PSYCHIATRIC &

VERBALIZING THE IMPLIED

 CLIENT: “I can’t talk to you or anyone. It’s

MENTAL HEALTH a waste of time”

 NURSE: “Do you feel that no one

NURSING understands?”
✓ ASSERTIVENESS: able to express
yourself without being emotional.
THERAPEUTIC COMMUNICATION SEEKING CLARIFICATION
SYMPATHY EMPATHY  CLIENT: “I’m feeling sick inside”
“I feel sorry for you” “I see you are sad”
 NURSE: “What do you mean by ‘feeling
“ I know how it felt “It must have been
sick inside’?”
like to lose a sister, I difficult for you to
lost mine I was 6” lose your sister when CONSENSUAL VALIDATION
you needed her most”
 CLIENT: “I am way out in the ocean”
FOCUS: Nurse’s own FOCUS: Patient’s
feelings feelings  NURSE: “You seem to feel lonely”
Acknowledges the IDENTIFYING THEMES
patient’s feelings
 This is to determine the patterns of
thoughts (this influences on the patient’s
OFFERING SELF behavior)
 “I’ll sit with you for a while”  “What comes into your mind each time
 Remain SILENCE. you…”
✓ Patient: able to organize his/her  “What do you do each time you argue with
thoughts. your wife?”
✓ Nurse: observes for non-verbal cues.  Cognitive Behavioral Therapy (CBT)
✓ Maintain eye contact. ✓ Able to correct the thinking of himself
to bring out the positive change of their
BROAD OPENING behavior.
 “How are you feeling today?”
 “Is there something you’d like to talk REFLECTING
about?”  CLIENT: “Do you think I should tell my
✓ Patient: able to choose the topic. dad”
 NURSE: “Do you think you should?”
EXPLORING
RULES IN THERAPEUTIC COMMUNICATION
 “Tell me more about you and your
TECHNIQUES
boyfriend”
1) DO NOT Agree
RESTATING 2) DO NOT Disagree
3) DO NOT Argue
 CLIENT: “I can’t sleep. I stay awake all
4) DO NOT Give Opinions
night”
5) DO NOT Suggest
 NURSE: “ You have difficulty sleeping” 6) DO NOT Recommend
✓ Patient: able to realize that he/she
able to communicate effectively PURPOSE: to give the client independent decision-
✓ Patient: realize that there is making opportunities
someone was able to understand
FORMULATING A PLAN PHASES OF NURSE-PATIENT
 FOCUS: Anger management issues
 “What could you do to let your anger out
RELATIONSHIP
harmlessly” A. PRE-ORIENTATION PHASE
 Nurse reads the patient’s chart (for
SUPPORTIVE CONFRONTATION comprehensive background)
 FOCUS: Acknowledge the feelings before  GOAL: Introspection
motivating the patient ✓ Inspecting of self-awareness
 “i know this isn’t easy to do, but i think you ✓ Explore your own thoughts, feelings,
can do it” values, beliefs, etc.
 “It would be difficult at first, but you’ll get ✓ Determining preconceptions
through it (preconceived judgments/prejudices)
 Toxic Positivity: Romanticizes resilience  PROBLEM: Reluctance of the Nurse

