PRELIM PSCYHIA REVIEW PDF

PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Women are four times more likely than men to CHAPTER 1-A: CONCE...

PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Women are four times more likely than men to CHAPTER 1-A: CONCEPTS OF MENTAL attempt suicide HEALTH & ILLNESS: MENTAL HEALTH GLOBAL ACTION PROGRAM; HISTORY In the Philippines, 3.3% of the population or OF PSYCHIATRIC CARE 3,298,652 Filipinos live with depression. Suicide Mortality Rate is 3.2 (per 100,000 STATE OF MENTAL HEALTH AND MENTAL population) ILLNESS ON THE COUNTRY AND THE In Northern Mindanao, in 2022 the suicide WORLD rate is.16% (per 100,000 population, while it Globally, mental health has become a increased in 2023 which is.66% (per 100,000 development priority. population) The World Health Report (2001) estimates that 1 in 4 people in the world will be affected by Mental Health Care Delivery System in the mental or neurological disorders at some point Philippines and its importance and Impact in in their lives. the Community Morbidity in Mental Health REPUBLIC ACT NO. 11036 Depression affects an estimated 4.4% of The Department of Health (DOH) has been at people in the world. the forefront in creating a national mental health policy, through the Republic Act 11036, Anxiety disorders affect 3.6% of the “The Mental Health Act”. The passing of the population. law supported and highlighted the value of A fifth of global cases come from the Western working together. Pacific, where 3.6% are affected by depressive Section 40 of the Mental Health Act reads as disorders and 2.9% by anxiety follows: “MANDATE – The Philippine Council for Mental Health, herein referred to In Northern Mindanao the highest case is as the Council. Psychosis or Schizophrenia 4.2% per 100,000 population in 2023 while.88 % in 2022. PHILIPPINE COUNCIL FOR MENTAL HEALTH STRATEGY FRAMEWORK 2024-2028 Mortality in Mental Health The Department of Health (DOH), in Suicide is the act of killing yourself, most partnership with the World Health often as a result of depression or other mental Organization (WHO) – Philippines, is illness. facilitating the formulation of the Philippine Men commit suicide three times the rate of Council for Mental Health Strategic Plan with women Monitoring and Evaluation Framework for  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN 2024-2028 as part of the key activities under Increased Financial Risk Protection for the WHO Special Initiative for Mental Health Accessing MNS Program & Services Improved Mental Health Literacy Improved Vision Mental Health and Wellbeing for all Access & Service Delivery for People Filipinos Experiencing Extreme Life Events Universal Access to Quality MNS and Mission Value, promote, and protect the basic Wellbeing Program & Services and Rights- rights of all Filipinos to Mental Health based Socio-economic Development through and Well-being, and provide Intersectoral Actions comprehensive, integrated, accessible and quality mental health programs CORE PROCESS and services. Inter-sectoral work for PCMH (Patient Centered Medical Home) (TWGs, Regional Guiding Biopsychosocial and Spiritual / Councils, LGUs, Legislators & SUOs) Principles Equitable Comprehensive / Integrated Health enabling Learning Institutions, and Balances Care Protecting Rights / Workplaces, and Communities Life Stage Approach Equitable Access to Quality, Affordable, Crisis-resilient MNS Program and Services Equitable Access to Affordable Essential Medicines for MNS IMPACT Enhanced & Expanded MNS Benefit Promotion of Mental Health & Wellbeing and Packages Reduce Premature Mortality Ensuring Rights & Social Protection of Service Prevention and Treatment of Substance Abuse Users, Care Providers, and Affected Families Reduce Vulnerability of Individual and Communities SUPPORT PROCESS Responsive MNS Policy & MOPs Aligned STRATEGIC FOCUS with UHC Risk reduction of Suicide Effective LGU Engagement Improved Access of PWUDs (Persons Who Quality MNS Research & Development & Use Drugs) to MNS (Mental Health Strategy) Dissemination Care and Aftercare Adequate Competent & Resilient MNS Improved Mental Health Literacy Service Providers Improve outcomes of Persons with Mental Expanded MAP-MH Health Conditions (Developmental, Neurologic, and Psychiatric) especially Improved Leadership & Governance of PCMH Chronic Conditions Secretariat, Technical Working Groups, and Regional MH Councils  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Integrated, CBMH, CBDR, MHPSS, mhGAP, 9. Smile Quality Rights, & Others 10. Spirituality Integrated MNS Information System 11. Stress debriefing Increased Budget Allocation for MNS and Social Protection 12. Sports NATIONAL MENTAL HEALTH Extreme Life Experience PROGRAM All primary care facilities have an MHPSS Regional Mental Health Program Implementation trained staff Promotion of 7 healthy lifestyles Provision of MHPSS thru the DOH NorMin Kumusta ka Hotline Wellness of Daily Living: Psychological First Aid (PFA) Training for Mental Health Awareness in the workplace, LGUs schools, and community Provision of MHPSS during emergencies and Suicide prevention activities disaster (disaster response) Advocacy activities on the 12 “S” ng DOH – NOTE: Persons in Crisis experiencing stressful in life stress management but not a daily experience Mental Health Playbook for peer support Mental Neurological and Substance Use Disorder group (MHS) Healthy Lifestyle advocacy activities – Trained all the doctors and nurses of the Healthy Pilipinas campaign primary care facilities of Northern Mindanao Mental Health Fair with mhGAP. NOTE: DOH 12 “S” MH medications provision to all LGUs who submitted their MH registry. 1. Self-awareness 2. Scheduling or time management Mentoring and coaching of mhGAP trained doctors and nurses of the primary care 3. Siesta or short nap facilities. 4. Speak to me Trained doctors of the primary care facilities 5. Sounds and songs for Full Accreditation to be a DOH Accredited 6. Sensation techniques or massage Physician to conduct DDE. 7. Stretching MOA signing of the creation of the Regional MH Council. 