PSYCHIATRIC

NURSING
• MENTAL HEALTH
– Is a balance in a
person’s internal
life and adaptation
to reality.
• MENTAL ILLNESS
– Is a state of
imbalance
characterized by
disturbance in a
persons thoughts,
feelings and
behaviours
• PSYCHIATRIC
NURSING
– Is an interpersonal
process whereby the
professional nurse
practitioner, through
the therapeutic use
of self and nursing
theories assist
clients to achieve
psychosocial well-
being.
• PERSONALITY
– Integration of
systems and habits
representing an
individuals
characteristics
adjustments to his
environment
expressed through
behaviours.
• MENTAL HYGEINE
– Measures to promote
mental health,
preventing mental
SELF AWARENESS
• Is a clear perception
about your
personality, including
strength and
weakness, thoughts,
beliefs, motivations
and emotions.
• It is knowing:
– What you want in your
life
– Your strength and
weaknesses
– What you want to
change about yourself
or about your life
– Your achievements so
far
– How to relate to others
– What you need to
improve as a person
– Your most important
beliefs and values
– How you see yourself
 NEUROSIS
• Any long term
mental or
behavioural disorder
in which contact to
reality is retained,
the condition is
recognized by the
patient as abnormal.
 PSYCHOSIS
• Mental or
behavioural disorder
wherein a patient
looses contact with
reality.
• Presence of
delusions,
hallucinations,
thought
disturbances,
alteration of mood,
COMMON BEHAVIOURAL
TERMS

• DISTURBANCES in
PERCEPTION
– Illusion
– Hallucination
• Auditory
• Visual
• Tactile
DISTURBANCES IN
THINKING and
• Neologism
• Word Salad
• Verbigeration
• Perseveration
• Echolalia
• Aphasia
• Ambivalence
• Flight of Ideas
• Looseness of
association
• Clang association
• Delusion
– Delusion of Grandeur
– Persecutory
– Ideas of Reference
– Somatic
• Concrete Association
• Magical thinking
DISTURBANCES in
AFFECT
• Inappropriate
• Blunt
• Flat
• Depersonalization
• Derealization
• Agnosia
DISTURBANCES in
MOTOR ACTIVITY
• Echopraxia
• Waxy Flexibility
• Ataxia
• Akathesia
• Dystonia
• Tardive Dyskenisia
• Apraxia
DISTURBANCES in
MEMORY
• Confabulation
• Déjà vu
• Jamais vu
• Amnesia
– Retrograde
– anterograde
 Satisfaction of
Human needs
• Physiologic
• Safety and security
• Love and
belongingness
• Self-esteem
• Self-actualization
Three divisions of the
Mind
• Conscious
• Subconscious
• Unconscious
 THEORIES OF
PERSONALITY
• SIGMUND FREUD
– Psychosexual Theory
– Structure of Personality
• ID
• EGO
• SUPEREGO
• ERICK ERICSON
– Psychosocial Theory
• JEAN PIAGET
– Cognitive Theory
• Lawrence Kohlberg
– Moral Development Theory
 DEFENSE
MECHANISMS
• Unconscious intrapsychic
adoptive efforts to
resolve emotional
conflict and cope with
anxiety
 EXAMPLES of DEFENSE
MECHANISMS
• Denial
• Displacement
• Projection
• Introjection
• Undoing
• Compensation
• Substitution
• Repression
• Supression
 EXAMPLES of DEFENSE
MECHANISMS
• Reaction formation
• Regression
• Dissociation
• Conversion
• Fantasy
• Identification
• Intellectualization
• Rationalization
• Sublimation
 NURSE-PATIENT
RELATIONSHIP
• Is a series of interaction between the
nurse and patient in which the nurse
assists the patient to attain positive
behavioural change.

– T: trust
– R: rapport
– U: unconditional positive regard
– S: setting limits
– T: therapeutic communication
 PHASES
• Pre-interaction
– Self-awareness
• Orientation
– Developing a mutually acceptable contact
• Working
– Identification and resolution of the patient’s
problem
• Termination
– Assist patient to review what he has
learned and transfer his learning to his
 When to terminate NPR
• Goals are accomplished
• Emotionally stable
• Greater independence
• Able to cope with anxiety, fear, loss
and separation

