2TI>N >,E2,E--I>N >/ ,EALIT@ AN* 7@ -I4NI/I&ANT ->&IAL >,>&&:2ATI>NAL *@-/:N&TI>N% >N&E &>N-I*E,E* A- A *EA*L@ *I-EA-E THE,E I- LA& >/ IN-I4HT IN 7EHABI>, *' LATE A*>LE-&EN&E AN* EA,L@ A*:LTH>>* ;C)?C y%o% #men$5 ?C)=C y%o% #"omen$ >7->LETE TE,M' *EMENTIA 2,AE&> Q F&>4NITIBE*ETE,I>,ATI>N EA,L@ IN LI/EG E:4ENE 7LE:LE,' -&HIJ F-2LITG5 2H,EN FMIN*G

Ris) ,act"rs

GENETICS' I*ENTI&AL TDIN- C8O ;CO />, /,ATE,NAL

TDIN-

#IOCHE.ICA +ACTORS

*opamine hypothesis' o!eracti!e

-erotonin imbalance

*ecreased brain !olume enlarged !entricles deeper

fissures and loss or underde!eloped brain tissue

= PSYCHOANAYTIC

lac0 of trust during the early stages Dea0 ego *efenses' ,E2,E--I>N ,E4,E--I>N 2,>3E&TI>N

ENVIRON.ENT IN+UENCES' 2>BE,T@ LA& >/ ->&IAL

-:22>,T H>-TILE H>ME ENBI,>NMENT I->LATI>N:N-ATI-/A&T>,@ H>:-IN4 *I-,:2TI>N IN

INTE,2E,->NAL ,ELATI>N-HI2- #*IB>,&E >, *EATH$

3>7 2,E--:,E >, :NEM2L>@MENT

Su(ty%es

CATATONIC TYPE prominent psychomotor disturbances are

e!ident% -ymptoms can include catatonic stupor and "a+y fle+ibili ty

*I->,4ANIJE* T@2E

"here thought disorder and flat affect are present together

2A,AN>I* T@2E

"here delusions and hallucinations are present but thought

disorder disorganized beha!ior and affecti!e flattening are absent

,E-I*:AL T@2E

"here positi!e symptoms are present at a lo" intensity only

:N*I//E,ENTIATE* T@2E

psychotic symptoms are present but the criteria for paranoid

disorganized or catatonic types has not been met

-ymptoms

A&&>,*IN4 T> 7LE:LE,' K A6-

Affect is inappropriate


9/18

Associati!e looseness

Autistic thin0ing

Ambi!alence

-ymptoms

2>-ITIBE -@M2T>M-

delusions auditory hallucinations and thought disorder and are

typically regarded as manifestations of psychosis%

NE4ATIBE -@M2T>M-

considered to be the loss or absence of normal traits or abilities

E%4% flat blunted or constricted affect and emotion po!erty of

speech and lac0 of moti!ation

-ymptoms

->&IAL I->LATI>N

&ATAT>NI& 7EHABI>,

HALL:&INATI>N- IN&>HE,EN&E #MA,E* L>>-ENE-- >/ A-->&IATI>N$ JE,>1 LA& >/ INTE,E-T ENE,4@ AN* INITIATIBE >7BI>:- /AIL:,E T> ATTAIN E2E&TE* LEBEL >/ *EB6T 2E&:LIA, 7EHABI>,

H@4IENE AN* 4,>>MIN4 IM2AI,E* ,E&:,,ENT ILL:-I>N- AN* :N:-:AL 2E,&E2TI>NE2E,IEN&E- EA&E,7ATI>N- AN* ,EMI--I>N- A,E &>MM>N N> >,4ANI& /A&T>,- A&&>:NT- />, THE -@M2T>M- INA7ILIT@ T> ,ET:,N T> 7A-ELINE /:N&TI>NIN4 A/TE,,ELA2-E A//E&T I- INA22,>2,IATENsg *+' Abnormal thought process 7L>&IN4' -:**EN &E--ATI>N >/ A TH>:4HT IN THEMI**LE >/ A -ENTEN&E :NA7LE T> &>NTIN:E THE T,AIN>/ TH>:4HT &I,&:M-TANTIALIT@' 7E/>,E 4ETTIN4 T> THE 2>INT >/

AN-DE,IN4 A :E-TI>N THE IN*IBI*:AL 4ET- &A:4HT :2IN &>:NTLE-- *ETAIL- AN* E2LANATI>N- &>N/A7:LATI>N L>>-ENE-- >/ A-->&IATI>N NE>L>4I-M D>,* -ALA*

Inter$enti"ns A--E-- 2H@-I&AL NEE*- -ET LIMIT- MAINTAIN -A/ET@ INITIATE >NE)>N)>NE INTE,A&TI>N 2,>4,E-- T>-MALL 4,>:2- -2EN* TIME DITH &LIENT- M>NIT>, />, ALTE,E* TH>:4HT 2,>&E-- MAINTAIN E4> 7>:N*A,IE- AB>I* T>:&HIN4 LIMIT TIME >/ INTE,A&TI>N 7E NE:T,AL *> N>T MAE 2,>MI-E- THAT &AN6T 7E E2T E-TA7LI-H *AIL@ ,>:TINE- *> N>T F4> AL>N4G DITH THE &LIENT6- *EL:-I>N- >,HALL:&INATI>N- 2,>BI*E -IM2LE &>M2LETE A&TIBITIE-

,E>,IENT -2EA T> THE &LIENT IN -IM2LE *I,E&T AN* &>N&I-EMANNE, -ET ,EALI-TI& 4>AL- E2LAIN EBE,@THIN4 THAT I- 7EIN4 *>NE *E&,EA-E -TIM:LI M>NIT>, />, -:I&I*E ,I- ENBI,>NMENT