8. Socials  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN CHAPTER 1-B: INTRODUCTION TO 9 Iron-deficiency anemia 2.2% MENTAL HEALTH GAP (MHGAP) 10 Birth asphyxia and birth trauma 2.2% A. Why train on mental, neurological and substance use disorders? B. What is mhGAP? Predictions for the leading causes of disability and C. What is the mhGAP Intervention Guide mortality in 2030: (mhGAP-IG)? World D. Base course E. Introduction to general principles of care 1. HIV/AIDS F. Key actions 2. Unipolar depressive disorder 1. Establish communication and build trust 3. Ischaemic heart disorder 2. Conduct assessment 3. Plan and start management High-income countries 4. Link with other services and supports 1. Unipolar depressive disorder 5. Follow up 2. Ischemic heart disease 3. Alzheimer Leading causes of years of life lived with disability: 1 Unipolar depressive disorders 10.9% Middle-income countries 1. HIV/AIDS 2 Hearing loss, adult onset 4.6% 2. Unipolar depressive disorder 3 Refractory errors 4.6% 3. Cerebrovascular 4 Alcohol use disorders 3.7% Low-income countries 1. HIV/AIDS 5 Cataracts 3.0% 2. Perinatal disorder 6 Schizophrenia 2.7% 3. Unipolar depressive disorder 7 Osteoarthritis 2.6% 8 Bipolar affective disorder 2.4%  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN What are the effects of stigma & discrimination? Emotional state? - Affects sense of self-worth Prognosis? - Contributes to shortened life expectancy - Slows recovery Access and quality of treatment? - Limits access and quality of health care In your community: Human rights? What are the daily challenges for persons with mental, neurological and substance use - Can lead to abuse disorders? Family? Employment? - Disrupts relationships Education? Marriage? Stigma and discrimination in the health care system: Social life? People with mental, neurological and Abuse? substance use disorders can experience stigma and discrimination from the health system Stigma & Discrimination Can you think of any examples from your Many individuals with mental, neurological or experience? substance use disorders are perceived by the community as weak, inhuman, dangerous, or What can you do to fight stigma and inferior because of their symptoms. discrimination? As a result of stigma, these people are excluded or they exclude themselves As health providers we can: A father about his intellectually challenged Change our own perception and attitude daughter. “Girls like her are only for house towards people with mental, neurological and work, bringing her to your clinic is a waste of substance use disorders. my time” Respect and advocate for the implementation “I cannot come to see a doctor. If someone sees of relevant international conventions, such as me, I will never get married” the United Nations Convention on the Rights of Persons with Disabilities.  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Reaffirm that all persons with all types of Mental Health Service Availability and Uptake disabilities must enjoy all human rights and Outpatient Care fundamental freedoms. 85 Mental health outpatient facilities attached to Play a large part in fulfilling these rights. a hospital What is the mental health gap? 11 Outpatient facilities specifically for children and adolescents Mental, neurological and substance use (MNS) conditions account for 13% of the global burden of disease. 119 “Community-based non-hospital” Mental health outpatient facilities Yet between 75-90% of individuals with MNS conditions do not receive the treatment they 1 Mental health day care or treatment facility require although effective treatment exists. This represents the mental health treatment Promotion & Prevention gap. Financial Resources Why is there a mental health gap? It is because of the following: Human resources Resources for Mental health Mental Health Workforce (Rate per 100,000 Resources for Mental Health population) Mental Health Financing 0.633 Psychiatrist 0.22% Government’s total expenditure on mental health 0.064 Child Psychiatrist Service-users pay mostly or entirely out-of- pocket for services and medicine 0.88 Psychologist The care and treatment of persons with major mental disorders (psychosis, bipolar disorder, 0.30 Occupational Therapist depression) Included national health insurance or 0.26 Speech Therapist reimbursement schemes in our country Php 12.19. According to the WHO Mental Health Atlas 2017, the Philippines total’ mental  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN health expenditure per person is (in PhP) Generates good health outcomes Mental Health Gap Action Programme (mhGAP) Global Perspectives: mhGAP is the WHO programme to scale up “Integrating mental health into primary care” care for mental, neurological and substance use disorders. Mental Health and Non-specialized healthcare: mhGAP was launched by the WHO Director- General in 2008. What is your current role and responsibility relating to the management of people with The initial focus is on increasing non-specialist mental, neurological, and substance use care, including primary healthcare, to address disorders? the unmet needs of people all over the world. Why should mental, neurological, and mhGAP-IG conditions: substance use disorders be managed in non- 1. Depression specialized health care, including primary 2. Psychosis health care? 3. Bipolar disorder WHO World Mental Health Plan 2013 – 2020 4. Epilepsy Mental health is valued, promoted, protected; 5. Developmental disorders mental disorders are prevented; and persons 6. Behavioral disorders afflicted by mental disorders are been able to 7. Dementia exercise the full range of human rights 8. Alcohol use and alcohol use disorders Access high quality, culturally appropriate health, and social care in a timely way to 9. Drug use and drug use disorders promote recovery 10. Self-harm/suicide Highest possible level of health and participate 11. Other significant emotional or medically fully in society at work, free from unexplained complaints stigmatization and discrimination Mental Health and Non-specialized healthcare: Capacity building in primary and secondary levels Mental and physical health are interwoven of care: Primary care for mental health Training & supervision Enhances access Availability of medicines & facilities Mental health promotion, psychosocial Promotes respect of human rights support, recovery programs Is affordable and cost effective  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN A. What is the mhGAP Intervention Guide Using the mhGAP-IG master chart: (mhGAP-IG)? Write down descriptions of people that you An evidence-based, clinical guide for the have seen in your work that you believe were assessment and management of mental living with an MNS disorder neurological and substance use disorders in Ensure that the descriptions are anonymous non-specialized health settings Write down the symptoms and how they would present to you. SEVEN GOOD REASONS FOR INTEGRATING MENTAL HEALTH INTO NON-SPECIALIZE HEALTH CARE 1. The burden of mental disorders is great. 