MOOD DISORDERS

THOUGHT DISORDERS

Predisposing Factors:

SCHIZOPHRENIA
Split Mind-

Genetic:
Aggression turned inward theory:
Object loss theory:
Personality Organization Theory:
Cognitive Theory:
Learned Helplessness Theory:
Psychoanalytic Theory:
Biologic Factor:

If one parent has bipolar disorder, 25 percent chance of transmission

overdeveloped superego
loss of parent before age 11
OCD, Oral dependent, hysterical personalities
negativism and pessimism
constant failures in life
Mania is a defense against an underlying depression
Depression due to rigid SE
Mania is cause by increased norepinephrine while depression is cause by low
norepinephrine ; biologic d/o

Signs and symptoms:

Appearance
Behavior
Communication
Nursing Diagnosis
Nursing Care
Milieu Therapy
Activity
Attitude therapy

Mania
Colorful
Highly driven, hyperactive
Talkative (Flight of ideas)
Risk for injury directed at others
Lithium
Non-stimulating
Quiet Type
Avoid competitive
Matter of Fact
(attitude of casualness)

Signs and Symptoms:

Hallucinations and illusions
Associative looseness and Affect disturbances , Autism, Apathy, Ambivalence
Delusions
Most acceptable theory on the cause of Schizophrenia, Biologic Theory dopamine hypothesis
Different Types and manifestations:
Catatonic
Distinguishing feature
Abnormal motor behavior
waxy flexibility ,
echopraxia
Defense mechanism
Repression

Ultimate form of self-destruction

cry for help
Major intervention: Prevention/ Listen
Risk Factors:
Sex (more female attempts at suicide but more males commit suicide)
Unsuccessful previous attempt
Identification with a family member who committed suicide
Chronic
Illness (e.g. Cancer)
Depression/Dependent personality
Age (18-25 and 40)/Alcoholism
Lethality of previous attempt/Losses
Nursing Diagnosis: Risk for self-directed injury
Nursing Care:
F
O
A
M

Disorganized
Bizarre behavior

Paranoid
Suspiciousness and
ideas of reference

Regression

Projection

Nursing diagnosis

Impaired motor activity

Impaired social
functioning

Potential for injury

directed at others

Priority nursing care

Circulation & Nutrition

Assistance with ADL

Nutrition and Safety

Other types:
Interventions :

SUICIDE

1.
2.
3.
4.

Depression
Sad
Passivity/Psychomotor retardation
Monotonous
Risk for injury to self
ECT and antidepressants
Stimulating
Monotonous activity
e. g. counting
Kind firmness

Not a single disease but a combination of disorders

Undifferentiated mixture of all types

Residual with minimal symptoms
Antipsychotics and Antiparkinsonian agents
Psychoanalysis

DELUSIONAL DISORDERS
Description: Characterized by suspicious, strange behavior,
which can be precipitated by a stressful event and can
manifest as an intense hypochondriasis
Nursing Assessment
A. Determine degree of suspiciousness and mistrust of
others.
B. Assess degree of anxiety.
C. Determine whether delusions are present.
1. Reference or control
2. Persecution
3. Grandeur
4. Somatic
5. Jealousy
D. Assess degree of insecurity.
SUBSTANCE ABUSE AND SUBSTANCE DEPENDENCE
Substance Abuse: use of a substance for other than its legitimate medical purpose

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Substance Dependence: physiological and psychological dependence of the body on a substance as evidenced
by tolerance and withdrawal
Tolerance: need for an increasing amount of the substance to produce its desired effect or it refers to the
declining effect of the drug.
Withdrawal: syndrome or a group of symptoms experienced by the patient when the amount of the substance is
reduced or when the intake is stopped.
ALCOHOLISM
alcoholism is a chronic disease or a disorder characterized by excessive alcohol intake and interference in the individuals
health, interpersonal relationship and economic functioning.
Alcoholism considered to be present when there is 1% or 10 ml for every 1000 ml of blood.
Theories of Causation
1. Psychoanalytic Theories oral fixation
2. Learning Theories learned behavior and influence
3. Biological Theories genetic tendencies
4. Socio-Cultural Theories effect of mass media and social influence
Progression of Alcoholism
1. Pre-alcoholic Phase starts with social drinking tolerance begins to develop
2. Prodromal Phase Alcohol becomes a need, blackouts occur; denial begins to develop
3. Crucial Phase cardinal symptoms of alcoholism develops (loss of control over drinking)
4. Chronic Phase the person becomes intoxicated all day