2ro!ide safe en!ironment

Limit stimuli

2-@&H>L>4I&AL TTT

7eha!ior therapy

-ocial s0ills training

-elf)monitoring

->&IAL TTT

Milieu therapy

/amily therapy

4roup therapy #long)term ttt$

,elated psychotic disorders

-&HIJ>A//E&TIBE *I->,*E, -&HIJ M>>* *I->,*E,

#MANIA1 *E2,E--I>N$

7,IE/ 2-@&H>TI& *I->,*E, -:**EN >N-ET >/

2-@&H>TI& -@M2T>M- LA-T- LE-- THAN ? M>- AN*

&LIENT ,ET:,N- T> 2,EM>,7I* LEBEL >/ /:N&TI>NIN4

-&HIJ>2H,ENI/>,M *I->,*E, -&HIJ - LA-TIN4

7ETDEEN ; M>NTH AN* R9M>-

*EL:-I>NAL *I->,*E, &HA,A&TE,IJE* 7@ 2,>MINENT

N>N7IJA,,E *EL:-I>N-

PERSONAITY 'ISOR'ERS

&L:-TE, A #>** E&&ENT,I&$ paranoid schizoid schizotypal

&L:-TE, 7 #7A* *,AMATI& E,,ATI&$ antisocial borderline histrionic narcissistic

&L:-TE, & #ANI>:- /EA,/:L$ a!oidant dependent >&*

CUSTER A; O'' ? ECCENTRIC= PARANOI'

chronic hostility pro.ected to others5 suspicious andmistrusts people

-een mostly in men

= SCHI>OI' social detachment Q FlonerG Fintro!ertG ,estriction of emotions Attention fi+ed on ob.ects rather than people /unctions "ell in !ocations


10/18

-&HIJ>T@2AL' INTE,2E,->NAL *E/I&IT- Magical thin0ing telepathy Apparent in childhood or adolescence

Inter$enti"ns ,"r PARANOI' '8O A--E- />, -:I&I*E ,I- AB>I* *I,E&T E@E &>NTA&T E-TA7LI-H T,:-TIN4 ,ELATI>N-HI2 2,>M>TE IN&,EA-E* -EL/)E-TEEM ,EMAIN &ALM N>NTH,EATENIN4 AN* N>N3:*4MENTAL 2,>BI*E &>NTIN:IT@ >/ &A,E ,E-2>N* H>NE-TL@ T> THE &LIENT />LL>D TH,: >N &>MMITMENT- 2,>BI*E A *AIL@ -&HE*:LE >/ A&TIBITIE- 4,A*:ALL@ INT,>*:&E &LIENT T> 4,>:2- *> N>T A,4:E DITH *EL:-I>N- :-E &>N&,ETE -2E&I/I& D>,*- *o not be secreti!e "ith client *> N>T DHI-2E, IN 2,E-EN&E >/ &LIENT A--:,E THAT THE &LIENT DILL 7E -A/E 2,>BI*E >22>,T:NIT@ T> &>M2LETE -MALL TA-- M>NIT>, EATIN4 *,ININ4 -LEE2IN4 AN* ELIMINATI>N2ATTE,N-

LIMIT 2H@-I&AL &>NTA&T M>NIT>, />, A4ITATI>N AN* *E&,EA-E -TIM:LI A-NEE*E*

CUSTER #; ERRATIC@ 'RA.ATIC@ OR E.OTIONA= ANTISOCIA

-yn' sociopath psychopathic semantic d1o Etiology' !enetics inter"ere in the dev#t o" positive interpersonal relationships

$rain damage or tra%ma

&o socioeconomic stat%s

'a%lty "amily relationships: neglect

Secondary gains

;C)K8 y%o%

SI!NS

Lac0 of remorse or indifference to persons hurt

Immediate gratification

/ailure to accept social norms

Impulsi!ity

&onsistent irresponsibility

Aggressi!e beha!ior

,ec0less beha!ior that disregards the safety of others

/ ALL &,IME I- &>MMITTE* 7@ ANTI->&IAL-

#NIHM ?888$

= #OR'ERINE

Latent ambulatory and aborti!e schizophrenics

7et"een moderate neurosis and fran0 psychosis but

(uite stable

Theories

"a%lty separation "rom mother( parent and child are )o%nd )y g%ilt

*ra%ma at +, mos -eakening o" ego.

/n"%l"illed need "or intimacy

-I4N- instability Impulsi!ity' unpredictable gambling shoplifting se+ substance

abuse hypersensiti!ity self)destructi!e profound mood shifts unstable intense relations *isturbance in self concept &>MM>N IN D>MEN *E/EN-E-' *ENIAL 2,>3E&TI>N -2LITTIN4 2,>3E&TIBEI*ENTI/I&ATI>N= HISTRIONIC

2attern of theatrical or o!ertly dramatic beha!ior -igns *iscomfort "hen the client isn6t the center of attention -elf)dramatization and e+aggerated emotions

uses physical appearance se+ually seducti!e and pro!ocati!ebeha!ior E+cessi!ely impressionistic speech lac0ing in detail #labileemotions$ 2roblems in dependence helplessness More fre(uent in "omen= NARCISSISTIC E+aggerated or grandiose sense of self)importance *e!elop early in childhood 2reoccupied "ith fantasies of unlimited success po"er andbeauty -igns arrogance need for admiration lac0 of empathy seducti!e socially e+ploitati!e manipulati!e >ccurs more in menCUSTER C; AN6IOUS OR +EAR+U= AVOI'ANT -ensiti!e to re.ection criticism humiliation disappro!al or shame Interferes "ith participation in occupational acti!ities de!6t ofrelationships and ta0e personal ris0s social inhibition longs for relationships An+iety anger and depression are common -ocial phobia may occur -een in ;8O of clients in mental clinics

= 'EPEN'ENT Lac0s confidence and unable to function in an independent role Allo"s other persons to be responsible of their li!es Most fre(uent personality disorder in the mental health clinic submissi!e beha!ior lo" self)esteem inade(uate helpless

= O#SESSIVE-CO.PUSIVE

2reoccupied "ith rules regulations o!erly concerned about

tri!ial detail e+cessi!ely de!oted to their "or0

*epression is common

Men are more affected than "omen

UN'ER STU'Y PERSONAITY '8O

2A--IBE)A44,E--IBE' -:LLEN AN* A,4:MENTATIBE,E-ENT- >THE,- ,E-I-T- /:L/ILLIN4 ,E-2>N-I7ILITIE-&>M2LAIN- >/ 7EIN4 :NA22,E&IATE*