• Common effect: regression

 Common problems in NPR
• Transference
• Counter-transference
 Principles of
CARE
• Accept patient as unique with
inherent value and worth
• Patient is viewed as holistic human
beings with interdependent and
interrelated needs
• Focus on the patient’s strength’s and
assets.
• Non-judgemental assistance towards
coping
Therapeutic Communication
• Offer self
• Exploration
• Silence
• Active listening
• Make observation
• Broad Opening
• Clarification
• Restating
• General leads
• Refocusing
• focusing
 Non-therapeutic
Communication
• “don’t worry be happy”
• “why?”
• Ignoring
• Flattery
• Arguing with the patient
 TYPES of
PSYCHOTHERAPIES
• Remotivation therapy
• Music Therapy
• Play therapy
• Group therapy
• Milieu therapy
• Family therapy
• Hypnotherapy
• Behaviour modification
• Types of behavioural
modification:
– Operant conditioning
– Desensitization
– Aversion
PSYCHOPHARMACOLOGY
• Are the use of medication to
treat or control mental and
behavioural problems.
 ANTI-
PSYCHOTICS/NEUROLEPTICS
• PHENOTHIAZINES
– chlorpromazine (Thorazine)
– fluphenazine (Prolixin)
– perphenazine (Trilafon)
– prochlorperazine (Compazine)
– thioridazine (Mellaril)
– triflouperazine (Stelazine)
• NON-PHENOTHIAZINES
– clozapine (Clozaril)
– haloperidol (Haldol)
– olanzapine (Zyprexia)
– resperidone (Risperdal)
 Mechanism of Action
• Antagonizes dopamine in the CNS by
blocking dopamine receptors and
reducing dopamine activity.

• INDICATION:
– Relieves psychotic symptoms of
schizophrenia and mania
– Acute management of agitation and
hyperactivity
 Side/Adverse effects
• Extrapyramidal Side effect
– Acute dystonia
– Pseudoparkinsonism
• Stiff stooped posture
• Mask-like faces
• Shuffling, festinating gait
• Drooling
• Pill rolling tremors/resting tremor
– Akathisia
– Torticollis
– Opisthotonus
– Oculogyric crisis
 Side/Adverse effects
• Neuroleptic Malignant Syndrome
– Rigidity
– High fever
– Unstable BP
– Diaphoresis and pallor
– Elevated enzymes: creatinine and
phosphokinase
– Confused/mute

• Discontinue medication ASAP!

 Side/Adverse effects
• Tardive dyskinesia
– Involuntary movements of the tongue,
facial and neck muscle
– Tongue protrusion and thrusting
– Lip smacking
– Blinking
– grimacing
 Contraindication
• Glaucoma
• Pregnancy and lactation
• Elderly clients
 Nursing Guidelines
• Give the medication after meals
• Instruct the client to rise slowly from a
lying position
• Instruct the client to report sore throat,
fever or muscular rigidity
• Inform the client that the medication
will achieve its full therapeutic effect
within 6-8 weeks
• Monitor client’s BP and body
temperature, blood levels, presence of
seizure, NMS and EPS
 ANTIDOTES
• NMS
– bromocriptine or amantadine
– dantrolene
– Muscle relaxants
• Dystonia
– dyphenhydramine
– benztropine
– diazepam
– lorazepam
• Pseudoparkinsonism
– Antiparkinsonian
• Tardive dyskinesia
– Early referral- dose reduction
 ANTIPARKINSONIAN
AGENTS
• Dopaminergic drugs
– Enhances dopamine activity, slows
deterioration of dopaminergic nerve
cells

• carbidopa-levodopa (Sinemet)
• amantadine (Symmetrel)
• bromocriptine mesylate (Parlodel)
• levodopa (Larodopa)
 ANTIPARKINSONIAN
AGENTS
• Anticholinergic Agents
– Inhibit excess in cholinergic activity
– Decreases signs and symptoms like:
• Tremors, rigidity, drooling, and
promotes optimal levels of motor
functions (gait, posture, speech)

• trihexypheiedil (Artane)
• biperidine Hydrochloride (Akineton)
• benztropine myselate (Cogentin)
• diphenhydramine HCL (Benadryl)
• Side Effects
– Blurring of vision, constipation,
orthostatic hypotension,
sorethroat*, headache,
photosensitivity, drowsiness

• Contraindications
– Glaucoma, tachycardia,
hypertension, duodenal ulcer
 Nursing Guidelines
• Inform the client that tremors and
rigidity will be decreased after 2-3
days of drug therapy
• Give the medication after meals
• Avoid sudden position change
• Inform the client to avoid Vit. B6
and protein rich foods
• Encourage the client to avoid
alcohol consumption
• Do not withdraw the medication
 ANTIDEPRESSANTS
• TRICYCLIC ANTIDEPRESSANTS
– Prolongs the action of norepinephrine
dopamine and serotonin by blocking the
reuptake of this neurotransmitters