ENCOURAGING COMPARISON
B. ORIENTATION PHASE
 FOCUS: Evaluation of the effectiveness of
 First face-to-face contact of the patient
used interventions
 GOAL: Establish Rapport
 “What is different about your feelings
(Trust/Congruence)
today”
1) Mutually set the contract
2) Involve the patient in planning
NON-THERAPEUTIC  PROBLEM: Resistance of the Patient
COMMUNICATION
1) Stereotyping: Just Have A Positive Attitude C. WORKING PHASE
 Longest phase of NPR
2) Reassuring: Everything Will Be Alright
 GOAL: Explore patient’s feelings/ Verbalize
3) Requesting an explanation: Why feelings of patient
 PROBLEM: Emotional Attachment
NURSE-PATIENT RELATIONSHIP 1) Transference (attachment of patient to
 MOST IMPORTANT ELEMENT: Acceptance nurse)
✓ MANAGEMENT:
✓ PURPOSE: to facilitate helping
a) Always remind patient about the
relationship
professional contract (able to set
 PROFESSIONAL RELATIONSHIP:
boundaries)
✓ Elements of a Contract: b) Redirect the emotions of the patient
a) Time, Day, Venue of sessions 2) Countertransference (attachment of
b) Termination of the relationship nurse to patient)
c) Participants 3) Cross transference (attachment of both
d) Registered Nurses and Patient’s nurse and patient)
Responsibilities
D. TERMINATION PHASE
 GOAL: Evaluation of the effectiveness of
interventions
 PROBLEM: Separation Anxiety
✓ MANAGEMENT:
1) Constantly remind patient about
the professional contrac.t
 COPING CRISIS FREUD’S STRUCTURAL THEORY
MECHANISMS
Conscious When coping OF PERSONALITY
mechanisms to mechanisms become A. ID
stressful events INEFFECTIVE  Pleasure seeking of the mind
 Demands immediate gratification
 Developed in INFANCY
TYPE OF CRISIS
1) SITUATIONAL CRISIS  PROBLEMS (Id > Superego)::
 Unexpected events a) Antisocial Disorder
 E.g. Sudden death of a loved one, Loss b) Narcissistic Disorder
of jobs B. EGO
 Balancer
2) ADVENTITIOUS CRISIS (SOCIAL CRISIS)  Developed at 2 YEARS OLD: Selfish
 Natural calamities  Reality (real you)
 E.g. Rape, War, Pandemic  PROBLEMS (Ego has been destroyed):
a) Schizophrenia
3) MATURATIONAL CRISIS C. SUPEREGO
 Expected events  Conscience
 E.g. Marriage, Retirement, Menopause  “Guilt feeling”
 Developed at 3 YEARS OLD
CRISIS INTERVENTION  PROBLEMS (Id < Superego):
 PRIORITY ASSESSMENT:
a) Anorexia Nervosa
1) Assess perception of the event
b) Obsessive Compulsive Disorder
2) Presence of Support System
3) Availability of the coping mechanism/s
EXAMPLE:
 DURATION OF CRISIS: 4-6 WEEKS (Self-
 ID: I want chocolate
limiting)
 SUPEREGO: You’re on a diet
 GOAL: Help client return to pre-crisis level
 EGO: ate a small bar of chocolate
 FOCUS: Here & Now (Immediate problem
✓ Experiences guilt and anxiety
of the patient)
✓ EGO develops ego defense mechanisms
 GESTALT THERAPY: focuses the
✓ PURPOSE: To protect itself.
individual’s problem in the PRESENT
moment.
 APPROACH:
a) Directive (Education of stress &
stress management)
b) Supportive

EGO DEFENSE MECHANISMS

DENIAL b) Boyfriend is cheating, to relieve his
 Refusal to accept the truth guilt, he starts to give flowers to his
 EXAMPLE: alcoholism girlfriend.