11/18

*E2,E--IBE' 4L>>M@ 7,>>*IN4 2E--IMI-TI& 4:ILT)2,>NE HI4HL@ &,ITI&AL >/ -EL/ AN* >THE,- &HEE,LE--%

Inter$enti"ns MAINTAIN -A/ET@ A4AIN-T -EL/)*E-T,:&TIBE7EHABI>,- ALL>D THE &LIENT T> MAE &H>I&E- AN* 7E A-IN*E2EN*ENT A- 2>--I7LE EN&>:,A4E THE &LIENT T> *I-&:-- /EELIN4- ,ATHE,THAN A&T THEM >:T 2,>BI*E &>N-I-TEN&@ IN ,E-2>N-E T> THE &LIENT6-A&TIN4 >:T *I-&:-- E2E&TATI>N- AN* ,E-2>N-I7ILITIE- DITH THE&LIENT IN/>,M THE &LIENT THAT HA,M T> -EL/ >THE,- AN*2,>2E,T@ I- :NA&&E2TA7LE I*ENTI/@ -2LITTIN4 7EHABI>, A--I-T THE &LIENT T> *EAL *I,E&TL@ DITH AN4E, *EBEL>2 A D,ITTEN &>NT,A&T DITH THE &LIENT EN&>:,A4E THE &LIENT T> 2A,TI&I2ATE IN 4,>:2A&TIBITIE- AN* 2,AI-E N>NMANI2:LATIBE 7EHABI>, -ET AN* MAINTAIN LIMIT- ,EM>BE THE &LIENT /,>M 4,>:2 -IT:ATI>N- IN DHI&H

ATTENTI>N)-EEIN4 7EHABI>,- >&&:, 2,>BI*E ,EALI-TI& 2,AI-E />, 2>-ITIBE 7EHABI>,- IN->&IAL -IT:ATI>N-

PSYCHOOGICA SE6UA '8O H@2>A&TIBE -E:AL *I->,*E, #A-E:ALIT@$ -E:AL ABE,-I>N *I->,*E, #AB>I*AN&E >/ >, LA& >/*E-I,E />, -E:AL INTE,&>:,-E$ /EMALE -E:AL A,>:-AL *1> #/AIL:,E >/ N>,MALL:7,I&ATIN4 A,>:-AL ,E-2>N-E$ MALE E,E&TILE *1> /EMALE >,4A-MI& *I->,*E, MALE >,4A-MI& *I->,*E,

2,EMAT:,E E3A&:LATI>N BA4INI-M:- -E&>N*A,@ -E:AL *@-/N 2A,A2HILIA- 4EN*E, I*ENTIT@ *1> 2T-* *:E T> 4ENITAL M:TILATI>N >, &HIL*H>>*-E:AL A7:-E

OTHER SE6UA PRO#E.S -E:AL *I--ATI-/A&TI>N #N>N)-2E&I/I&$ LA& >/ -E:AL *E-I,E AN>,4A-MIA IM2>TEN&E

-T* IN/I*ELIT@ *ELA@ >, A7-EN&E >/ E3A&:LATI>N *E-2ITE A*E:ATE-TIM:LATI>N INA7ILIT@ T> &>NT,>L TIMIN4 >/ E3A&:LATI>N INA7ILIT@ T> ,ELA BA4INAL M:-&LE- EN>:4H T> ALL>DINTE,&>:,-E INA*E:ATE BA4INAL L:7,I&ATI>N 2,E&E*IN4 AN**:,IN4 INTE,&>:,-E 7:,NIN4 2AIN >N THE B:LBA >, IN THE BA4INA DITH&>NTA&T T> TH>-E A,EA- :NHA22INE-- >, &>N/:-I>N ,ELATE* T> -E:AL>,IENTATI>N 2E,-I-TENT -E:AL A,>:-AL -@N*,>ME -E:AL A**I&T H@2E,-E:ALIT@ 2>-T E3A&:LAT>,@ 4:ILT -@N*,>ME THE /EELIN4 >/4:ILT A/TE, THE MALE >,4A-M