2. Mental and physical health problems are interwoven. Who is the target audience for mhGAP-IG? 3. The treatment gap for mental disorders is Staff not specialized in mental health or enormous. neurology 4. Enhance access to mental health care. General physicians, family physicians, nurses 5. Promote respect for human rights. First point of contact and outpatient care 6. It is affordable and cost-effective. First level referral centers 7. Generates good health outcomes. Community health workers NOTE: THERE IS NO HEALTH WITHOUT MENTAL HEALTH The Master Chart CHAPTER 1-C: HISTORY OF PSYCHIATRIC CARE Ancient Times: Demonic or Divine Renaissance Time: Criminals Pre-Christian Time Priest: Exorcism  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Aristotle: Four Humors The study of the human mind and treatment approaches to psychiatric conditions. Happiness Calmness Bleuler (1857-1930) Anger Sadness - Was optimistic about treatment The “Decade of the Brain" can be traced to Kraepelin’s.” ABC MANAGEMENT OF MENTAL ILLNESS: St. Mary’s of Bethlehem: Bedlam PSYCHOTROPIC DRUGS (1950’s) A - Assistance Lithium - 1949 B - Banishment Chlorpromazine - 1950 C - Confinement Monoamine oxidase inhibitors - 1952 Haloperidol - 1957 ENLIGHTENMENT (1790’s) Tricyclic antidepressants (TCA’s) - 1958 Pinel (1745-1825) Benzodiazepine - 1960 - Unchained the mentally ill (1793) Some mental disorders are caused by chemical The insane were no longer treated as less than imbalances. If the chemical problem could be human found through research, then a chemical cure could be found as well. Also, people would no Human dignity was upheld longer need to be confined. Tuke (1723-1822) A destigmatization of mental illness occurred. - Established the York Retreat Parents and others were not to blame. The term least restrictive environment evolved from this The Asylum movement develop discovery. SCIENTIFIC STUDY (1870’s) COMMUNITY MENTAL HEALTH (1960’s) Freud (1856) Community mental health center acts (1963) - Emphasized the importance of early - Individuals do not need to be life experiences in shaping mental hospitalized away from family and health. community. Humans could be studied, and that study held Advantage: Intervention in familiar promise for treating and curing. surroundings has helped many people and less expensive. Kraepelin (1856-1926) Disadvantages: Homelessness is linked to deinstitutionalization, and many people “slip - Developed classification of mental through the cracks” of the system. illness.  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN EVOLUTIONARY TIMELINE IN required that to be PSYCHIATRIC NURSING accredited schools of nursing must provide Social Date Psychiatric Nursing an experience in Environment psychiatric nursing 1873 Linda Richards 1952 Hildegard Peplau graduated from New published England Hospital for Interpersonal Women and Children Relations in Nursing 1882 First school to prepare Community Mental 1963 Perspective in nurses to care for the Health Center Act Psychiatric Care mentally ill opened at passed published; Journal of McLean Hospital in Psychiatric Nursing Massachusetts and Mental Health Services published American Journal 1900 of Nursing first 1979 Issues on Mental published Health Nursing published; 1913 John Hopkins was certification of first school of nursing psychiatric mental to include a course on health nurse specialist psychiatric nursing in established by ANA its curriculum First edition of Principles of Florence 1910 Psychiatric Nursing Nightingale died published (Stuart and Sundeen) National Mental 1946 Health Act passed 1973 Standards of by Congress, Psychiatric-Mental creating National Health Nursing Institute of Mental Practice published; Health (NIMH) and certification of providing training psychiatric-mental funds for health nurse psychiatric nursing generalist established education. by American Nurses Association (ANA) 1950 National League for Nursing (NLN)  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN 1986 American Psychiatric FACT 2 Nurses Association (APNA) established Depression is characterized by sustained sadness along with psychological, behavioral, National Center for 1985 Standards of Child and physical symptoms. It is ranked as the Nursing Research and Adolescents seventh most important cause of disease created in National Psychiatric and burden in low- and middle-income countries, Institutes of Health Mental Health as it tends to be disabling, recurring or long- (NIH) Nursing Practiced lasting, and often remains untreated. published by ANA FACT 3 1987 Archives of On average about 800 000 people commit Psychiatric Nursing suicide every year, 86% of them in low- and published; Journal of middle-income countries. More than half of the Child and Adolescent people who kill themselves are aged between Psychiatric and 15 and 44. Mental disorders are one of the most Mental Health prominent and treatable causes of suicide. Nursing published 2000 Hildegard Peplau died FACT 4 In emergencies, the number of people with mental disorders is estimated to increase by 6 10 FACTS ON MENTAL HEALTH to 11%. Beyond mental disorders, people in “No health without mental health” emergency situations also often experience psychosocial problems that cannot be Realization: quantified. Through recent inter-agency ONE out of FOUR PEOPLE In This guidelines, humanitarian agencies now agree COUNTRY Is MENTALLY UNBALANCED on how to address such problems. Think of YOUR 3 CLOSEST FRIENDS... If They Seem OKAY Then YOU’RE THE ONE FACT 5 Mental disorders are among the risk factors for FACT 1 communicable and non-communicable About half of mental disorders begin before the diseases. They can also contribute to age of 14. Around 20 % of the world's children unintentional and intentional injury. At the and adolescents are estimated to have mental same time, many health conditions increase the disorders or problems, with similar types of risk for mental disorder, and complicate disorders being reported across cultures. Yet, diagnosis and treatment. regions of the world with the highest percentage of population under the age of 19 FACT 6 have the poorest level of mental health resources. Stigma about mental disorders and discrimination against patients and families prevent people from seeking mental health  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN care. Contrary to expectations, levels of stigma depression and 25 million people from were higher in urban areas and among people schizophrenia; 91 million people are affected with higher levels of education by alcohol use disorders and 15 million by drug use disorders. A recently published WHO report shows that 50 million people suffer from FACT 7 epilepsy and 24 million from Alzheimer and Human rights violations of psychiatric patients other dementias. are routinely reported in most countries. These Many other disorders affect the nervous system include physical restraint, seclusion and denial or produce neurological sequelae. Projections of basic needs and privacy. Few countries have based on a WHO study show that worldwide in a legal framework that adequately protects the 2005, 326 million people suffer from migraine; rights of people with mental disorders. 