REGRESSION SUPPRESSION
 Return to earlier stage of development  CONSCIOUS forgetting
 EXAMPLES:  “I don’t want to talk about it”
a) Dementia (Alzheimer’s)  EXAMPLES:
b) 5 yr. old acted like a toddler by “temper a) Anorexia nervosa (they suppress that
tantrums” knowing that his mother is they are hungry in fear of getting fat)
now having another baby
REPRESSION
brother/sister.
 UNCONSCIOUS forgetting
✓ MANAGEMENT: involve the child
 EXAMPLES:
in preparing the baby
a) Dissociative Amnesia (totally forgotten
INTROJECTION details of the event yet still increases
 Blaming SELF anxiety)
 EXAMPLES:
RATIONALIZATION
a) Major Depression
 Making unreasonable/unjustifiable
PROJECTION excuses
 Blaming OTHERS  “Nagdadahilan”
 EXAMPLES:  EXAMPLES:
a) Paranoid patients
INTELLECTUALIZATION
DISPLACEMENT  Disregarding the emotions
 Redirecting emotions to a less threatening  “It is God’s Will”
object or person  EXAMPLES:
 “Kick the cat” Phenomenon
SPLITTING
 EXAMPLES:
 Seeing others as either GOOD or BAD (NOT
a) Phobia
neutral)
REACTION FORMATION  EXAMPLES:
 Acting the OPPOSITE of your true a) Borderline Personality Disorder
emotions (unpredictable mood)
 EXAMPLES:
SUBSTITUTION
a) Hugging someone you hate
 Replacing unattained goals with easily
b) Bipolar Disorder
achievable goals
UNDOING  To something that is High to something
 Doing something to relieve the that is Low
guilt/anxiety  EXAMPLES:
 EXAMPLES: a) DREAM: Doctor
a) Obsessive Compulsive Disorder CURRENT JOB: Janitor in Hospital
b) A unfertile woman wants to have a
baby turns into having adopting a dog
COMPENSATION LEVELS OF ANXIETY
 Overachieving in a different field 1) MILD
 EXAMPLES:  (N) level
a) A failed bar examiner turned into a  Manifestation:
multi-billionaire a) Increased alertness
SUBLIMATION b) Effective in learning
 Unacceptable drive to something which is 2) MODERATE
acceptable actions  Manifestation:
 EXAMPLES: a) Selective attention
a) PAST: Rapist b) Narrowed perception
CURRENT: Priest c) Pacing
b) PAST: Prostitute  MANAGEMENT:
CURRENT: DSWD volunteer a) Redirect the patient
b) Oral anxiolytics
REACTION FORMATION  Parasympathetic stimulation:
 Imitate other person (like/dislike) a) Para tae (diarrhea)
 EXAMPLES: b) Para ihi (urinary frequency)
a) Bullies c) Para dura (increased salivation)
3) SEVERE
ANXIETY  Manifestation:
 NEUROTRANSMITTER: Gamma Amino a) Unable to perform tasks
Butyric Acid b) Unable to redirect
✓ Decrease of GABA c) Unable to decide
 CHARACTERISTIC: Contagious  MANAGEMENT:
 INITIAL NURSING ACTION: Assess own a) IM anxiolytics
level of anxiety 4) PANIC
 PRIORITY:  Manifestation:
a) SAFETY a) Delusional hallucinations
b) STAY with the patient b) Violence/suicide
 DRUG OF CHOICE:  MANAGEMENT:
a) Benzodiazepines (-lam, -pam) a) Take control “restraints”
✓ Alprazolam
GENERALIZED ANXIETY DISORDER
✓ Diazepam
 Uncontrollable worry for at least 6 months
✓ Clonazepam with physical symptoms:
 NURSING EDUCATION: a) Palpitations
a) Avoid alcohol (respiratory b) Anorexia
depressant) c) Difficulty of sleeping
✓ COMPLICATION: Respiratory d) Easy fatigability
arrest
ANXIETY RELATED DISORDERS EATING DISORDERS
 PSYCHODYNAMICS: Parental
OBSESSIVE COMPULSIVE DISORDER
Harassment/Antagonism
 OBSESSION: repetitive thoughts
 SOCIAL CULTURAL FACTORS:
 COMPULSION: repetitive actions (rituals)
a) Developmental pressure
✓ This decreases level of guilt/anxiety
 NEUROTRANSMITTER: Decrease
 Defense Mechanism: UNDOING Serotonin & Decrease norepinephrine
 MANAGEMENT:  AGE GROUP: Adolescence (Females)
a) Allow the patient perform the rituals
(prevent panic attacks)
ANOREXIA BULIMIA
b) Adjust the schedule of the patient NERVOSA NERVOSA
c) Gradually limit the rituals Perfectionist Hunger-Anger Cycle
d) CBT Self-restricted diet Binge-Purge Syndrome
 Ate too much
PHOBIC DISORDER (Bingeing)
 Irrational fear  After too much
 3 MAIN TYPES: eating, patient
have “guilt
a) Social Phobia
feeling”
✓ Irrational fear of dealing or speaking with  Patient self-
strangers vomits (Purging)
b) Agoraphobia Compulsive exercising Tooth decay
✓ Fear of inescapable places regardless of  Due to self-vomiting,
closed or open  MANAGEMENT: HCl rises up and
c) Specific Phobia ✓ Distract the destroys the tooth
patient enamel
✓ Claustrophobia (fear of closed spaces)
✓ Invite patient for  Dentist is one of the
 Defense Mechanism: DISPLACEMENT a walk first to suspect
 MANAGEMENT: someone with
Systematic Desensitization (Gradual bulimia nervosa
exposure of the feared object) Alopecia Use of laxatives &
a) Talk frequently about the feared Enemas
object Anemia Hypokalemia
Life-threatening! Ability to maintain
normal body weight
Russel’s Sign

