MENTAL HEALTH AND

PSYCHIATRIC NURSING

VERNALIN B. TERRADO, RN
PSYCHOTIC DISORDER

DYSFUNCTIONAL/ MALADAPTIVE COPING

PATTERN
 PSYCHOSIS

a mental illness that markedly interferes with a

person's capacity to meet life's everyday demands.
In a specific sense, it refers to a thought disorder in
which reality testing is grossly impaired.
Brain disease that disrupts perceptions, thinking,
feelings, and behaviors. It can cause distortions of
reality, false beliefs, hallucinations, and changes in
speech patterns, moods, and behaviors. It disrupts
the person’s ability to function, socialize, and work.
 Just the facts!

Age: Adolescence or early Adulthood

Stress: onset and relapse association
Dopamine antagonists: drugs that block dopamine
receptors are therapeutic
Men= women
Diagnostic term used to describe a major psychotic
disorder characterized by disturbances in perception,
thought process, realty testing, feeling, behavior,
attention, motivation.
Is Schizophrenia a
Split personality or
a deteriorating
personality?
 Bleuler’s Four A’s
Affective disturbance- flat,blunted
Autism- thoughts on self, extreme withdrawal,
unable to relate to outside world.
Associative looseness- verbalizations are
disorganized.
Ambivalence- simultaneous opposite feelings
 CAUSES

DOPAMINE THEORY-D1 receptors

GENETIC FACTORS
Prenatal infections
Perinatal complications
Other stressors
GENERAL ASSESSMENT
 Speech Abnormalities

1. Clang Associations
2. Echolalia
3. Loose Association and flight of ideas
4. Word salad
5. Neologisms
 Thought distortions

 Overly concrete thinking

 Hallucinations
 Delusions
TYPES  Thought
1. Somatic
2. Persecutory Type
blocking
3. Jealous  Magical thinking
4. Erotomanic Type
5. nihilistic delusion
6. Delusion of control
7. Delusion of reference
8. Religious delusion
 Social Interactions

1. Poor interpersonal relationships

2. Withdrawal and Apathy
 Other findings
1. Regression
2. Ambivalence
3. Echopraxia
SYMPTOM CATEGORIES
 POSITIVE SYMPTOMS

SYMPTOMS THAT ARE

PRESENT BUT
SHOULD BE ABSENT
e.g. hallucinations,
delusions
Amenable by
antipsychotics
 NEGATIVE SYMPTOMS

Absence of normal
characteristics
 Apathy
 Lack of motivation
 Blunted affect
 Poverty of speech
 Anhedonia
 Asociality
 SUBTYPES

Paranoid schizophrenia
Disorganized Schizophrenia
Catatonic Schizophrenia
Undifferentiated Schizophrenia
Residual Schizophrenia
 Paranoid Schizophrenia
Characterized by
persecutory or grandiose
delusional thought
content and possibly
delusional jealousy.
Auditory hallucinations,
tendency to argue,
possible violence.
Treatment-
antipsychotics,
psychosocial therapies,
and rehabilitation.
 Nursing Intervention

Build trust, be honest and dependable.

Avoid whispering or laughing with patient around.
Do not touch patients without warning them.
Approach him in a calm, unhurried manner.
If he tells you to leave him alone, do leave – but make
sure to return soon.
Set limits firmly. Avoid a punitive attitude.
Respond neutrally and don’t take his remarks
personally.
Orient patients to time, person, and place.
Be flexible and give patient some control.
Don’t try to combat delusions with logic.
If suicidal thoughts are expressed or says he hears
voices telling him to harm himself, institute suicide
precautions.
Make sure the nutritional needs are met.
Postpone procedures that require physical contact if
patient becomes suspicious or agitated.
Don’t tease, joke, argue with or confront the patient.
 Disorganized Schizophrenia

Disorganized schizophrenia is marked by incoherent,

disorganized speech and behaviors and by blunted or
inappropriate affect.
Signs and symptoms:
 incoherent, disorganized speech, with markly loose
associations.
 Grossly disorganized behavior
 Extreme social withdrawal
 Blunted, silly, superficial, or inappropriate affect.
 Catatonic Schizophrenia

Tendency to remain in a fixed stupor for long

periods.
May yield brief spurts of extreme excitement.
Increased potential for destructive violent behavior.
May remain mute and refuse to move about or tend
to his personal needs.
May show bizarre mannerisms, such as facial
grimacing and sucking mouth movements
Rapid swings between stupor and excitement.
Bizarre postures
Diminished sensitivity to painful stimuli
Negative symptom
Echolalia
echopraxia
 Undifferentiated Schizophrenia

Presence of schizophrenic symptoms but criteria for

paranoid, catatonic, or disorganized subtypes are not
met.
 Residual Schizophrenia

