TREATMENT OF THE MENTALLY ILL

AND
ROLE OF NURSES IN THE RAPEUTIC NURSE – PATIENT RELATIONSHIP

I. STRUCTURE SUSTAINED THE RAPEUTIC NURSE – PATIENT RELATIONSHIP

GENERAL AIM:
1. To establish rapport.
2. To provide comfort.
3. To promote feelings of confidence, trust, and security in the patient to the degree that the needs are met and
recovery from illness favored.

IN THE PROCESS, THE NURSE:

- Makes use of approaches gained from a theoretical frame of references; after gaining patient’s confidence and
trust, nurses encourages patient to talk about himself.
- Then patient may cast the nurse into a role such as mother, father, or sibling, and relate to the nurse as the
patient related to these significant persons in the part.
- Attention to nutrition, rest, and medications are necessary and helpful nursing actions; these stabilize
physiological processes which in turn influence the person’s general state of health.
- Anxiety are often relieved when socials, psychological and communication techniques are skillfully used during
nurse-patient interaction.

PHASES OF THERAPEUTIC RELATIONSHIPS:

1. FIRST PHASE – introductory, orientation period during which the nurse and pt. Get acquainted. Nurse function is
necessary in initial approach.
2. SECOND PHASE – the nurse encourages the patient to further verbalize and classify his discussions and give
emotional support needed by the patient.
3. THIRD PHASE – the patient may become vocal and active as he relates with the nurse in the role into which he
has cast her as a significant person. It is a period when the patient may ventilate between being dependent upon
the nurse and trying to become independent.
4. FOURTH PHASE – final stage/ termination

PHASES OF NURSE – PATIENT RELATIONSHIP

1. ORIENTATION PHASE – general encounter
2. PHASES OF EMERGING IDENTITY – time when come to know the patient
3. PHASE OF EMPHATY – is having an understanding of the patient’s behavior
4. PHASE OF SYMPHATY – nurse is having a feeling of involvement
5. PHASE OF RAPPORT – the time where the nurse should start

FOUR PHASES OF THE NURSE PATIENT INTERACTIONS;

1. PRE - INTERACTION
a. Reading patient’s record and data
b. Interviewing relatives
c. Home visit
d. Interviewing persons who takes care of him

2. INITIAL INTERACTION – first counter, mutual introduction, phase of orientation

OBJECTIVES;
a. To establish rapport
b. To set contract with the patient – tell the patient that from this day on up to this day (exact date and time ) you
will be his student nurse.
c. To observe patient’s behavior continually; to learn more about him and to strengthen rapport established.

3. CONTINUING, WORKING, OR MAINTENANCE PHASE – patient is assumed to have more understanding of

reality and has released the needed skills of living.
OBJECTIVES
a. to assist patient to have more contract with reality
b. to help with the modification of the environment
c. to help the patient achieve a sense of his own worth
d. to help patient express ideas and interest through some creative works ( e. g. painting)
e. to assist the patient develop awareness of his maladaptive behavior to something which is adaptive and to
prepare patient for the termination of their relationship.

4. TERMINATION PHASE – tell the patient the exact time and date you will have your exposure in the ward.
II ATTITUDE THERAPY:

1. MATTER OF FACT – ( Manic-depressive)

- showing of mutual response to a behavior whether it be agitation, criticism, hostility and anxiety. (Here the
therapist should avoid showing special concern to the patient but should deal on reality basis). You should not
forget that manic patients are suffering depression but shows satisfaction and happiness.
2. ACTIVE FRIENDLINESS – ( Withdrawn and regressing )
- implies taking the initiative in making friendly gestures to show special interest to demonstrate giving tactfulness
and trying to satisfy patient’s desires and needs. (Important role is with the use of praise). It is always the nurse
who starts friendliness especially for patient’s who are withdrawn an d regressing (Schizophrenic Paranoid) they
are the ones who have experienced so much frustration in life.
3. PASSIVE FRIENDLINESS – (Suspicious patients)
- Patient is allowed to take the initiative to set the pace for friendliness. Nurse indicates friendly readiness to
respond but wait for the patient’s move then respond in a warm and friendly manner.
4. KIND FIRMNESS – (for highly depressed patients)
- denotes firm insistence; requests are expressed in friendly manners. Note bossy fashion but indicating that the
requests are for his best and are to be followed.
5. NO DEMAND – (for assaultive, impulsive, and hyperactive patients)
- implies strength authority. Patient who cannot control himself.
6. WATCHFULNESS – ( for suicidal patients)
- continuous observations, close observation, integrated with kind firmness.
7. INDULGENCE – (integrated with matter of fact)
- certain flexibility is used in dealing with patients.

III. SOMATIC THERAPHY (ELECTRO CONVULSIVE THERAPHY)

It is a form of therapy also known as “Shock Therapy.” For the most part today, their prescription access when the
patient’s problem remains resistant over time to the psychotherapeutic approach or, and in the case of serious
depressive psychosis.
The most commonly used somatic therapy is the ECT introduced in 1937 by Cerletti and Binni ( Italian Psychiatrists)
which was described as a method of producing convulsion by electricity and began its use in the treatment of
Schizophrenia.

PROCEDURES:
Consists of attaching electrodes to opposite side of patient’s forehead sending an alternating current of electricity of
110 – 170 volts for 0. – 1 – 0. 1 second through the head. If causes almost instantaneous loss of consciousness
followed by grand mal type of seizures both clonic and tonic phase.

CLONIC – tremors all over the body after attaching electronics and there is continues rigidity (38 seconds).
TONIC – there is cessation of breathing, prolonged apnea (artificial respiration is needed).

INDICATIONS OF ECT:
1. Catatonic Schizophrenia subgroup
2. Manic – depressive and over active depression
3. Involution melancholia
4. Psychotic depression

RATIONALE:
1. Electronic current produced in the brain.
2. Painful events are forgotten.
3. Guilt feelings are removed.

CONTRAINDICATIONS:
1. Bone diseases
2. Presence of fractures
3. Cardiac condition
4. Acute pulmonary tuberculosis
5. Hypertension
6. Tumors of the brain

PREPARATIONS FOR ECT:

1. NPO for about 2-3 hours before treatment.
2. Complete and thorough examination and neuralgic laboratories.
3. Consent for the treatment to be signed by the responsible relatives.
4. Explain to the patient what is to be done.
5. Ask patient to void 9to empty his bladder0.
6. Check TPR and BP.
7. Remove pieces of jewelry, hairpin and other mental objects to prevent breakage and further injuries.
8. Remove dentures to prevent injury during convulsion.
9. Loosen clothing.
10. Do not allow patient to take a back resting on a pillow to promote hyperextension of the spine.
11. Do not allow patient to take a bath because water is a good conductor of electricity.
12. Place a restraint before starting procedure.

DURING CONVULSIVE TREATMENT:

1. Mouth gag is inserted and gentle pressure to the chain to avoid dislocation or fractures of the jaw.
2. Gentle pressure is exerted on the shoulder, thigh and joints to avoid fracture of long bones and vertebrae.

POST TREAMENT:
1. Check for respiratory difficulties, give artificial respiration if necessary until effects of muscles relaxant wear off.
2. Observes of any signs of fracture especially compression of the spine.
3. Keep on the restraint until the patient has completely reacted.
4. Reassures him that blurred visions, confusion and loss of memory are temporary.
5. Help him recall events and knowledge that are important to him.
6. Passive exercises of upper and lower extremities promote circulation.

POINT TO NOTE:
1. Type of seizure obtained.
2. Duration and description of reaction.
3. Time of occurrence.
4. Behavior and general reaction and attitude.
5. Function of treatment.