 Scarring of knuckles
d/t self-vomiting
 NURSING DIAGNOSES:
a) Altered Nutrition
b) Electrolyte Imbalance (#1 PRIORITY)
c) Body Image Disturbance (perception of
the patient)
 INTERVENTIONS:
a) Involve the patient in planning meals
b) Set time limit during meals
c) Supervise the client after eating
d) Accompany patient to bathroom
  PSYCHOTHERAPEUTIC MANAGEMENT: ANTISOCIAL  Lack Of Control
PERSONALITY  Lawbreakers
a) Self-monitoring DISORDER  Shows No
✓ Diary of food intake Remorse
✓ Journal (Record of  Manipulative
HISTRIONIC  Sexually
emotions/reflections) PERSONALITY Seductive
✓ Patient will be able to relate his DISORDER  Overly
food intake and his emotions Dramatic
 Attention
 EVALUATION: Seekers (Use
✓ Body mass index: own bodies to
✓ (N) BMI: 18.5-24.9 gain attention
to others)
 MEDICAL TREATMENT: NARCISSISTIC  Self Is “Special”
✓ SSRIs (Selective Serotonin Reuptake PERSONALITY  Sense Of Self-
Inhibitors) DISORDER Entitlement
 Grandiosity
− E.g. Fluoxetine (Prozac)  Deny any form
of weakness

DEPENDENT  Does Not

PERSONALITY DISORDERS PERSONALITY Decide
DISORDER  Relies On
 Patterns of behavior disrupts Others For
interpersonal relationships Support And
Validation
 DIAGNOSIS: Adolescent Age OBSESSIVE  Perfectionists
 Improves in 40-50 years C ANXIOUS/ COMPULSIVE  “My Way”
FEARFUL PERSONALITY  Ego-Syntonic
DISORDER  Must Follow
CLUSTER TERMED AS PERSONALITY SYMPTOMS Fear of Rules
DISORDER rejection  Rules Cannot
PARANOID  Suspicious Be Bent
PERSONALITY  Unforgiving Fear of AVOIDANT  Desires
DISORDER criticism PERSONALITY Relationships
SCHIZOID  Distant DISORDER But Extreme
A ODD/ PERSONALITY  Loner Fear of Anxiety Kicks
ECCENTRIC DISORDER  Aloof failure In
 No Interest In  Insecure
Relationships  Avoids
 Lifelong Social Responsibility
Withdrawal  Inferior
(Asocial)  Fear Of
SCHIZOTYPAL  Magical Rejection
PERSONALITY Thinking  MANAGEMENT: BEHAVIORAL THERAPY
DISORDER  Superstitious
 Believes in (Role Playing)
lucky charms
 Dresses
 GOAL OF MANAGEMENT:
Weirdly a) Able to return to the community
 “Sixth Sense”
Belief
b) Establish meaningful relationships
BORDERLINE  Instability
PERSONALITY  Unpredictable
DISORDER Mood
 Suicidal
BAD  Impulsivity
B  Identity
DRAMATIC/ Disturbance
ERRATIC  “I Cannot
Control Anger”

ILLUSION
  Problem of perception  Does not return to the original topic
 Misinterpretation of external stimulus  Did not answer the question
3) ASSOCIATIVE LOOSENESS
HALLUCINATION (DERAILMENT)
 Problem of perception  Fragmented thoughts
 False sensory perception  Does not have connectivity of
 MANAGEMENT: HARDER (yamete) thought
a) Hallucination must be recognized 4) FLIGHT OF IDEAS
b) Assess the content of hallucination  Rapid speech (jumps from one topic
✓ To determine if to institute safety to another)
precautions 5) ECHOLALIA
c) Reality Presentation  Repeating words of OTHERS
d) Distract Immediately 6) PALILALIA
e) Engage patient in reality-based  Repeating OWN words
activities 7) ECHOPRAXIA
f) Reintegrate with therapeutic milieu  Repeating actions of OTHERS
(environment) 8) MANNERISM
 Repeating own actions
DELUSION
 False belief
 MANAGEMENT: CAVVE
a) Clarify the delusion
b) Acknowledge the feelings, not the
delusion
c) Voicing doubt
d) Validate the statement of the patient
e) Engage in reality activities

IDEAS OF REFERENCE/REFERENTIAL
DELUSION
 Give meaning to the action of others
 E.g. CLIENT: “Nurse, those two guys are
planning to do something bad to me”

DISTURBANCE IN THOUGHT:
1) CIRCUMSTANTIAL THINKING
(circumstantiality)
 Providing unnecessary details
 Returns to the original topic
 Answers the question
2) TANGENTIAL THINKING (Tangentiality)
 Providing unnecessary details
 Lack of focus