Hallucinations
Increased vital signs
Tremors and agitation
Sweating and Seizure

Onset
Essential
feature
Other S/Sx

D. Tremens
Faculty metabolism
of alcohol
Acute
Delirium
Vital Signs
Visual and tactile
Coarse tremors

Nursing diagnosis: Ineffective individual coping

Principles of Nursing Care: ACUTE
1. Librium Dec. seizures
2. Well-lighted room
3. DAT / Administration of glucose
4. Monitor vital signs
5. Vitamins - Thiamine

ABUSE
Phases of Crisis
Denial
Increased tension

initial reaction
the person recognizes the presences of a crisis and continues to do activities of
daily living.
Disorganization
the person is preoccupied with the crisis and is unable to ADL.
Attempts to reorganize
individual mobilizes previous coping mechanism.
Some Conditions Requiring Crisis Intervention
RAPE
Essential Elements Necessary to Define an Act of Rape
1. U
2. L
3. A
Different Kinds of Rape
Power-compensation for low self esteem
Anger means of retaliation
Sadistic errotization of sexuality

Common Withdrawal Signs and Symptoms

Criteria
Cause

Long terms of care CHRONIC

Community resources
Other coping means aside from denial
Personal responsibility for not drinking
Isolation
Nutrition Vitamin B & C, CHO diet
Group therapy

COMPLICATIONS:
Korsakoff Psychosis
Thiamine & Niacin
deficiency
Chronic
Memory disturbances

Wernickes P.
Thiamine
deficiency
Chronic

Retrograde A
Anterograde A
Confabulation
Korsakoffs P.

Confusion
Opthalmoplegia
Ataxia
Thiamine def.

Principles of Nursing Care:

1. provide safety and security
2. preservation of evidence
3. rape trauma counseling
Rape Trauma Syndrome (RTS)
1. H
2. A
3. D
4. S
BATTERED WIFE SYNDROME (BWS)
Characteristics of Abusive Husband:
1.
2.
3.
Phase
1. Tension building phase
2. Acute battering incident
3. Aftermath/honeymoon stage

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Principles of Nursing Care:

1. teach women assertiveness technique
2. marital counseling or divorce therapy
CHILD ABUSE
Abuse
Violence
Neglect
Physical abuse
Emotional abuse
Sexual abuse

- is what happens when an adult takes advantage of his authority over a child.
- refers to the use of force.
- lack of provision of those things which are necessary for the childs growth and
development.
- abuse in the form of inflicting pain
- insult and undermining ones confidence
- abuse in the form of unwanted sexual contact

Characteristic of Abusive Parents

- they come from violent families
- they were also abused by their parents
- they have inadequate parenting skills
- they are socially isolated because they dont trust anyone
- they are emotionally immature
- they have negative attitude towards the management of the abused
Indicators of Child Abuse:
Violent family pattern
Inconsistencies (Wounds , scars and bruises of different stages of healing )
Social isolation , sexual preoccupation
Emotional lability and depression
No reaction / apathy
Principles of Nursing Care:
1. attend to immediate physiologic needs ( wound care ) and provide safety
2. report to ( Barangay Captain , DSWD personel and Police within in 48 hours )
3. play therapy
SEXUAL DISORDERS
Cause: Psychological factors, unresolved oedipal complex
1. Gender Identity Disorders discomfort with sexuality
2. Arousal and Desire Disorders
3. Orgasmic disorders
4. Paraphilia a term which generally refers to abnormal sexual behaviour
Types:
Sexual Stimulus
Exhibitionism
- publicly showing the genitals
Fetishism
- from inanimate objects
Anilingus
- tongue brushing the anus
Cunnilingus
- tongue brushing the vulva
Fellatio
- inserting the penis into the mouth
Partialism
- inserting the penis into the other parts of the body
Pedophilia
- sexual intercourse with a child
Urophilia
- urinating on the partner
Coprophilia
- smearing feces on the partner
Masochism
- sexual gratification from experiencing pain
Sadism
- inflicting pain
Telephone scatologia
- sex on phone