THEORIES OF ECT ACCORDING TO PATIENT’S REACTION:

1. THE CONDITION EFFECT-symptoms are regarded as behavioral features that the patient requires recently than
the other normal modes of responding.
2. PURNISHMENT THEORY – they believe that the artificially induced convulsion interfered as kind of punishment,
thus it relieves the patient ambivalent feelings of guilt, become conscious and verbally express what feelings they
had.

TWO TYPES OF ELECTRODES:

1. BURDICT TYPE- rubber band with electro jelly
2. AEBRO TYPE – cloth electrodes with water or saline

IV. PSYCHOTHERAPHY
- Is the treatment of emotional and personality problem and disorders by psychological means. The most important
therapeutic factor common to all types of psychotherapy is the therapist – patient relationship, the patient comes
to know that he or she ca share feelings, attitudes and experiences with the therapist. In most psychotherapy, the
therapist is not depreciate censure, or judge, no matter what they revealed, but with respect to the patient’s dignity
and worth, understanding, empathy, acceptance, and support.

METHODS OF PSYCHOTHERAPY:
1. INDIVIDUAL PSYCHOTHERAPY – sometimes referred to as “direct interview psychotherapy”, is conducted
through interviews or communication between the physician and patient. It is the type of psychotherapy, which is
the foundation upon which all psychiatric treatment rests.

This type of psychotherapy does not require the physician to dig in the deep forces in the unconscious mind. The
patient merely discuss his immediate symptoms with the psychiatrist on a conscious level. Although the
psychiatrist may have understanding about the relationship between the patient’s symptoms and discussion and
unconscious motivation, he does not prove deeply into the unconscious. The psychiatrist makes use of his
knowledge in alleviating patient’s symptoms.

PROCEDURE:
1. During the interview the physician’s objective is to gain understanding of the patient’s personality and problems.
2. He learns all he can about the patient’s early development, his adjustment to family, school, friends, vacation, and
all factors which have contributed tyo the development of the patient’s personality and conflicted the situation.
TECHNIQUE USED BY THE PSYCHIATRIST;
1. He may find it necessary to desensitize certain in the patient’s life which had a mentally traumatizing effect.
2. It may be necessary for the physician to ensure or encourage patient who has a little faith.
3. He may be able to help the patient change his behavior or through the use of persuasion and suggestion.

INDICATION:
Individual psychotherapy may be used as a treatment in self, as a primary step to other psychiatric treatment, or in
conjunction with tranquilizing drug or shock therapy

3. GROUP PSYCHOTHERAPY –came into prominence during the World War II. The objective of group
psychotherapy is to help the patient understand the cause of emotional difficulties and with the resolution of
problem associated with living experiences. It differs from individual psychotherapy because it is an indirect way of
helping a person gain insight into his problematical situation and the conflict.

OBJECTIVES:
1. To provide a constructive experiences which will assist the individual to feel differently about himself and
others.
2. To give support
3. To provide opportunities for the individual to discuss and examine problems in any area of life.

STAGES:
1. establishment of a relationship.
2. maintenance and growth
3. termination

PROCEDURE: The group may vary in a number for a few to a many, but the ideal group association is started.
1. The psychiatrist interview each patient individually several times before group association is started.
2. He becomes familiar with each one’s history, personality development and symptoms before forming the group.
3. The members are composite in type: there are aggressive leader types, as well as the shy, retiring personalities.

These sessions are held regular once or twice a week for about an hour at a time.
INDICATIONS:
1. If a patient manifest aversion to the individual therapy because of fear, competitiveness, distrust or antagonism
toward all authority figures.
2. Patient lacking sibling experiences, having antagonistic sibling attitudes, living in situations without opportunities
for participation, experiencing destructive family relations, showing character disorders, presenting evidence of
generalized maladjustment’s, or fearing homosexual involvement with an individual therapist.
3. Patient with dull intelligence may benefit more therapy in peer groups.
4. Generally for children.