SE6UA E6PRESSION HETE,>-E:ALIT@ H>M>-E:ALIT@ 7I-E:ALIT@

T,AN-BE-TI-M

PARAPHIIAS

= E6HI#ITIONIS.' THE ,E&:,,ENT :,4E >, 7EHABI>, T>

E2>-E >NE- 4ENITAL- T> AN :N-:-2E&TIN4 2E,->N%

+ETISHIS.' THE :-E >/ N>N)-E:AL >, N>NLIBIN4

>73E&T- >, 2A,T >/ A 2E,->N- 7>*@ T> 4AIN -E:AL

E&ITEMENT% PAR*IA&ISM,E/E,- T> /ETI-HE-

-2E&I/I&ALL@ INB>LBIN4 N>N-E:AL 2A,T- >/ THE 7>*@%

+ROTTEURIS.;THE ,E&:,,ENT :,4E- >, 7EHABI>, >/

T>:&HIN4 >, ,:77IN4 A4AIN-T A N>N&>N-ENTIN4

2E,->N%

= SE6UA .ASOCHIS.' THE ,E&:,,ENT :,4E >,

7EHABI>, >/ DANTIN4 T> 7E H:MILIATE* 7EATEN 7>:N*

>, >THE,DI-E MA*E T> -://E,%

SE6UA SA'IS.' THE ,E&:,,ENT :,4E >, 7EHABI>,

INB>LBIN4 A&T- IN DHI&H THE 2AIN >, H:MILIATI>N >/ THE

BI&TIM I- -E:ALL@ E&ITIN4%

TRANSVESTIC +ETISHIS.' A -E:AL ATT,A&TI>N

T>DA,*- THE &L>THIN4 >/ THE >22>-ITE 4EN*E,%

= PE'OPHIIA' THE -E:AL ATT,A&TI>N T> 2,E2:7E-&ENT

>, 2E,I2:7E-&ENT &HIL*,EN%

VOYEURIS.' THE ,E&:,,ENT :,4E >, 7EHABI>, T>

>7-E,BE AN :N-:-2E&TIN4 2E,->N DH> I- NAE*

*I-,>7IN4 >, EN4A4IN4 IN -E:AL A&TIBITIE- >, MA@

N>T 7E -E:AL IN NAT:,E AT ALL%

0*1ER PARAP1I&IAS N0* 0*1ER2ISE SPE3I'IED#U-E:AL

*I->,*E, N>-U$

telephone scatalogia #obscene phone calls$

necrophilia #corpses$

partialism #e+clusi!e focus on one part of the body$

zoophilia#animals$

coprophilia #feces$

0lismaphilia #enemas$

urophilia #urine$

SO.ATO+OR. '8O

SO.ATI>ATION '8O' H >/ MAN@ 2H@-I&AL &>M2LAINT-

7E4INNIN4 7E/>,E THE A4E >/ =8 >&&:,,IN4 >BE, A 2*

>/ -EBE,AL @,- ,E-:LTIN4 IN TTT 7EIN4 ->:4HT >,

-I4NI/I&ANT >&&:2ATI>NAL >, ->&IAL /NIN4%

CONVERSION '8O; ; >, M>,E - >/ *E/I&IT- A//E&TIN4

B>L:NTA,@ M>T>, >, -EN->,@ /:N&TI>N -:44E-TIN4 A

NE:,>L>4I&AL >, 4ENE,AL ME*I&AL &>N*ITI>N52,E&E*E* 7@ &>N/LI&T- >, -T,E-->,-5 &AN6T 7E

E2LAINE* AN* -AN&TI>NE* 7@ &:LT:,AL 7EHABI>,%

Most common' blindness deafness paralysis inability to tal0

FLa belle indifferenceG


12/18

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

EATING 'ISOR'ER #EHAVIORS

#INGE' ,A2I* &>N-:M2TI>N >/ LA,4E :ANTITIE- >/

/>>* IN A *I-&,ETE 2E,I>* >/ TIME% #A' H:N*,EN*-

>/ &AL5 7' TH>:-AN*- >/ &AL AT A -ITTIN4$

= PURGE' MALA*A2TIBE EATIN4 ,E4:LATI>N ,E-2>N-E

THAT IN&L:*E- E&E--IBE EE,&I-E />,&E* B>MITIN4

>&* , *I:,ETI&- *IET 2ILL- LAATIBE- AN* -TE,>I*-%

= +AST8 RESTRICT' IN&L:*E- BE4ETA,IAN *IET ELIMINATIN4

ALL MEAT DITH>:T -:7-TIT:TIN4 N>NANIMAL ->:,&E- >/

2,>TEIN >& A7>:T />>* &H>I&E- AN* EATIN4 HA7IT-%

ANORE6IA #UI.IA

,A,E B>MITIN4 >, *I:,ETI&1LAATIBE A7:-E M>,E -EBE,E DT L>-- -LI4HTL@ @>:N4E, M>,E INT,>BE,TE* H:N4E, *ENIE* EATIN4 7EHABI>, MA@ 7E &>N-I*E,E* N>,MAL AN* A->:,&E >/ E-TEEM -E:ALL@ INA&TIBE >7-E--I>NAL AN* 2E,/E&TI>NI-T /EAT:,E- *>MINATE /,E:ENT LE-- DT L>-- -LI4HTL@ >L*E, M>,E ET,>BE,TE* H:N4E, E2E,IEN&E* EATIN4 7EHABI>, &>N-I*E,E* />,EI4N AN* ->:,&E>/ *I-T,E-- M>,E -E:ALL@ A&TIBE AB>I*ANT *E2EN*ENT >, 7>,*E,LINE /EAT:,E- A-DELL A- >7-E--I>NAL /EAT:,E-

AN>,EIA 7:LIMIA c"!%licati"ns *EATH /,>M -TA,BATI>N #>, -:I&I*E IN &H,>NI&ALL@ILL$

AMEN>,,HEA /EDE, 7EHABI>,AL 2,>7LEM- #THE-E IN&,EA-E DITHLEBEL >/ -EBE,IT@$ *EATH /,>M H@2>ALEMIA >, -:I&I*E MEN-E- I,,E4:LA, >, A7-ENT *,:4 AN* AL&>H>L A7:-E -EL/)M:TILATI>N AN*

OTHER #EHAVIORA PRO#E.S'EIRIU.

THE ME*I&AL * TE,M THAT *E-&,I7E- AN >,4ANI&MENTAL *I->,*E, &HA,A&TE,IJE* 7@ A &L:-TE, >/&>4NITIBE IM2AI,MENT- DITH AN A&:TE >N-ET DITH A-2E&I/I& 2,E&I2ITATIN4 /A&T>,%= S6' *IMINI-HE* ADA,ENE-- >/ THE ENBI,>NMENT*I-T:,7AN&E- IN 2-@&H>M>T>, A&TIBIT@ AN* -LEE2)DAE &@&LE% COGNITIVE' THE MENTAL 2,>&E-- &HA,A&TE,IJE* 7@N>DIN4 THININ4 AN* 3:*4IN4%

&>4NITIBE *I-->NAN&E' arises "hen ? opposingbeliefs e+ists at the same time%

&>4NITIBE *I-T>,TI>N-' #$ or #)$ distortions ofreality that might include errors of logic mista0es in reasoning orindi!idualized !ie" of the "orld that do not reflect reality%

Term' confusion Q cogniti!e impairment

'E.ENTIA THE ME*I&AL * TE,M THAT *E-&,I7E- AN >,4ANI&MENTAL *1> &HA,A&TE,IJE* 7@ A &L:-TE, >/ &>4NITIBEIM2AI,MENT- >/ 4ENE,ALL@ 4,A*:AL >N-ET AN*I,,EBE,-I7LE DITH>:T I*ENTI/IA7LE 2,E&I2ITATIN4-T,E-->,-%= TYPES;

BA-&:LA, or M:LTI)IN/A,&T BA-&:LA, DITH ALJHEIME,6- *-E A*' most common *EMENTIA DITH LED@ 7>*IE-' ?ndmost common5neurofilament material 2A,IN->NIAN *EMENTIA AI*- *EMENTIA &>M2LE /,>NTAL L>7E *EMENTIA or 2I&6- *-E' cytoplasmic"#$$%"&'#()* +-.#)& "#..#(* $#)) #/%01%))'2% $3(4534% ! "#.1%6%()'#(

&,E:TJ/EL*T)3A>7 *-E' prion #proteinaceous infectious

particles$ Q spongy brain5 related to T-E 7-E in mad co" dse

&>,TI&>7A-AL *E4ENE,ATI>N or H:NTIN4T>N6-

*-E1&H>,EA' .er0y mo!6ts

-:2,AN:&LEA, 2AL-@' clumping of protein tau Q slo" mo!6t

"ea0 eye mo!6t #esp% do"n"ard$ impaired "al0ing balance

= REVERSI#E CAUSES'

