Psychiatric and Mental Health Nursing
Study Guide
Schizophrenia - ** -A series of thought disorders characterized by perceptual
distortions or a break from reality.
-1% of the population has the genetic predisposition (dopamine abnormality) for
schizophrenia, and when an individual with this predisposition is exposed to significant
life stressors, symptoms often develop.
-Because of the perceptual distortions associated with this disorder, patients often have
difficulty functioning and meeting basic needs and they demonstrate erratic or agitated
behavior.
-These symptoms also result in social skills deficits and often depression and anxiety.
Signs and symptoms of schizophrenia - ** -Hallucinations
-Delusions
-Flat affect
-Algolia (diminished thoughts)
-Lack of motivation
-Impaired judgment
-Inability to make decisions
-Social withdrawal
-Erratic behavior
-Paranoia
-Poor hygiene
-Loss of appetite
-Poor sleeping habits
-Difficulty with speech
-Suicidal thoughts
Diagnostics for schizophrenia - ** Clinical exam based on the DSM diagnostic criteria
Complications of schizophrenia - ** -Decreased quality of life
-Suicidal thoughts
-Danger to self and others
Drug therapy for schizophrenia - ** -Antipsychotics
-Antiepileptics
-Antianxiety medications
-Antidepressants
Nursing care for patients with schizophrenia - ** -Safety is first and most important.
-Avoid large groups and overstimulation.
-Avoid encouraging delusional ideas and try to bring the patient back to a state of
reality.
,-If the patient is experiencing suicidal thoughts, precautions and frequent monitoring are
needed.
-ECT can also be used to treat symptoms, especially if the patient is catatonic.
-Administer meds as ordered while assessing for side effects.
-Because of long-term treatment, side effects are common.
-Poor compliance is also a problem.
-Social rehabilitation is important when the disorder is chronic.
-Cognitive behavior therapy is used to cope with the symptoms as well as supportive
therapy for patients and families.
Generalized Anxiety Disorder (GAD) - ** -A group of disorders characterized as long-
term state of worry.
-The symptoms decrease one's participation in activities of daily life because of the
constant state of worry.
-Can vary from mild to a feeling of panic, with intensifying symptoms at each stage.
-Obsessive compulsive disorder adds repetitive thoughts (preoccupied with germs or
locking doors) and actions (repeatedly washing hands, rechecking doors multiple times)
to the anxiety and is a long-term disorder.
Signs and symptoms of generalized anxiety disorder - ** -Trembling
-Increased heart rate
-Cold hands/feet
-Sweating
-Palpitations
-Dizziness
-Sense of impending doom
-Irritability
-Fatigue
-Frequent urination
-Impaired concentration
-SOB
-Chest pain
-Vision changes
-Decreased attention span
-Muscle tension
-GI upset
Diagnostics for generalized anxiety disorder - ** -Based on clinical symptoms and DSM
categories.
-GAD is diagnosed if the patient's symptoms persist for more than 6 months
Complications of generalized anxiety disorder - ** -Panic disorder
-Suicidal thoughts
-Depression
Drug therapy for generalized anxiety disorder - ** -Benzodiazepines
,-SSRIs
Nursing care for patients with generalized anxiety disorder - ** -If the patient is
experiencing an anxiety episode, stay with them and use breathing techniques to help
them stay calm.
-Decrease stimuli.
-Administer meds as ordered.
-Refer the patient for cognitive therapy if needed.
Depression - ** -A group of clinical disorders characterized primarily by an abnormally
low mood that can develop at any age from childhood to adulthood.
-Mood is a pervasive feeling that is experienced subjectively and influences thoughts,
behaviors, physical sensations, and perceptions.
-A depressed mood is different from a brief passing sadness or grief after a loss.
-A decrease in the necessary levels of serotonin in the CNS combined with
environmental stressors is believed to be the cause.