4. SUPPORTING PSYCHOTHERAPY – is anxiety suppressive. It seeks to diminish anxiety through reassurance,

modifying the social environment through changing living quarters, hospitalization or by prescription of anxiolytic
drugs/ agent. It may either be prolonged or brief, defending on his nature of patient’s problem. No attempt is made
to produce insight, although the therapist recognizes resistant defenses or remove the patient from the anxiety-
provoking environment. This permits time for the restoration of personality organization.
INDICATIONS:
Its is believed that this type of psychotherapy is the method of choice for those who are able to maintain a job yet feel
strongly the need for assistance, recognizing that their symptoms are psychological in origin, and are willing to
cooperate with the therapeutic effort.
PROCEDURE:
1. The patient is seen one or two times a week; medication is prescribed when indicated to relieved symptoms
while the therapist ascertains the social pressures to which the patient is exposed.
2. The therapist may assume the decision-making functions of the patient for a short time as well as encourage
specific actions that may resolve the conflict situation.
3. He gives concrete and detailed advice on how to achieve the patient’s desires. The therapist will predicted the
patient’s future behavior on the basis on his past performance and rehearse his actions to anxiety- producing
task to cope with the affects which will be aroused when he task action.

4. OCCUPATIONAL THERAPY OR SHORT THERAPY

- It encouraged the patient to develop an interest which may re- establish old skills and knowledge initiative.
- It also aids to develop an interest which may re-establish old skills and knowledge initiative.
- It also aids to develop the patient’s self-esteem and self-confidence and eventually may contribute much toward
helping him capable of copying with life actions of the hospital.
- Any activity mental or physical, prescribed or guided to aid the patient’s recovery from disease or injury.
 TYPES OF OCCUPATIONAL THERAPY
1. ART THERAPY- is a form of expression by which the emotionally and mentally ill can communicate their
problems. Patient can overcome his inability to verbalize feelings and attitudes, which help patient to uncover
past experiences and traumas.
OBJECTIVES:
a. Faciliates rapid detection and recognition of patient’s deeper problem.
b. It helps patient to recognize his problem and mental illness.
c. Will give an idea whether patient is improving or not.
d. As a research device.
MAIN PURPOSE OF ART THERAPY:
a. To ventilate patient’s feelings in terms of color and design.
b. To encourage patient or an individual to reach a part of his potential not realized before.
c. To develop talents to the fullest.
DIFFERENT USES OF ART THERAPY:
a. Used as a diagnostic tool
b. Aids in the therapeutic process.
c. Used as means or tool evaluate patient’s treatment.
IMPORTANT ASPECTS OF ART THERAPY:
a. Content
b. Size
c. Color
d. Organization (Color and its meaning )

OBJECTIVES:
a. To serve as a diagnostic tool to come out with the patient’s appropriate disease or ailment.
b. To aid in releasing part of life unconsciously.
c. To be oriented with time, place and person.
d. To be able to adjust with other patient’s

INDICATIONS OF MUSIC THERAPY:

a. To provide an revenue for expressing feeling, it is uniquely helpful to patients, especially those who find self-
expression difficult.
b. It can provide an excellent focus for group experience and group cooperation.
c. Patients usually have the opportunity to participate in hospital orchestra, band, or chorus.

3. PLAY THERAPY- a form of therapy wherein the therapist engage the child/ patient in play for the therapeutic
opportunity to discharge strong emotions in the atmosphere with a trusted therapist.
OBJECTIVITY:
a. To discover the causes of the child’s/ patient’s conflict through observation of his play and to interpret it to the
child’s / patient’s language which he understand.
INDICATIONS:
a. To establish rapport with the child/ patient and serves as a means of establishing communication between the
psychiatrist and the patient.
b. It is a path of investigation by which a wealth of information can be obtained about the patient and his
environment.
PROCEDURE:
a. It could be a play with a group of patients or in a special room equipped with the play materials.
b. The psychiatrist brings the child into the room and invites him to make use of the materials.