-ubdural hematoma

Tumor #meningioma$

&erebral !asculitis

Hydrocephalus

TE,M-' *I->,IENTATI>N MEM>,@ L>-- #-EN->,@

2,IMA,@ -E&>N*A,@ TE,TIA,@ D>,IN4 MEM>,@$

&>N/A7:LATI>N &>N/:-I>N

= 'ISTUR#ING #EHAVIORS

Aggressi!e psychomotor

Nonaggressi!e psychomotor

Berbally aggressi!e

2assi!e

/unctionally impaired' loss of ability to do self)care


13/18

'EIRIU. $s 'E.ENTIA

,A2I* >N-ET D1 DI*E /L:&T:ATI>N- H@2E,ALE,T T> *I//I&:LT T> A,>:-E L>& /L:&T:ATIN4 A//E&T *I->,IENTE* &>N/:-E* ATTENTI>N -LEE2 *I-T:,7E* MEM>,@ IM2AI,E* *I->,*E,E* ,EA->NIN4 4,A*:AL &H,>NI& DITH &>NTIN:>:- *E&LINE N>,MAL L>& LA7ILE A//E&T *I->,IENTE* &>N/:-E* ATTENTI>N INTA&T -LEE2:-:ALL@ N>,MAL MEM>,@ IM2AI,E* *I->,*E,E* ,EA->NIN4 &AL&:LATI>N'EIRIU. $s 'E.ENTIA IN&>HE,ENT &>N/:-E* *EL:-I>NAL -TE,E>T@2E* ILL:-I>N- HALL:&INATI>N- 2>>, 3:*4MENT IN-I4HT MA@ 7E 2,E-ENT IN L:&I* M>MENT 2>>, 7:T BA,IA7LE IN M-E

*I->,4ANIJE* ,I&H IN &>NTENT *EL:-I>NAL2A,AN>I* N> &HAN4E IN 2E,&E2TI>N 2>>, 3:*4MENT N> IN-I4HT &>N-I-TENTL@ 2>>, 2,>4,E--IBEL@ D>,-EN- INM-E

A>HEI.ER5S 'E.ENTIA

M>-T &>MM>N T@2E >/ *EMENTIA -TA4E-'B .I'; i!%aire !e!"ry@ insii"us l"ses in A'@ su(tle%ers"nality changes@ s"cially n"r!al

B .O'ERATE; "($i"us !e!"ry l"ss@ "$ert A' i!%air!ent@%r"!inent (eha$i"ral i,,iculties@ $aria(le s"cial s)ills@su%er$isi"n neeeB SEVERE; ,rag!ente !e!"ry@ n" rec"gniti"n ", ,a!iliar%e"%le@ assistance neee ,*

= APRA6IA' INA7ILIT@ >, *I//I&:LT@ IN 2E,/>,MIN4 A2:,2>-E/:L >,4ANIJE* TA- >, -IMILA, -ILLE*

A&TIBITIE-

= A.NESIA' -I4NI/I&ANT MEM>,@ IM2AI,MENT IN THE

A7-EN&E >/ &L>:*E* &>N-&I>:-NE-- >, >THE,

&>4NITIBE -@M2T>M-

PSYCHIATRIC '8O IN CHI'REN

MENTAL ,ETA,*ATI>N

2E,BA-IBE *EB6TAL *1>

A:TI-M

,ETT6- *1>

&HIL*H>>* *I-INTE4,ATIBE *1>

A-2E,4E,6- *1>

2** N>-

LEA,NIN4 *1>

,EA*IN4

MATHEMATI&-

D,ITTEN E2,E--I>N

A&A*EMI& 2,>7LEM

LEA,NIN4 *1> N>-

M>T>, -ILL- *1>

&>MM:NI&ATI>N *1>

E2,E--IBE LAN4:A4E

MIE* ,E&E2TIBE1E2,E--IBE

2H>N>L>4I&AL

-T:TTE,IN4

-ELE&TIBE M:TI-M

&>MM:NI&ATI>N *1> N>-

M>B6T TI& *1>

*EB6TAL &>>,*INATI>N

T,AN-IENT TI&

&H,>NI& M>T>,B>&AL TI&

T>:,ETTE6- *1>

-TE,E>T@2I& M>B6T *1>

TI& *1> N>-

*I->,*E,- >/ INTAE ELIMINATI>N

2I&A

,:MINATI>N

/EE*IN4 *1>

EN:,E-I-

EN&>2,E-I-

>THE,' 7:LIMIA AN>,EIA


14/18

A*H* *I-,:2TIBE 7EHABI>, *1>

A*H*

A*H* N>-

&>N*:&T *1>

>22>-ITI>NAL *E/IANT

&HIL* ANTI->&IAL

*I-,:2TIBE 7EHABI>, N>-

M>>* *1>

M3 *E2,E--IBE *1>

7I2>LA, I >, II

*@-TH@MI&

MIE* E2I->*E

H@2>MANI& E2I->*E

M>>* *1> *:E T> ME*I&AL &>N*ITI>N

-:7-TAN&E)IN*:&E* M>>* *1>

ANIET@ *1>

*1> >/ ,ELATI>N-HI2

-E2A,ATI>N ANIET@

,EA&TIBE ATTA&HMENT >/ IN/AN&@ >, EA,L@

&HIL*H>>*

2A,ENT)&HIL* ,ELATI>NAL 2,>7LEM

-I7LIN4 ,ELATI>NAL 2,>7LEM

2,>7LEM- ,ELATE* T> A7:-E >, NE4LE&T

MENTAL ,ETA,*ATI>N

AN I 7EL>D 8 -I4NI/I&ANT LIMITATI>N- IN TD> >,M>,E A,EA- >/ A*A2TIBE 7EHABI>, #I%E% A7ILIT@ T>/:N&TI>N AT A4E LEBEL IN AN >,*INA,@ ENBI,>NMENT$AN* EBI*EN&E THAT THE LIMITATI>N- 7E&AME A22A,ENT IN

7E/>,E ;< @%>% THE />LL>DIN4 ,AN4E- 7A-E* >N THE DE&H-LE,A*:LT INTELLI4EN&E -&ALE#DAI-$ A,E IN -TAN*A,* :-ET>*A@'