61 million from cerebrovascular diseases; 18 million from neuroinfections, or neurological FACT 8 sequelae of infections. Number of people with neurological sequelae of nutritional disorders There is huge inequity in the distribution of and neuropathies (352 million) and skilled human resources for mental health neurological sequelae secondary to injuries across the world. Shortages of psychiatrists, (170 million) also add substantially to the psychiatric nurses, psychologists, and social above burden. workers are among the main barriers to providing treatment and care in low- and middle-income countries. CHAPTER 1-D: CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS; FACT 9 CONCEPTS AND PATTERNS OF HUMAN In order to increase the availability of mental BEHAVIOR health services, there are five key barriers that need to be overcome: the absence of mental FAMILY DYNAMICS: FAMILY SYSTEM health from the public health agenda and the implications for funding; the current Unique interaction and relationship of family organization of mental health services; lack of members to one another. - Bowen (1987) integration within primary care; inadequate human resources for mental health; and lack of There are elements to family systems to which public mental health leadership. are very unique, relative to their own practices, culture and tradition. FACT 10 Governments, donors, and groups representing ELEMENTS OF FAMILY: HIERARCHY mental health workers, patients and their families need to work together to increase Degree of intergenerational boundaries mental health services, especially in low- and between members reflecting the power middle-income countries. The financial structure of the family. - Faber (2002) resources needed are relatively modest. Patriarchal or matriarchal Estimates made by WHO in 2002 showed that 154 million people globally suffer from Power in the family  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN ELEMENTS OF FAMILY: ROLES ELEMENTS OF FAMILY: INTERLOCKING RELATIONSHIPS 1. SAVIOR/HERO Alliances and subgroups Look good, achieve well and never let the family down to compensate for the shame the FUNCTIONAL TO DYSFUNCTIONAL family feels. SPECTRUM – not an either or no family is perfectly functional 2. MASCOT Dysfunction is present in one way or another “Comic relief” for the hyper stressed family, using humor to minimize the pain in situations FAMILY SYSTEMS THEORY and to deflect hurt. What affects one family member affects the rest of the family 3. LOST CHILD Families can be a cause or trigger of drug use Avoid conflict, suppress their emotions, and can be counted on to “not rock the boat.” When a family member has a substance use disorder, the family system changes because all of its elements and functions are affected. 4. SCAPEGOAT Families are critical to the recovery of drug Often blamed, creates other problems to users. deflect attention away from the real issue. - “Everyone has mental health” 5. ENABLER/RESCUER/CAREGIVER MENTAL HEALTH Excuses behaviors of the concerned members A state of well-being in which every individual and are unwilling to hold them accountable for realizes his or her own potential, can cope with their actions. the normal stresses of life, can work productively, and is able to make a contribution ELEMENTS OF FAMILY: RULES to the community. (WHO) Spoken and unspoken Rules that inhibit expression and open family A person who has mental health: communication that may lead to substance Self-Image Realizes one’s own abuse potential Rules that often lead to patterns of behavior.  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Health conditions that are characterized by Resiliency Can cope with the normal alterations in thinking, mood, or behavior (or stresses of life some combination thereof associated with distress and/or impaired functioning) Productivity and Can work productively and Creativity fruitfully NOTE: You have a mental disorder if you have an impaired functioning Sense of Purpose Can contribute to the community MENTAL ILLNESS A state of imbalance characterized by a MENTAL HEALTH disturbance in a person's thoughts, feelings & behavior. Is the simultaneous success at working, loving & creating with the capacity for mature & Is the inability of the person to effectively flexible resolution of conflicts between adjust to life as demonstrated by the use of instincts, conscience, other people & reality. multiple coping mechanisms, which do not (American Psychiatric Association) buffer the individual from profound psychic insults. Mental Health Problem Is the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, & behaviors MENTAL HEALTH PROBLEM that are age-appropriate & congruent with Also affects a person’s thinking, feeling, or local & cultural norms. (Townsend). social relationships but not to the extent that Is the successful performance of mental significantly hampers functioning like that of a function, resulting in productive activities, mental disorder. fulfilling relationships, & the ability to adapt to change & cope with adversity. It provides Mental Disorder Causes: people with the capacity for rational thinking, communication skills, learning, emotional MULTIFACTORIAL growth, resilience & self-esteem (US DOH & Psychological Human Services, 1999) Biological Implies mastery in the areas of life involving Sociocultural love, work & play. It does not occur in one factor or disorder MENTAL DISORDER 1. BIOLOGICAL “Collectively all diagnosable mental disorders” Neurotransmitter  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Genetic makeup 3. SOCIAL/ENVIRONMENTAL Brain structure Certain stressors can trigger an illness in a person who is susceptible to mental illness, NOTE: Neurotransmitter: Serotonin, Dopamine which include: Death or separation of parents Hereditary Traits Dysfunctional family life Mental illness is more common in people who have relatives with a mental condition. Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness There are genes that increase the risk of developing mental illness that can be Changing jobs or schools triggered by stressful situations. Social or cultural expectations Environmental exposures before birth. Substance abuse Exposure to viruses, toxins, alcohol, or drugs while in the womb can cause mental MENTAL HYGIENE illness Is the science that deals with measures to Brain chemistry promote mental health, prevent mental illness Fluctuating levels of natural brain & suffering & facilitate rehabilitation dealing chemicals (neurotransmitters). with preservation of mental & emotional health. In some cases, imbalance levels of hormones The science of maintaining mental health & preventing the development of psychosis, neurosis, or 2. PSYCHOLOGICAL Trauma PSYCHIATRIC NURSING Loss Interpersonal process whereby the professional Response to stress nurse practitioner through the therapeutic use Severe Psychological Trauma of self, assist an individual family, group, or community to: - Experienced frequently while growing up, such as emotional, physical, or Promote Mental Health sexual abuse Prevent Mental Illness & Suffering An important early loss Participate in the Treatment & Rehabilitation - It can be direct, like the loss of a parent, or symbolic loss like a lack of care of the Mentally Ill Poor ability to relate to others  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Is a process whereby the nurse assists the How are these medications used to treat Mental person as individuals or in groups, to develop Disorders? a more positive self-concept, a more satisfying Psychotropics treat the symptoms of mental pattern of interpersonal relationships, & a more disorders satisfying role in society. (Taylor) - They cannot cure the disorder, but they Is the provision of nursing care to patients make people feel better so they can where the major therapeutic goal is the function. prevention, detection, treatment & Psychotropics usually works slowly. rehabilitation of psychiatric disorders. - Keep in mind the rule: “Start low, Go (Matheney & Topalis) Slow.” Psychiatric Mental Health Nursing is a Psychotropics work differently for different specialized area of nursing practice employing people. theories of human behavior as its science & purposeful use of self as its art. It is directed toward both preventive & corrective impacts FACTORS THAT CAN AFFECT HOW upon mental disorders & their sequelae, & is MEDICATION WORK concerned with the promotion of optimal Type of Mental Health Disorder mental health for society, the community & Physical Illness those individuals who live within it. (American Nurses’ Association) Age, Sex, Body Size It is both a Science & and Art Habits: Drinking Alcohol and Smoking Genetic Core: Interpersonal Process Diet Other medications or Supplements BASIC PSYCHOTROPIC MEDICATIONS: FOR NON-SPECIALIST MENTAL HEALTHCARE Compliance to Medications PROVIDERS Antipsychotics What are PSYCHOTROPIC DRUGS? Used to treat Schizophrenia or Schizophrenia- Medications used to treat psychiatric disorders related disorders, Mania, and other Psychoses. Alter chemical levels in the brain which impact Typical: thought, mood, and behavior. - First Generation Antipsychotics - Antipsychotics - Blocks Dopamine Receptors - Antidepressants - Especially good at reducing the - Mood Stabilizers positive symptoms of psychosis (e.g. - Antiparkinsonianism hallucinations, delusions) - Hypnotic Sedatives - Can cause extrapyramidal motor disabilities (some of which are quite  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN severe) - Do not give if you have grossly abnormal blood pressure or heart rate. Some service users may have slightly Atypical: increased vital signs due to agitation - Novel; second to third generation from psychosis. antipsychotics. Observe service user for an hour in the - Blocks Dopamine, Serotonin, and other emergency room and reassess vital signs every Receptors. 15 minutes for 1 hour. - Treating both the positive and negative symptoms of psychosis; also improves cognitive functions. ATYPICAL ANTIPSYCHOTICS FOR - Less likely to cause extrapyramidal MAINTENANCE MEDICATIONS side effects but some has higher risk for metabolic changes. Before Initiating Atypical Antipsychotic: Weigh all patients and track BMI during ANTIPSYCHOTICS FOR PSYCHIATRIC treatment. EMERGENCIES AND ACUTE AGITATION Get baseline personal and family history of Risperidone 2mg ODT (Orally Disintegrating diabetes, obesity, dyslipidemia, hypertension, Tablet) and cardiovascular disease. for those with psychosis and with no comorbid Get waist circumference (at umbilicus), blood cardiac disease. pressure, fasting plasma glucose, and fasting lipid profile. Olanzapine 10 mg ODT (Orally Disintegrating Tablet) Treat or refer patients with diabetes, hypertension, dyslipidemia for treatment, for those with psychosis, with less risk for including nutrition and weight management, metabolic syndrome, with impaired sleep and physical activity counseling, smoking appetite. cessation, and medical management. Aripiprazole 10 mg ODT (Orally 1. Risperidone Disintegrating Tablet) Indication: Psychosis associated with for those with medical comorbidities, also if Schizophrenia and Bipolar Disorder avoiding weight gain. Haloperidol 5mg/ml ampule, 0.5ml-1ml IM Dosing: for those in dire need of chemical restraints due - Initial dose: 2mg/tab, ½ to 1 tab ODHS to agitations. - Maximum dose: 6mg/day. But, at 4mg/day, greater chance of EPS symptoms Note: - In nonemergent settings, initial dosage Assess vital signs prior giving any recommendation is 1 mg/day orally in antipsychotics divided 2 doses  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN - Increase each day by 1 mg/day orally - May increase effect of antihypertensive until desired efficacy is reached. agents 3. Aripiprazole Side effects: extrapyramidal syndrome, dizziness, dry mouth, constipation, cessation Indication: of menses, metabolic syndrome, hyperprolactinemia. Psychosis associated with Schizophrenia and Bipolar Disorder Drug - drug Interaction: Dosing: - Carbamazepine (reduced level of