4. BIBLIO THERAPY- a form of therapy with the use of printed materials as a means of modifying and stimulating
patient’s emotion and at the same time providing information to the patient.
OBJECTIVES AND PURPOSE:
a. To improve the attention span of individual with limited power of concentration.
b. To divert the attention and lift the spirit of a depressed patient.
c. To help relieve insomnia, stimulate the imagination and foster desirable attitudes and ideas in-patient.
PRICIPLES TO CONSIDER IN SELECTING TOPICS TO DISCUSS TO THE PATIENTS:
a. Select literature in accordance with patient’s educational preparation, intellectual capacity and interests. (Size
up the personality of patients, his line of interest).
b. Avoid literature of controversial nature which appear to steer up a feelings of distress within the patient.
c. Literature advisable are concerning history, travel, hobbies, art, biographies.
d. For educational readings, choose books of reliable authority.
HOW TO MOTIVATE PATIENTS IN INTEREST:
a. Impromptu discussion.
b. By sketching the highlight of certain literature.
c. Provide up-to-date books in the hospital, newspaper or bulletin.
5. REMOTIVATION TECHNIQUE – it is a simple socialized group therapy, usually 10-12 participants with an effort
to reach the unwounded area of pt’s personality and moving again towards reality.
It comes from the word motivation with a prefix “re” which means that the technique is being done repeatedly.
Dorothy Haskin Smith introduced remotivation technique and was introduced by Dr. Jaime T. Castaneda in NCMH.
It is not only conducted in rehabilitation ward but also in receiving and continued treatment wards every week. It is
done once or twice a week for 45 minutes to one hour.
OBJECTIVES:
a. To bring patient back to reality.
b. To develop the ability to communicate and share ideas and experiences with others.
c. To develop feelings of acceptance and recognition.
d. To promote group harmony and identification.
INDICATIONS:
Remotivation can be used in any ward situation, regardless of length, time, a patient has been hospitalized, his age or
the reason for his illness, and sex.
VALUES TO THE PATIENT:
a. Stimulates the patient to think about something and talk about himself.
b. Gives him reason to value himself and increase his self-respect.
c. Takes him out of the darkness of the world of life.
d. Makes him a part of the group.
e. Takes the patient out of the vegetable class.
PHYSICAL SET- UP AND ARRANGEMENT:
a. Patient may be seated in a circle.
b. Patient may be in a u-shape
SUBJECT TO BE COVERED:
1. Geography
2. History
3. Science
4. Literature
5. Industry
6. Sports
7. Hobbies
8. Nature
TOPICS TO BE AVOIDED:
1. Sex
2. Love
3. Politics
4. Religion
5. Family relationship
6. Marital relationship
7. Other controversial issues
PROCEDURE:
a. should be nature in approach.
b. Avoid argumentation.
c. Avoid side tracking into individual’s conversation.
d. Always be optimistic.

STEPS INREMOTIVATING TECHNIQUE:

A .CLIMATE OF ACCEPTANCE- (5 minutes )
- The leader who is at the center of the group greets each patient and introduced himself. If this is first session, we
must ask the patient I introduce themselves. Leader, after necessary introduction, may comment on the weather
or on the patients personal appearance or may give any pleasant comment. The objective of the leader in giving
this comment is to create a relaxed atmosphere.
b. BRIDGE OF REALITY – (15 minutes)
- Ask bounce of questions. Question should be alert and easy to answer. Then ask for anybody who knows a point
about your topic for discussion. Question s must be from general to the specific. Try to red your poetry to the
group and later ask the patient to read it. Show your visual aid.
c. SHARING THE WORLD WE LIVE IN – (15 MINUTES)
- Stimulating questions leading to the topics, leaders should try to explore the topic under discussion.
d. APPRECIATION OF THE WORKS OF THE WORLD – (15 MINUTES)
- This step is blended with step no.3. Be sure to relate it with the patient so he will be able to think of himself in
relation to a certain job.
e. CLIMATE OF APPRECIATION – (15 MINUTES)
- Leader should try a summary about the topic which was discussed. Express your appreciation to the patient for
coming to the session and tell them about the next session and what topic is to be discussed.
V. OTHER FORMS OF THERAPEUTIC ACTIVITIES;
THEARAPEUTIC COMMUNITY – it is a very special kind of milieu therapy where the total structure of the patient unit
is involved in a helping process.
ELEMENTS OF THE THERAPEUTIC ACTIVITY;
1. people and patient’s relationship
2. Physical environment
3. Organization