&LA-- I TE,M-2,>/>:N* 7EL>D ?8 I*I>T-EBE,E ?8=K IM7E&ILEM>*E,ATE =CKS M>,>NMIL* C89S7>,*E,LINE 8S

,ETT6- *1>

*EBEL>2MENT I- N>,MAL :NTIL 9);< M>NTH- DHENLAN4:A4E AN* M>T>, MILE-T>NE- ,E4,E-- 2:,2>-E/:L HAN* :-E I- L>-T A&:I,E* *E&ELE,ATI>N IN THE ,ATE >/ HEA* 4,>DTH#,E-:LTIN4 IN MI&,>&E2HAL@ IN ->ME$ HAN* -TE,E>T@2E- A,E T@2I&AL AN* 7,EATHIN4I,,E4:LA,ITIE- -:&H A- H@2E,BENTILATI>N 7,EATHH>L*IN4 >, -I4HIN4 A,E -EEN IN MAN@% EA,L@ >N A:TI-TI&)LIE 7EHABI>, MA@ 7E -EEN &>MM>N IN /EMALE-CHI'HOO' 'ISINTEGRATIVE '8O "r HEER5S SYN'RO.E

&** HA- ->ME -IMILA,IT@ T> A:TI-M 7:T AN A22A,ENT

2E,I>* >/ /AI,L@ N>,MAL *EBEL>2MENT I- >/TEN N>TE*

7E/>,E A ,E4,E--I>N IN -ILL- >, A -E,IE- >/

,E4,E--I>N- IN -ILL-%

&HA,A&TE,IJE* 7@ LATE >N-ET #V= @EA,- >/ A4E$ >/

*EB6TAL *ELA@- IN LAN4:A4E ->&IAL /:N&TI>N AN*

M>T>, -ILL-5 -ILL- A22A,ENTL@ ATTAINE* A,E L>-T

ASPERGER5S '8O

&HA,A&TE,IJE* 7@ *I//E,EN&E IN LAN4:A4E AN*

&>MM:NI&ATI>N -ILL- A- DELL A- ,E2ETITIBE >,

,E-T,I&TIBE 2ATTE,N- >/ TH>:4HT AN* 7EHABI>,%

-I4N-' :NA7LE T> INTE,2,ET >, :N*E,-TAN* THE

*E-I,E- >, INTENTI>N- >/ >THE,- AN* THE,E7@ A,E

:NA7LE T> 2,E*I&T DHAT T> E2E&T >/ >THE,- >, DHAT

>THE,- MA@ E2E&T >/ THEM

Narro" interests or preoccupation "ith a sub.ect to the e+clusion

of other acti!ities

,epetiti!e beha!iors or rituals

2eculiarities in speech and language

E+tensi!e logical1technical patterns of thought

-ocially and emotionally inappropriate beha!ior and interpersonal

interaction

2roblems "ith non!erbal communication

&lumsy and uncoordinated motor mo!6ts

CHRONIC .OTOR8 VOCA TIC

TI& I- A -:**EN ,E2ETITIBE -TE,E>T@2E*

N>N,H@THMI& INB>L:NTA,@ M>BEMENT #M>T>, TI&$ >,

->:N* #2H>NI& TI&$ THAT INB>LBE- *I-&,ETE 4,>:2- >/

M:-&LE-%

&AN 7E INBI-I7LE T> THE >7-E,BE, #E%4% A7*>MINAL

TEN-IN4 >, T>E &,:N&HIN4$

TOURETTE5S '8O &HA,A&TE,IJE* 7@ THE 2,E-EN&E >/ M:LTI2LE

2H@-I&AL #M>T>,$ TI&- AN* AT LEA-T >NE B>&AL #2H>NI&$

TI&5 THE-E TI&- &HA,A&TE,I-TI&ALL@ DA AN* DANE

TTT' NE:,>LE2TI& ME*I&ATI>N-

haloperidol #Haldol$

pimozide #>rap$
http://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scalehttp://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scalehttp://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scalehttp://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scale


15/18

A'H'INATTENTI>N' /AIL:,E T> 2A@ &L>-E ATTENTI>N T> *ETAIL- >,MAIN4 &A,ELE-- MI-TAE- DHEN *>IN4 -&H>>LD>,>, >THE, A&TIBITIE- T,>:7LE EE2IN4 ATTENTI>N />&:-E* *:,IN4 2LA@>, TA--

A22EA,IN4 N>T T> LI-TEN DHEN -2>EN T> /AIL:,E T> />LL>D IN-T,:&TI>N- >, /INI-H TA-- AB>I*IN4 TA-- THAT ,E:I,E A HI4H AM>:NT >/MENTAL E//>,T AN* >,4ANIJATI>N -:&H A- -&H>>L2,>3E&T- /,E:ENTL@ L>-IN4 ITEM- ,E:I,E* T> /A&ILITATETA-- >, A&TIBITIE- -:&H A- -&H>>L -:22LIE- E&E--IBE *I-T,A&TI7ILIT@ />,4ET/:LNE-- 2,>&,A-TINATI>N INA7ILIT@ T> 7E4IN AN A&TIBIT@ *I//I&:LTIE- DITH H>:-EH>L* A&TIBITIE- #&LEANIN42A@IN4 7ILL- ET&%$ *I//I&:LT@ /ALLIN4 A-LEE2 MA@ 7E *:E T> T>> MAN@TH>:4HT- AT NI4HT /,E:ENT EM>TI>NAL >:T7:,-T- EA-IL@ /,:-T,ATE* EA-IL@ *I-T,A&TE*HYPERACTIVITY-I.PUSIVE #EHAVIOUR /I*4ETIN4 DITH HAN*- >, /EET >, -:I,MIN4 IN -EAT LEABIN4 -EAT >/TEN EBEN DHEN INA22,>2,IATE ,:NNIN4 >, &LIM7IN4 AT INA22,>2,IATE TIME- *I//I&:LT@ IN :IET 2LA@ /,E:ENTL@ /EELIN4 ,E-TLE-- E&E--IBE -2EE&H AN-DE,IN4 A :E-TI>N 7E/>,E THE -2EAE, HA-/INI-HE* /AIL:,E T> ADAIT >NE- T:,N