Risperidone); Fluoxetine and - Initial dose: 10mg once daily in the Paroxetine (increase level of morning Risperidone) - Maximum dose: 30mg/day - May increase effect of antihypertensive - Increased weekly by 5 mg if symptoms agents are still not manageable Side effects: Akathisia - psychomotor 2. Olanzapine restlessness Indication: Psychosis associated with Schizophrenia and 4. Quetiapine Bipolar Disorder Indication: Treatment-resistant depression in combination Psychosis associated with Schizophrenia and with fluoxetine Bipolar Disorder Dosing: - Initial dose: 5-10 mg once daily orally Dosing: (at night) Initial dosing; - Maximum dose: 20mg/day - Increase by 5 mg/day once a week until - 25mg/tab, 1 tab BID on first day desired efficacy is reached - 100mg/tab, 12 tab BID on second day - 100mg/tab, 1 tabs BID on third day Side effects: - 300mg/tab, 1 tab ODHS on fourth day. - Metabolic Syndrome, sedation. - Increase by 100-150mg/day until - Use with caution in service users with desired dose DM, seizures, BPH, narrow angle - Maximum dose: 800mg/day glaucoma, hepatic disease Side effects: Drug - drug Interaction: - QT prolongation, sedation, weight - Concurrent use of cigarette smoke and gain, hypotension, dry mouth, carbamazepine decreases serum constipation Olanzapine concentration - Metabolic syndrome  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Drug - drug Interaction: - Eyeballing: WBC and neutrophil count is within normal - Avoid use with drugs that increase the - Calculation: multiply the total number QT interval and in patients with risk of WBCs by the percentage of factors for prolonged OT interval neutrophils and dividing by 100 5. Clozapine Indication: TYPICAL ANTIPSYCHOTICS FOR MAINTENANCE MEDICATIONS Consider giving Clozapine to psychotic service users with 2 failed trials of other antipsychotic 1. Haloperidol use (Treatment Resistant) Psychosis associated with Schizophrenia and Side effects: Bipolar Disorder - Orthostatic hypotension, neuroleptic malignant syndrome Dosing - Extrapyramidal symptoms, parkinsonism, tardive dyskinesia, - Initial dose: 25mg at night. Increase by - Tardive dystonia 25-50mg every 2-3 days. (In practice, - Anticholinergic effects: dry mouth, once a week may suffice) urinary retention, constipation, - Maximum dose: 450mg/day - Tachycardia - Akathisia - Galactorrhea, amenorrhea Side Effect: - Use with caution in service users with - Agranulocytosis, Metabolic Syndrome DM, seizures, BPH, narrow angle - Orthostatic hypotension, myocarditis/ glaucoma, hepatic disease cardiomyopathy 2. Chlorpromazine Drug Interactions: Indication: - Increased risk of neuroleptic malignant Psychosis; Schizophrenia with predominantly syndrome with Lithium positive symptoms (delusions, hallucinations) - Increased risk of myelosuppression with long-acting depot antipsychotics. Dosing CBC monitoring weekly in first 6 months, - Initial dose: 75-100 mg daily every 2 weeks for the next 6 months, then - Maximum dose: 400mg daily monthly after once with effective dosing. Side Effects: Measure Absolute Neutrophil Count at each - Extrapyramidal symptoms, CBC taken: parkinsonism, tardive dyskinesia, - ANC < 1500: discontinue Clozapine - Tardive dystonia - 3000 > ANC > 1500, with downward - Orthostatic hypotension, trend in CBC: maintain extrapyramidal symptoms, neuroleptic - Clozapine, consider decreasing malignant syndrome - Anticholinergic effects: dry mouth, urinary retention, constipation,  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN - Tachycardia preference - Use with caution for elderly patients Dosing: Drug Interactions: - Usual dose in practice: 20mg/cc, 1 cc - Can cause false positive in urine drug IM monthly with BP precautions screening for amphetamines Side effects: LONG-ACTING DEPOT - Sedation, dizziness, extrapyramidal ANTIPSYCHOTICS FOR MAINTENANCE symptoms (lesser) - Anticholinergic effects: dry mouth, MEDICATIONS urinary retention, constipation, tachycardia 1. Fluphenazine Decanoate - Orthostatic hypotension, extrapyramidal symptoms, neuroleptic Indication: malignant syndrome Do not give to child, adolescent, pregnant Consider giving depot as primary medications women, and to patients who have loss of if with compliance issues or as per service-user consciousness or in coma. preference. Dosing: 3. Paliperidone Palmitate - Initial dose: 25mg/cc, 0.5cc to 1 cc every 2-4 weeks Indications - Maximum dose: 50mg every 2-4 weeks for service users with compliance issues or as - Usual dose in practice: 25mg monthly per preference Contraindication: Dosing - Do not give if with impaired - Starting dose: 150mg IM at day 1 then consciousness or parkinsonism 100mg at day 8 - Maintenance dose: 75mg to 150mg IM Side effects: monthly - Sedation, dizziness, extrapyramidal - Give at least Risperidone 2mg/tab, 1 symptoms tab ODHS for two weeks and observe - Anticholinergic effects: dry mouth, for adverse drug reactions prior to urinary retention, constipation, initiation of Paliperidone Palmitate tachycardia - Orthostatic hypotension, Side Effects: extrapyramidal symptoms, neuroleptic - Dose dependent extrapyramidal malignant syndrome symptoms, hyperprolactinemia, metabolic syndrome 2. Flupentixol Decanoate - Reduced risk of neuroleptic malignant syndrome Indications: - QT prolongation Consider giving depot as primary medications if with compliance issues or as per service-user  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN MOOD STABILIZERS - Recommended assay: therapeutic range is 50-100 mcg/ml Are used to treat bipolar disorders or as adjunct - Maximum dose at 60 mkd; rarely done to other Mood Disorders and other Psychoses. in practice Are more commonly prescribed to treat bipolar disorder, more commonly referred to 2. Lithium Carbonate as manic-depression. Indications: Consider giving Lithium to service users with Lithium Salts acute manic (elevated) symptoms Lithium Consider giving Lithium as adjuncts to service Anticonvulsants users with MDD Valproic Acid Dosing Carbamazepine - Initially 450mg/tab, 1 tab BID Lamotrigine - May be increased weekly depending on Neuroleptics Assay at 7th day; if assay unavailable, may check BUN and Crea prior to Olanzapine increasing - Recommended assay: Therapeutic Quetiapine range is 0.6–1.2 mmol/L. Risperidone Aripiprazole Side Effects: - CNS: Tremors, ataxia, memory 1. Divalproex Na/ Valproic Acid problems - GI symptoms, polyuria, polydipsia, Indications: weight gain Consider giving Valproate to service users with acute manic (irritable) symptoms