1. PATIENT’S GOVERNMENT – is a group activity where all patients in the ward or representative from the different
words of the pavilion are sent to the general counsel of the governing patient which meets regularly. They also
select their own officers to take lead in representing suggestion to the administrative officers
PRIMARY FUNCTION OF THE MEMBERS;
a. To formulate rules and regulations aside from the already established guiding principles of the pavilion under
which they live and settle their grievenesstion.
OBJECTIVES:
a. To improve ward and strengthen confidence and cooperation between patient and administration.
b. It serves as an avenue for ego satisfaction.
DISADVANTAGE:
a. It could lead to patient’s frustration.
2. COMMUNITY MEETING – is a group meeting which strictly involves all patients of the ward wherein they discuss
problems common to everybody- pertaining to foods, ward set-up, water and attitude of the personnel. They also
discuss on the present possible solution to present problem and referred to person concerned to person
concerned like administration, dietary and social services, etc. it id done for 45 minutes to 1 hour.
OBJECTIVE;
A . To create awareness of patient of their daily activities and to keep bridge to reality.

3. ADVISORY BOARD MEETING: (45 minutes to 1 hour)

- a group activity which involves all patients in the ward to discuss about promotion, demotion, attention of patients
status, learning on how they behave, attend to their assignment of task.
OBJECTIVE:
a. to increase mutual responsibility among patients and exercise engagement for individual and group functioning for
the purpose of understanding self and others.
DIFFERENT STATUS OF PATIENTS:
a. Status special or Staff’s special Patient Status
1. patient is generally dependent on staff
2. does not attend to his needs
3. does not verbalize
4. needs close care of staff
b. Patient’s Special
1. Isolates himself from others.
2. Appears restless, walks back and forth
3. Verbalize desired to run away from the hospital
4. Needs constant companion.
c. Semi – independent
1. Has the tendency to neglect personal grooming.
2. Does not converse with others and needs help to express verbally.
3. Has to be reminded for daily activities.
d. Independent
1. Demonstrate ability to take care of himself; his grooming, etc.
2. Takes medication everyday, without being reminded.
3. Express himself verbally and task for help when remind.
4. Attends daily activities regularly and on time.
5. Abides with community rules and regulations without difficulty

4. SMALL GROUP MEETING - not whole community is present, it involves only 10-12 patients. Personal
problem is discussed. The patients are encouraged to open up, ventilator talk about the personal problems
with co-patients. The motivator is either the occupational therapist or nursing attendant.
5. CIRCLE MEETING – it takes about 15-30 minutes where all patients in the ward are present with the nurse
handling the report book or the highlight of the 24-hours happening in the ward. It includes passes,
discharges, time out of patients, accident, death of anything unusual.
This is usually done before breakfast after all the patients have cleaned the ward and attend to their
personal hygiene and ward assignments.
6. TREATMENT PLANNING CONFERRENCE –Conference attended by all members of the psychiatrist team to
discuss treatment, plan, or scheme about newly patient. It is usually done in the receiving wards. The
members are the doctor, nurse psychologist, and the social worker.
 7. DISCHARGE PLANNING CONFERENCE – Discussion about the possible trial to visit a certain person or
patient. Patient will be sure first by the physician in charge. An then plan for an out- on – will be discussed during
the conference. Home conduction will be schedule and arranged by the social worker.
7. FAMILY MEETING – a meeting of a doctor, his patient and his family or immediate relatives.