INTE,,:2TIN4 THE A&TIBITIE- >/ >THE,- ATINA22,>2,IATE TIME- IM2:L-IBE -2EN*IN4 LEA*IN4 T> /INAN&IAL*I//I&:LTIE-

+REDUENTY PRESCRI#E' STI.UANTS

A,E METH@L2HENI*ATE #,ITALIN AN* &>N&E,TA$

AM2HETAMINE- #A**E,ALL$ AN* *ET,>AM2HETAMINE-

#*EE*,INE$

/EIN4>L* *IETDHI&H INB>LBE- ,EM>BIN4 -ALI&@LATE-

A,TI/I&IAL &>L>,- AN* /LAB>,- AN* &E,TAIN -@NTHETI&

2,E-E,BATIBE- /,>M &HIL*,EN- *IET-%

CON'UCT '8O

,E2ETITIBE AN* 2E,-I-TENT 2ATTE,N >/ 7EHABI>, IN

DHI&H THE 7A-I& ,I4HT- >/ >THE,- >, MA3>, A4E)

A22,>2,IATE ->&IETAL N>,M- >, ,:LE- A,E BI>LATE*

A44,E--I>N T> 2E>2LE ANIMAL-

*E-T,:&TI>N >/ 2,>2E,T@

*E&EIT/:LNE-- >, THE/T

-E,I>:- BI>LATI>N- >/ ,:LE-

$eginning )e"ore age +4>22>-ITI>NAL *E/IANT

&HA,A&TE,IJE* 7@ AN >N4>IN4 2ATTE,N >/

*I->7E*IENT H>-TILE AN* *E/IANT 7EHABI>, T>DA,*

A:TH>,IT@ /I4:,E- THAT 4>E- 7E@>N* THE 7>:N*- >/

N>,MAL &HIL*H>>* 7EHABI>,

-I4N-

Losing temper

Arguing "ith adults

,efusing to follo" the rules

*eliberately annoying people

7laming others

Easily annoyed

Angry and resentful

-piteful or e!en re!engeful

SU#STANCE A#USE

E&E--IBE >, :NHEALTH@ :-E >/ -:7-TAN&E- -:&H

A- AL&>H>L T>7A&&> >, *,:4- >, :-E >/ 2,>*:&T-

-:&H A- />>*

TE,M-'

T>LE,AN&E' the declining effect of the same drug dose "hen it

is ta0en repeatedly o!er time

HA7IT:ATI>N' a psychological dependence of the use of a drug

A**I&TI>N' the biological and1 or psychological beha!iors

related to substance dependence

DITH*,ADAL -@M2T>M-' result from a biological need that

de!elops "hen the body becomes adapted to ha!ing an addicti!e

drug in the system5 occurs "hen serum le!els decrease

A''ICTION

AL&>H>L' 7L>>* AL&>H>L LEBEL- >/ 8%;O #;88M4

AL&>H>L1*L >/ 7L>>*$ >, HI4HE,

DITH*,ADAL

Anorexia Anxiety

Easily startled 1yperalertness

1PN Insomnia

Irrita)ility 5erky mov#t

Possi)ly: hall%cinations6 ill%sions or vivid nightmares

Sei7%res -89, hrs a"ter cessation.

*achycardia tremors

DITH*,ADAL *ELI,I:M


16/18

Agitation Anorexia

Anxiety Deliri%m

Diaphoresis

Disorientation ith "l%ct%ating levels o" conscio%sness

'ever -+;; to +;4 '.

1all%cinations and del%sions

Insomnia *achycardia and 1PN

*isulfiram #Antabuse$ therapy

Nursing care

>7TAIN IN/> A7>:T *,:4 T@2E AN* AM>:NT &>N-:ME* A--E-- B1- ,EM>BE :NNE&--A,@ >73 /,>M ENBI,>NMENT 2,>BI*E >NE)>N)>NE -:2E,BI-I>N I/ NE&E--A,@ 2,>BI*E A :IET &ALM ENBI,>NMENT DITH MINIMAL-TIM:LI MAINTAIN >,IENTATI>N EN-:,E -A/ET@ :-E ,E-T,AINT- 2,>BI*E 2H@-I&AL NEE*- 2,>BI*E />>* AN* /L:I*- A- T>LE,ATE* A*MINI-TE, ME*I&ATI>N- &>LLE&T 7L>>* AN* :,INE -AM2LE- />, *,:4-&,EENIN4

