• 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 wellbeing.
• PERSONALITY
– Integration of systems and habits representing an individuals characteristics adjustments to his environment expressed through behaviours.
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
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
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
• 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
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)
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
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