Contraindications/Caution: Consider giving Valproate to schizophrenic - Renal and cardiac impairment – service users as an adjunct to antipsychotics contraindicated Consider giving Valproate to service users with - NSAIDs, diuretics, ACE inhibitors can seizure disorder and behavioral symptoms increase lithium concentrations – use with caution - Generally used with caution if with Dosing other maintenance medications - Dosing: calculate dose per day, 20-30 - Decreased Na – contraindicated mg/kg/day (mkd), initially 500mg/tab, 1 tab BID - May be increased weekly depending on assay at 7th day; if assay unavailable, may check liver function tests  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Lithium Carbonate: Common Side Effects Lithium: Cardiovascular abnormalities (most commonly Ebstein’s anomaly of the tricuspid Mild valves) Vomiting Pregnant women should not use these GI problems medications unless absolutely necessary. All women with childbearing potential should Dry mouth take 1 to 4 mg of folic acid daily. Dizziness Slurred speech ANTIDEPRESSANTS & ANTIANXIETY Lethargy or excitement MEDICATIONS Muscle weakness Are used to treat Depression and Anxiety Disorders or as adjunct to other Mood Disorders. Other indications include social Moderate anxiety disorder, panic disorders, obsessive- compulsive disorder (OCD), eating disorders, Persistent of mild symptoms chronic pain and occasionally, and Anorexia posttraumatic stress disorder (PTSD). Blurred vision 1. Selective serotonin reuptake inhibitors Muscle fasciculation (SSRIs) Chronic limb movements SSRIs are the most widely prescribed type of Hyperactive deep tendon reflexes antidepressants. Preferred over other antidepressants, as they cause fewer side effects. Severe An overdose is also less like to be serious. Convulsions Ex. Fluoxetine, Escitalopram, Paroxetine, and Sertraline. Syncope Delirium 2. Serotonin-noradrenaline reuptake inhibitors (SNRIs) Circulatory failure Increase levels of two types of brain chemicals, Oliguria and renal failure noradrenaline, and serotonin. Stupor to coma Ex. Duloxetine and Venlafaxine. Death 3. Noradrenaline and specific serotonergic antidepressants (NASSAs) Warning Pregnancy & Lactation NASSAs may be effective for some people Carbamazepine: Craniofacial abnormalities, who are unable to take SSRIs. fingernail hypoplasia, and spina bifida Cause fewer sexual problems. However, they may also cause more drowsiness at first. Valproate Na: Neural tube defects  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Ex: Mirtazapine Vortioxetine - Multimodal acting antidepressant that 4. Monoamine oxidase inhibitors (MAOIs) functions as a 5-HT3 and 5- HT7 and 5-HT1Dreceptor antagonist, 5-HT1B An older type of antidepressant that are rarely receptor partial agonist, 5-HT1A used nowadays. receptor agonist and inhibitor of the 5- Cause potentially serious side effects HTT. Ex: Tranylcypromine, Phenelzine and - Shows a distinct profile in cognitive Isocarboxazid. performance in depression. 5. Tricyclic antidepressants (TCAs) SELECTIVE SEROTONIN REUPTAKE Older type of antidepressant and no longer INHIBITORS (SSRIS) usually recommended as the first treatment for depression because they can be more dangerous if an overdose is taken. 1. Escitalopram Cause more unpleasant side effects than SSRIs and SNRIs. Considered as the SSRI with the least drug- Older type of antidepressant and no longer drug interaction usually recommended as the first treatment for Dosing: depression because they can be more - MDD Initial Dose: 10mg/tab, 1 tab dangerous if an overdose is taken. ODAM after meals May also be recommended for other mental - Anxiety Initial Dose: 10mg/tab, 1⁄2 tab health conditions, such as OCD and bipolar ODAM after meals disorder. - Maximum dose: 10mg/tab, 1 tab BID Ex: Amitriptyline, Clomipramine, Dosulepin, - Titrate up once every week to every Imipramine, Lofepramine, and Nortriptyline. month depending on latest symptomatology of the service user - If with little or no improvement: 6. Other Novel Antidepressants increase by 5mg/day - If with significant improvement: may Agomelatine observe at current dose. - Melatonergic (MT1 and MT2) agonist and serotonergic (5HT2C) antagonist 2. Fluoxetine (increasing dopamine and norepinephrine).Ex: Amitriptyline, Dosing: Clomipramine, Dosulepin, - Initial dose: 20mg/cap, 1 cap ODAM Imipramine, Lofepramine and - Maximum dose: 60mg/day Nortriptyline. - Titrate up once every week to every - Favorable side-effect profile with sleep month depending on latest restorative action in the absence of symptomatology of the service user sedation and minimal effect on sexual - If with little or no improvement: function increase by 20mg/day - If with significant improvement: may observe at current dose  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN - Tendency to be behaviorally activating; ANTI-DEMENTIA MEDICATIONS avoid giving at night - Transient activating side effects: Are used to treat behavioral and psychological Anxiety, agitation, nervousness. symptoms of Neurocognitive Disorders such as Dementia. 3. Sertraline 1. Donepezil Dosing: - Initial dose: 25mg/cap, 1/2 cap OD For mild to severe Alzheimer’s disease or - Maximum dose: 200mg/day Vascular Dementia - Titrate up once every week to every Dosing: month depending on latest symptomatology of the service user - 10mg/tab, ½ tab HS up to 1 tab BID - If with little or no improvement: - Mild to moderate: 5-10mg/day increase by 12.5mg to 25mg each time - Increase dose on a weekly basis - If with significant improvement: may Contraindications: observe at current dose. - Contraindicated to those with known Side Effects hypersensitivity - Usually transient (~2 weeks): Nausea, - Use with caution in service users with sweating, somnolence, dizziness, GI conditions (risk of ulcers, vomiting) insomnia, constipation, diarrhea, and asthma increase appetite, fatigue, pyrexia, yawning 2. Memantine - Sexual dysfunction: difficulties with obtaining erection or orgasm may not For moderate to severe Alzheimer’s disease or be transient. Vascular Dementia or mild to severe - Consider giving benzodiazepines Alzheimer’s disease or Vascular Dementia during 1st 2 weeks only. Dosing: - QT Prolongation, require regular ECG monitoring - 10mg/tab, 1⁄2 tab HS up to 1 tab BID - For those with severe renal Contraindications/Caution impairment: 5mg BID - Use on elderly at half-dose but may be - Increase dose on a weekly basis prone to hyponatremia. - May take without food - Use with caution for those with medications related to clotting of Side Effects: dizziness, headache, confusion, bloodSexual dysfunction: difficulties constipation with obtaining erection or orgasm may Contraindicated to those with known not be transient hypersensitivity - May be used with children 12 and up Are used to Extrapyramidal Symptoms and other side effects of psychotropic medications.  