SPOUSE A#USE

7ATTE,IN4 2,E&I2ITATE- ;'K -:I&I*E ATTEM2T- >/ ALLD>MEN DIBE- E2LAIN THE IN3:,IE- A- 7EIN4 -EL/)IN/LI&TE*>, A&&I*ENTAL

2HA-E-

Tension)building' series of small incidents that leads to beating

Acute beating phase' "ife becomes ob.ect of assault beha!ior

Lo!ing phase' batterer is remorseful and assures spouse that he

"ill not harm her again% This leads to reconciliation%

M@TH-

They belie!e that if they try not to antagonize "ith their husband

he "ill change%

Efforts to coerce the "ife out of the !ictim role can be fruitful%

= +ACTS

Domen stay in relationships "ith men "ho batter because they

feel guilty or responsible of the husband6s beha!ior

Dife de!elops little sense of self)"orth immobilized and unable

to remo!e self from the relationship%

A--E--MENT' IN3:,IE- >THE, EBI*EN&E INTE,BENTI>N-' DITH &>N-ENTCHI' A#USE

2H@-I&AL 7ATTE,IN4EM>TI>NAL-E:ALNE4LE&T

E'ERY A#USE

A BA,IET@ >/ 7EHABI>,- THAT TH,EATEN THE HEALTH

&>M/>,T AN* 2>--I7L@ THE LIBE- >/ THE EL*E,L@

IN&L:*IN4 2H@-I&AL AN* EM>TI>NAL NE4LE&T EM>TI>NAL

A7:-E BI>LATI>N >/ 2E,->NAL ,I4HT- /INAN&IAL A7:-E

AN* *I,E&T 2H@-I&AL A7:-E%

&>MM>NL@ &>MMITTE* 7@ &A,E 4IBE,-%

SE6UA A#USE

&>M2>NENT-

-e+ual Misuse' inappropriate se+ual acti!ity

,ape' there is actual penetration

Incest' refers to the relationship bet"een the !ictim and abuser

blood relati!e or step parent role

INTE,BENTI>N-

&hildren' thru play or role playing "ith puppets

2re!ention of further se+ual abuse

CO.PETE' SUICI'E

-EL/)IN/LI&TE* *EATH

LEBEL- >/ -:I&I*E

Ideation' thought

Attempt' acted upon but failed

&ompleted

CHE.ICA RESTRAINT

&HEMI&AL ,E-T,AINT-' ME*I&ATI>N- :-E* T> ,E-T,I&T

THE 2ATIENT6- /,EE*>M >/ M>BEMENT >, />,

EME,4EN&@ &>NT,>L >/ 7EHABI>, 7:T A,E N>T A

-TAN*A,* T,EATMENT />, THE 26- ME*I&AL >,

2-@&HIAT,I& &>N*ITI>N%

2H@-I&AL ,E-T,AINT-' A,E AN@ MAN:AL METH>* >,2H@-I&AL >, ME&HANI&AL *EBI&E ATTA&HE* T> >,

A*3A&ENT T> THE 26- 7>*@ THAT HE >, -HE &ANN>T

EA-IL@ ,EM>BE AN* THAT ,E-T,I&T- /,EE*>M >/

M>BEMENT >, N>,MAL A&&E-- T> >NE6- 7>*@ MATE,IAL

>, E:I2MENT%

SECUTION AN' RESTRAINTS

-E&L:TI>N' THE INB>L:NTA,@ &>N/INEMENT >/ A

2E,->N AL>NE IN A ,>>M /,>M DHI&H THE 2E,->N I-

2H@-I&ALL@ 2,EBENTE* /,>M LEABIN4%

No therapeutic e!idence other than a last resort to ensure safety%

E!idence suggest that it adds to further trauma and physical harm

4:I*ELINE-

All hospital staff "ho ha!e direct contact "ith the p+ should ha!e

ongoing education and training in the proper use of seclusion and

restraints and other alternati!es


17/18

2hysician or licensed practitioner should e!aluate need "ithin ;

hour after the initiation of this inter!ention%

Ma+ of K hours for adults ? hours for ages S); and ; hour for

children under S yrs

>rders may be rene"ed for ?K hrs before another face to face

e!aluation

&ontinuous assessment monitoring and e!aluation5 recorded

4ood nursing care

/or both restrained and secluded' constant monitoring face to

face or by both audio and !ideo e(uipment%

2+ should be released A-A2

>THE, 4:I*ELINE-

-E&L:-I>N

,oom should allo" obser!ation and communication "ith p+

,emo!e all items that p+ might use to harm self

*ocument' rationale response to inter!ention physical condition

nsg care rationale for termination

,E-T,AINT-

4i!e support reassurance

2osition in anatomical position

2ri!acy is important

!1s &irculation chec0

-hould be released ( ?hrs

A!oid tying to the side rails of bed

Assist in periodic change in body positions

TER.INATING THE INTERVENTION

A- ->>N A- MET THE &,ITE,IA />, ,ELEA-E

,EBIED DITH 2 THE 7EHABI>, THAT 2,E&I2ITATE* THE

INTE,BENTI>N 26- &A2A&IT@ T> EE,&I-E &>NT,>L

>BE, 7EHABI>,

*E7,IE/IN4' ,EBIEDIN4 THE /A&T- ,ELATE* T> AN

EBENT 2,>&E--IN4 THE ,E-2>N-E T> THEM5 &AN 7E

:-E* A/TE, AN@ -T,E--/:L EBENT

THERAPEUTIC I.PASSES

A,E 7L>&- IN THE 2,>4,E-- >/ THE N:,-E)2T

,ELATI>N-HI2

2,>B>E- INTEN-E /EELIN4- IN 7>TH THE N:,-E AN*

2ATIENT

,E-I-TAN&E

T,AN-/E,EN&E

&>:NTE,T,AN-/E,EN&E

7>:N*A,@ BI>LATI>N-

RESISTANCE

,EL:&TAN&E >, AB>I*AN&E >/ BE,7ALIJIN4 >,E2E,IEN&IN4 T,>:7LIN4 A-2E&T- >/ >NE-EL/

E4' -:22,E--I>N >, ,E2,E--I>N INTEN-I/I&ATI>N >/

- -EL/)*EBAL:ATI>N >, H>2ELE--NE-- INTELLE&T:AL

INHI7ITI>N- A&TIN4 >:T >, I,,ATI>NAL 7EHABI>,

-:2E,/I&IAL TAL INTELLE&T:AL IN-I4HT1

INTELLE&T:ALIJATI>N T,AN-/E,EN&E ,EA&TI>N-%

TRANS+ERENCE

:N&>N-&I>:- ,E-2>N-E IN DHI&H THE 2 E2E,IEN&E-

/EELIN4- AN* ATTIT:*E- T>DA,* THE N:,-E THAT DE,E

>,I4INALL@ A-->&IATATE* DITH >THE, -I4NI/I&ANT

/I4:,E- IN HI- >, HE, LI/E%

H>-TILE T,AN-/E,EN&E' anger and hostility resistance

*E2EN*ENT T,AN-/E,EN&E' submissi!e subordinate and

regards the nurse as a god)li0e figure5 !ie"s relationship as magical

Dhat do you doW

LI-TEN&LA,I/@,E/LE&T

E2L>,E1 ANAL@JECOUNTERTRANS+ERENCE

&,EATE* 7@ THE N:,-E6- -2E&I/I& EM>TI>NAL

,E-2>N-E T> THE :ALITIE- >/ THE 2ATIENT5

INA22,>2,IATE IN THE &>NTET &>NTENT AN* INTEN-IT@

>/ EM>TI>N5 N:,-E- I*ENTI/@ THE 2 DITH IN*IBI*:AL-

/,>M THEI, 2A-T AN* 2E,->NAL NEE*-

T@2E-' ,EA&TI>N- >/ INTEN-E

lo!e or caring

*isgust or hostility

An+iety often in response to resistance by the p+

= EG

*ifficulty empathizing

/eelings of depression before or after the session

&arelessness about implementing the contract

*ro"siness during the sessions

Encouragement of the p+6s dependency

Arguments "ith the p+

2ersonal or social in!ol!ement "ith the p+


18/18

-e+ual or aggressi!e fantasies to"ard the p+

Tendency to focus on only one aspect or "ay of loo0ing at

information presented by the p+

Attempts to help the p+ "ith matters not related to the identified

nursing problems

/eelings of anger or impatience because of the p+6s

un"illingness to change

*reams about or preoccupation "ith the p+

260831655 psychiatric nursing notes docx

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