Voyeurism
Frotteurism
Transvestism
Nursing diagnosis: Altered sexual functioning
Principles of Nursing Care:
1. Limit setting -Behavior Modification
2. psychotherapy - psychoanalysis

- sexual gratification by seeing others in the nude

- rubbing the genitalia to the body parts
- using the apparel of the opposite sex

CONDITIONS COMMON IN THE ELDERLY

Delirium
Disorientation
Acute
Involves young and old
Clouded sensorium
Reversible
Good prognosis

Dementia
Loss/impairment of memory
Chronic
Exclusive in the elderly
Clear sensorium
Irreversible
Poor prognosis

Alzheimers disease: Main pathology: presence of senile plaques-destroys neurons (decreased acethylcholline),
neurofibrillary tangles and cortical atrophy
3 phases
1. Forgetfulness Phase-difficulty of remembering appointments(Anterograde amnesia)
Aphasia-inability to talk
Agnosia- inability to recognize object and sensory stimuli integration
Apraxia-inability to perform ADL, unpurposeful movements
Amnesia/Memory Loss/Mnemonic disturbance
2. Advance Phase-difficulty of remembering past events but not recent events(Retrograde amnesia)
Wandering
Incontinence
3. Terminal Phase-death occurs in 1 year, bedridden and debilitation
Nursing Diagnosis: Altered thought processes
Nursing Care:
Calendar, Clock (frequent orientation), Color - REORIENTATION
Consistency (one nurse to lessen confusion) ROUTINE / REPETITION
Cholinesterase Inhibitors REGULATION - -- MEMORY ENHANCERETYLCHOLINE
DISORDERS EVIDENT BEFORE ADULTHOOD
Autism
Main Problem: pervasive developmental disorder of Interpersonal functioning
Most Acceptable Cause:
Biological factors brain anoxia, intake of drugs
Disturbed mother-child relationship
Signs and symptoms:
1. echolalia and no eye contact, attachment to inanimate objects, crying tantrums
; SOCIAL INTERACTION PROBLEMS
2. loves to spin objects , loves blocks not balls , dislike touch; ; DISTURBANCE IN SENSORY INTEGRATION
3. resists change in the routine and SUSTAINED ODD PLAY
Management of priority problems
Tantrum - involves headbanging = place a helmet on the head
Communication all vowels = use build up and break down

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Routines consistency
Nursing diagnosis: Potential for injury

2.
3.

Mental Retardation
Main problem: Inadequate mental functioning; IQ less than 70
Maximum developmental age : 18 years old
Causes: perinatal disturbances , infections, metabolic d/o , injuries and genetic predisposition
Levels of Mental Retardation
1. Mild/Moron
IQ: 50/55-70
2. Moderate/Imbecile
IQ: 35/40 -50/55
3. Severe/Idiot
IQ: 20/25 -35/40
4. Profound
Below 20-25
Nursing diagnosis: Impaired intellectual functioning
Potential for injury
Principles of Nursing Care:
1. Repetition

Educable
Trainable
Needs close supervision
Needs custodial care

R
R

Attention Deficit Hyperactivity Disorder

Main problem: decreased attention span ( Inattention), hyperactivity, easy distractibility and impulsivity
Causes:
F
U
N
P
E
Nursing diagnosis: Potential for injury and Alteration in Nutrition ; less than body requirments
Principles of Nursing Care:
Nutrition: highly nutritious small frequent ,finger foods
Safety: constant supervision
Drug of Choice: Methylphenidate (Ritalin) monitor for growth suppression

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Nurse Joseph Bahian Abang