 History of at least one schizophrenia episode

 Lacks prominent delusions, hallucinations,
disorganized speech, and grossly disorganized or
catatonic behavior
 Continuing evidence of schizophrenia because of the
presence of negative symptoms.
 Schizoaffective Disorder

symptoms of psychosis and thought disorder along

with all the features of a mood disorder
 Schizophreniform

symptoms of schizophrenia are experienced for less

than the 6 months required for a diagnosis of
schizophrenia.
 Delusional Disorder

one or more non-bizarre delusions with no

impairment in psychosocial functioning
 Shared psychotic disorder

similar delusion shared by two people, one of

whom has psychotic delusions.
 Drug therapy
Conventional Antipsychotics
 Chlorpromazine(Thorazine)
 Fluphenazine(prolixin)
 Haloperidol(Haldol)
 Molindone(Moban)
 Perphenazine(Trilafon)
 Thioridazine(Mellaril)
 Thiotixine(Navane)
 Trifluoperazine(Stelazine)
 Atypical Antipsychotics
Clozapine
Olanzapine(Zyprexa)
Quetiapine(Seroquel)
Risperidone(Risperdal)
Ziprasidone(Geodon)
 Relive positive symptoms
 Improve negative symptoms
 Enhance serotonin and stabilize dopamine
 Less likely to cause motor adverse effects
Other drugs are used such as mood stabilizing
agents such as lithium, carbamazepine(Tegretol),
and valproic Acid(Depakote) manage negative
symptoms\
ECT- used in acute schizophrenia and is effective in
reducing depressive and catatonic symptoms of
schizophrenia.
 Dissociative Disorders
Marked by the disruption of
the fundamental aspects of
waking consciousness, and the
general experience and
perception of oneself and the
surroundings.
Dissociation is unconscious
defense mechanisms to
prevent anxiety-provoking
feelings and thoughts from the
conscious mind.
Dissociation is a common
occurrence from normal to
pathologic.
 CAUSES

Psychological theories
Biological theories
Learning theory
 Dissociative amnesia

A dissociative amnesia may be present when a person is

unable to remember important personal information,
which is usually associated with a traumatic event in
his/her life. The loss of memory creates gaps in this
individual's personal history. 
Recent Amnesia- occur immediately after a traumatic
experience
Localized Amnesia-occurs when the individual cannot
remember what occurred during a specific period of time.
Selective amnesia- ability to recall some events during
a specific period of time.
 Dissociative fugue

A dissociative fugue may be present when a person

impulsively wanders or travels away from home and upon
arrival in the new location are unable to remember his/her
past.
Travel and behavior may appear to casual observers
Fugue states lasts from a few hours to several days.
Rare and usually follows severe psychosocial stress, such as
marital quarrels, personal rejections, military conflict, natural
disaster, financial difficulty, and suicidal ideation.
The condition is usually diagnosed when relatives find their
lost family member living in another community with a new
identity.
 Dissociative identity disorder

Dissociative identity disorder was formerly called

"multiple personality disorder."
Each personality has its own personal history and
identity and takes on a totally separate name.
These patients are admitted to inpatient psychiatric
units when they are suicidal
Medications are given symptomatically.
Safe environment and trusting relationship should
be provided.
 Depersonalization disorder

Feelings of detachment or estrangement from one’s self

are signs of depersonalization.
Individuals with this disorder will report feeling as if they
are living in a dream or watching themselves on a movie
screen.
They feel separated from themselves or outside their own
bodies. People with this disorder feel like they are "going
crazy" and they frequently become anxious and depressed.
Sense of Depersonalization may be restricted to a single
body part, such as a limb—or it may encompass the whole
self.
 Paranoid Personality Disorder

PPD is a type of psychological personality disorder

characterized by an extreme level of distrust and
suspicion of others. Paranoid personalities are
generally difficult to get along with, and their
combative and distrustful nature often elicits
hostility in others.
 Diagnosis of PPD

Paranoid PD is considered a Cluster A personality

disorder along with Schizoid and Schizotypal, and
characterized by odd or eccentric behavior. A
diagnosis of PPD should be considered when these
paranoid behaviors become persistent anddisabling.
 According to the DSM-IV-TR (Diagnostic and
Statistical Manual of Mental Disorders), a patient
must fit at least four of the following criteria in order
to be diagnosed with PPD:

unfounded suspicion that others are exploiting, harming,

or deceiving him or her
preoccupation with unjustified doubts about the loyalty
of friends or associates
reluctance to confide in others because of unwarranted
fear that the information will be used against him or her
finds hidden demeaning or threatening meanings in
benign remarks or events .
persistently bears grudges and is unforgiving
frequently perceives attacks on his or her character
and is quick to react angrily or to counterattack
unjustified suspicions regarding fidelity of spouse
or sexual partner
Prevalence of Paranoid Personality
 The prevalence of Paranoid Personality Disorder has been estimated to be as
high as 4.5% of the general population and occurs more commonly in males

Cause of PPD
 threatening domestic atmosphere experienced during childhood
 This disorder is more common among first-degree biological relatives of
those with Schizophrenia and Delusional Disorder, Persecutory Type

Course of Paranoid Disorder

 PPD often first becomes apparent in early adulthood. The course of this
disorder is chronic

Treatment of Paranoid Personality Disorder

 Psychotherapy
 Medications is given symptomatic