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Avoid spilling any liquid concentrate on skin; INTERVENTIONS: PSYCHOTROPIC contact dermatitis can occur. SIDE EFFECTS Common with Lamotrigine 1. ANTICHOLINERGIC EFFECTS: DRY MOUTH 4. SEDATION: Offer sugarless candy, ice, or frequent sips of Discuss with the physician the possibility of water. administering drugs at bedtime. Ensure that patients practice strict oral Discuss with the physician possible decrease in hygiene. dosage or order for less sedating drug unless the objective is really to sedate the patient. BLURRED VISION 5. ORTHOSTATIC HYPOTENSION: Explain that symptoms will most likely subside after a few weeks. Instruct the patient to rise slowly from a lying or sitting position. Offer to assist with tasks requiring visual acuity. Monitor BP (lying and standing) each shift. Document and report significant changes. CONSTIPATION 6. PHOTOSENSITIVITY: Offer foods high in fiber; encourage increase in physical activity and fluid intake. Ensure that patients wear protective sunscreens, clothing, and sunglasses while spending time outdoors. URINARY RETENTION Instruct patients to report any difficulty 7. AGRANULOCYTOSIS: urinating. Monitor Intake and Output. Relatively rare, but serious one. Monitor CBC and calculate ANC. 2. GASTROINTESTINAL SIDE EFFECTS: Observe the symptoms of sore throat, fever, May be administered with food to minimize GI malaise, etc. upset. May need to decrease or discontinue Concentrate forms may be diluted and medication. administered with fruit juice or other liquid; it should be mixed immediately prior to 8. NEUROLEPTIC-INDUCED administration. MOVEMENT DISORDERS: Observe symptoms and report; Administer 3. SKIN RASH: anti-parkinsonian drugs Report the appearance of any rash on skin to Biperiden 2 mg/tab, 1 tab once a day the physician.  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Diphenhydramine 50mg/cap, 1 cap once a day Early onset in the course of treatment Diphenhydramine 50mg/ml, 1ml IM High incidence in men, in younger patients, and those given high doses of high-potency Provide comfort and may stay with the patient medications. to offer reassurance and support. Can fluctuate spontaneously and respond to reassurance, so that the clinician acquires the ANTI-PARKINSONISM: ANTICHOLINERGIC false impression that the movement is Biperiden HCI hysterical or completely under conscious control. Usually daily oral dose = 2 mg one to three times a day Can be painful and frightening and often results in noncompliance with future drug treatment regimens. Diphenhydramine HCI An alternative treatment to Biperiden 2. ACUTE PARKINSONISM Also as relatively safe to hypnotic (sleep- Usually occurs within 5 to 90 days of the inducer) agent initiation of treatment 50mg/capsule, 1 cap once a day at night Can occur at all ages, higher risk in elderly and 50mg/ml, 1 ml ampule. 0.5-1 ml IM/IV females NEUROLEPTIC-INDUCED MOVEMENT Manifestations: DISORDERS Muscle stiffness (lead pipe rigidity) 1. ACUTE DYSTONIA Cogwheel rigidity Brief or prolonged contractions of muscles that Shuffling gait result in obviously abnormal movements or postures: Stooped posture Oculogyric crises (upward deviation of the Drooling eyeball) Coarse tremor Tongue protrusion Rabbit-syndrome (rhythmic motion of the Trismus (muscle spasms in your mouth/lips, resembling the chewing temporomandibular joint) movements of a rabbit) Torticollis (stiff neck that makes it hard or painful to turn your head) 3. AKATHISIA Laryngeal-pharyngeal dystonias (spasms May present as subjective feelings of can result in tightness in the throat, recurrent restlessness, objective signs of restlessness, or hoarseness, and changes in voice quality both: and/or difficulty speaking) Sense of anxiety Dystonic postures of the limbs and trunk Inability to relax  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN Jitteriness Mutism Pacing Obtundation Rocking motions while sitting Agitation Rapid alternation of sitting and standing AUTONOMIC EFFECTS: 4. TARDIVE DYSKINESIA High fever A delayed effect of antipsychotics Sweating Consists of abnormal, involuntary, irregular Increased pulse and blood pressure choreoathetoid movements of muscles of the head, limbs, and trunk LABORATORY FINDINGS: Most common presentations: Increased WBC count Perioral movements: darting, twisting, and Increased CK and liver enzymes plasma protruding tongue myoglobin, and myoglobinuria Chewing and lateral jaw movements Occasionally associated with renal failure Lip puckering Facial grimacing CHAPTER 3: PSYCHOSOCIAL THEORIES AND THERAPY Finger movements and hand clenching Severe cases: torticollis, retrocollis, trunk Types of psychosocial theories: twisting, and pelvic thrusting. Psychoanalytic Developmental 9. NEUROLEPTIC MALIGNANT Interpersonal SYNDROME: Humanistic Behavioral Rare, but may be fatal. Discontinue neuroleptic Existential drugs immediately. Monitor VS, degree of muscle rigidity, PSYCHOANALYTIC THEORIES intake/output, and level of consciousness. SIGMUND FREUD: THE FATHER OF Do initial supportive measures. Refer PSYCHOANALYSIS immediately to the medical hospital. Sigmund Freud (1856-1939) developed A life-threatening complication that can occur psychoanalytic theory in the late 19th and early anytime during the course of antipsychotic 20th centuries in Vienna, where he spent most treatment. of his life. His theory supports the notion that all human behavior is caused and can be explained MOTOR AND BEHAVIORAL CHANGES: (deterministic theory). Muscular rigidity and dystonia akinesia  PSYCHIATRIC-MENTAL HEALTH NURSING | LECTURE REVIEWER: PRELIM SECOND SEMESTER | S.Y. 2024 – 2025 TRANSCRIBED BY: BRAILLE BONCALES, SN He believed that repressed (driven from THREE LEVELS OF AWARENESS: conscious awareness) sexual impulses and CONSCIOUS, PRECONSCIOUS, AND desires motivate much human behavior. UNCONSCIOUS Conscious: PERSONALITY COMPONENTS: ID, SUPEREGO, AND EGO. Refers to the perceptions, thoughts, and emotions that exists in the person’s awareness, Id such as being aware of happy feelings or thinking about a loved one. Is the part