• imapramine (Tofranil)
• amitriptyline (Elavil)
• clomipramine (Anafril)
• doxepin (sinequan)
 ANTIDEPRESSANTS
• MONOAMINE OXIDASE INHIBITORS
– Blocks the metabolic destruction of
neurotransmitters by the enzyme
monoamine oxidase

• tranylcypromine (Parnate)
• isocarboxacid (Marplan)
• phenelzine (Nardil)
 ANTIDEPRESSANTS
• Selective Serotonin Reuptake
Inhibitors
– Inhibits reuptake and destruction of
serotonin to prolong its action

• fluoxetin (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)
• fluvoxamine (Luvox)
 ANTIDEPRESSANTS
• CNS STIMULANTS
– Increases levels of neurotransmitters in
the brain thereby increasing CNS
activity and decreasing hyperactivity

• methylphenidate (Ritalin)
• amphetamine (Benzedrine)
 SIDE EFFECTS
• TCA’s
– Cardiac arrhythmias
– Palpitation, orthostatic hypotension
– Constipation
– Sedation, Confusion

• MAOI
– Hypertensive crisis
– Liver and cardiovascular disease
– Weight gain
– Sexual dysfunction
– Photosensitivity
 SIDE EFFECTS
• SSRI’s
– Tremors
– Decreased libido
– Nervousness
– Insomnia
– Anxiety

• CNS stimulants
– Growth suppression
– insomnia
 CONTRAINDICATIONS
• Liver disease
• Cardiovascular disease
• Glaucoma
• Hypertension
 NURSING GUIDELINES
• TCA’s
– Give the medication after meals.
– Inform the client that the initial effect of
the medication happen after 2-3 weeks.
– Tell the client that the full therapeutic
effect occurs within 3-6 weeks of
compliance
– Emphasize compliance of medication
regimen
– Avoid citrus foods
 NURSING GUIDELINES
• MAOI
– Give the medication after meals
– Inform client that initial effect of the
medication occurs after 2-3 weeks
– The full therapeutic effect is achieved
after 3-4 weeks
– Avoid tyramine rich foods
– Monitor BP and food items
 NURSING GUIDELINES
• SSRI
– Give the medication after meals
– Initial effect occur after 2-3 weeks of
therapy
– Full therapeutic effect is achieved after
3-4 weeks

• CNS STIMULANTS
– Give the medication in the morning or
before 2 PM
 ANTI-MANIC
• Alters the level of dopamine and
other neurotransmitters.

– lithium carbonate (Eskalith)

– carbamazepine (Tegretol)
 SIDE EFFECTS
• Fine tremors leading to coarse
tremors
• Thirst
• Nystagmus
• Nephrotoxicity
• Cardiac toxicity
• Hyperthyroidism
 CONTRAINDICATION
• Cardiovascular disorders
• Renal disorders
• Hyponatremia
• On diuretic therapy
• Brain damage
• Pregnancy and lactation
 NURSING GUIDELINES
• Inform client that the initial effect
occurs after 10-14 days
• Full therapeutic effect is achieved
within 3-4 weeks of drug compliance
• Give the medication with food or milk or
after meals
• Instruct the client to include sodium
rich foods in the diet not exceeding to
6-10 grams a day
• Tell the client to avoid caffeine,
diuretics and activities that increase
perspiration
 NURSING GUIDELINES
• Monitor serum levels once a month
in the morning 12 hours after the last
dose
– Maintenance dose: .5 – 1.2 mEq/L
– Acute level : 1.5 mEq/L
– Level for the elderly client: .4 -10 mEq/L

• Antidote for lithium toxicity

– mannitol (Osmitrol)
– acetylzolamide (Diamox)
 ANTI ANXIETY
• Depresses the
reticular
activating
system and
reduces anxiety
by stimulating
the action of
neurotransmitte
r GABA
 ANTI ANXIETY
• BENZODIAZEPINES
– alprazolam (Xanax)
– chlordiazepoxide (Librium)
– diazepam (Valium)
– lorazepam (Ativan)
– oxazepam (Serax)

• AZASPIRONES
– buspirone (Buspar)

• NON-BENZODIAZEPINES
– hydroxyzine (Vistaril)
– meprobamate (Equanil)
 SIDE EFFECTS
• Sedation, dizziness, drowsiness
• Dry mouth
• Dependency
• hepatotoxicity
 CONTRAINDICATIONS
• Glaucoma
• Liver and kidney dysfunction
• Pregnancy and lactation
 NURSING GUIDELINES
• Give the medication before
meals
• Instruct client to rise uo slowly
• Avoid caffeine and alcohol
• Monitor blood levels
• Report presence of sore throat,
jaundice, weakness and fever