CONCEPT UNDERLYING THERAPEUTIC COMMUNITY:

1. ADL SESSIONS- a series of meeting with a group of patient (10-12) to stimulate them again about living in a
normal society outside the hospital
2. MUSIC THERAPY- refers to the use of rhythmical or continuation of sounds and tones of artistic expression and
showing of emotion. It is considered as a creative expression and means of enriching emotional stability.
3. BIBLIOGRAPHY- which is the use of printed words as a means of modifying or stimulating emotion and providing
information.
4. PSYCHODRAMA- rule playing opportunity to freely expressed his feelings and lessening emotion trauma.
5. FAMILY THERAPY- involves the interaction and behavior of family members.
6. PLAY THERAPY – patient are encourage to perform imaginative play with various toys or materials provided by
the therapist.
7. MIILIEU THERAPY- scientific manipulation of environment which aims at focussing charges of the personality of
the patients to regain a positive relation to his family and community.

VI. PHARMACOLOGICAL THERAPY

CHEMOTHERAPY- a form of treatment by chemical substance having as specific effect on the micro-organic cause of
the disease without injuring the patient.
ROLES OF THE NURSE CHEMOTHERAPY
1. Explain to the patient the need to take the medicine at level of understanding.
3. Know the treatment goal in psychiatry.
4. Interact with the doctor in planning management of patient.
5. Know reaction of the drug.
SIDE EFFECTS OF CHEMOTHERAPY:
1. Rigidity
2. Salivation
3. Rolling of eyeballs
4. Hypertension
5. Blurring of vision
6. Tremor of upper and lower extremities
7. Skin rashes
8. Lack jaw

CLASSIFICATION OF PSYCHITROPIC DRUGS USED THERAPEUTICALLY:

1. NEUTROLEPTICS- are agents that have the capacity to modified effective states without seriously impairing
cognitive functions. They react upon CNS in modifying behavior, they affect the functioning of the extrapyramidal
nervous system and the autonomic nervous system. Generally, they act blocking dopamine receptors in the brain.
REPRESENTATIVE MEMBERS: Phenothiazines, butypophenones, thioxanthenes, Dihydroinlines, Raunolfo Alkaliods
2. ANTIDEPRESSANTS AND AFFECTIVE MODULATORS- are complex agents with pharmacological effects in
particular on the biogenic amines norepinephrine and serotonin
3. ANXIOLYTIC SEDATIVES – are sedative hypnotic that generally depress brain function.
REPPRESETATIVE MEMBERS: Amphetamine, Methylphenidate, dibenzoxepin, Caffeine

4. SOMONIFACIENTS – includes the well-known barbiturates

REPRESENTATIVE MEMBERS: Barbiturates, Choral Hydrate. Ethylchlorinal, Glutethimide, Methyprylon,
Methaqualone, Paraldehyde
5. TRANQUILIZER – drugs that produce emotional calmness and relaxation with sedation. It act as principally in the
lower brain cortex.

CHARACTERISTICS OF MAJOR TRANQUILIZER:

1. Highly effective in controlling signs and symptoms of acutely and chronically disturbed patient.
2. It produces emotional calmness and mental relaxation.
3. They produce some of the reversible extrapyramidal symptoms (EPS): rigidity, tremor, and drooling.
4. They produce relatively a high incidence of annoying reaction but little if any habituation or dependency.

INDICATIONS OF MAJOR TRANQUILIZER:

1. Symptomatic treatment of excitement and emergency treatment of acute psychotic breaks.
2. Long term treatment of psychotic refractory schizophrenia.
3. Maintenance therapy of psychosis.
4. Decrease motor behavior.