Signs and symptoms of depression - ** Changes in mood:
-Sadness and despair
-a sense of emptiness
-Anhedonia (loss of ability to enjoy pleasure)
-Low self-esteem
-Excessive emotional sensitivity
-Pessimistic thinking
-Irritability
-Excessive guilt
-Indecisiveness
-Often, suicidal thoughts
Vegetative symptoms
-Disturbance of sleep
-Increase/decrease in appetite
-Weight gain/loss
-Lack of motivation
-Difficulty functioning in all aspects of life
Diagnostics for depression - ** -Clinical exam using the DSM.
-Many self-reports and structured interviews available to assist with diagnosis
Complications of depression - ** -Suicide
-Increased physical problems, especially in older adults
-Slower healing from surgery
Drug therapy for depression - ** -Antidepressants (SSRIs are used first)
-Antianxiety meds
-Sleep meds
, -If the patient is not responding well, an antipsychotic may be added to the
antidepressant.
Nursing care for patients with depression - ** -Provide safety.
-Develop a crisis plan if the patient's suicidal thoughts increase.
-Encourage involvement in therapy as well as adherence to medications.
-Cognitive behavior therapy to reduce depressive thoughts has been successful in
decreasing recurrences of depression by providing a problem-solving approach and
support therapy.
-Exercise and well-balanced meals are also important in preventing recurrences.
-Use of a full-spectrum light box is effective for seasonal affective disorder.
-Psychoeducation for the patient's family is important.
-Encourage involvement in self-help groups.
Bipolar disorder - ** -A disorder in which one's mood varies from manic to depressive
episodes.
-If the depressive episodes and manic episodes are very mild, the condition is labeled
cyclothymia.
Signs and symptoms of bipolar disorder - ** Mania:
-Euphoria
-Irritability
-Grandiosity
-Increased self-esteem
-Decreased need for sleep
-Racing thoughts and pressured speech
-Increased activity
-Poor judgment involving spending sprees, promiscuity, gambling, or other behaviors.
-Depressive symptoms are the same as in depression.
Diagnostics for bipolar disorder - ** -Based on symptoms of mania and depressive
episodes.
-Various depression scales may be used to help make a diagnosis.
Complications of bipolar disorder - ** -Erratic behavior can be harmful to the patient or
others.
-The patient may experience suicidal thoughts.
Drug therapy for bipolar disorder - ** -Mood stabilizers (lithium, SSRIs,
benzodiazepines)
-Antidepressants should always be ordered with a mood stabilizer to avoid activation of
mania.
-Poor compliance is often an issue.
Nursing care for patients with bipolar disorder - ** -Monitor the patient frequently and
closely because of rapid changes in mood.
Study Guide
Schizophrenia - ** -A series of thought disorders characterized by perceptual
distortions or a break from reality.
-1% of the population has the genetic predisposition (dopamine abnormality) for
schizophrenia, and when an individual with this predisposition is exposed to significant
life stressors, symptoms often develop.
-Because of the perceptual distortions associated with this disorder, patients often have
difficulty functioning and meeting basic needs and they demonstrate erratic or agitated
behavior.
-These symptoms also result in social skills deficits and often depression and anxiety.
Signs and symptoms of schizophrenia - ** -Hallucinations
-Delusions
-Flat affect
-Algolia (diminished thoughts)
-Lack of motivation
-Impaired judgment
-Inability to make decisions
-Social withdrawal
-Erratic behavior
-Paranoia
-Poor hygiene
-Loss of appetite
-Poor sleeping habits
-Difficulty with speech
-Suicidal thoughts
Diagnostics for schizophrenia - ** Clinical exam based on the DSM diagnostic criteria
Complications of schizophrenia - ** -Decreased quality of life
-Suicidal thoughts
-Danger to self and others
Drug therapy for schizophrenia - ** -Antipsychotics
-Antiepileptics
-Antianxiety medications
-Antidepressants
Nursing care for patients with schizophrenia - ** -Safety is first and most important.
-Avoid large groups and overstimulation.
-Avoid encouraging delusional ideas and try to bring the patient back to a state of
reality.
,-If the patient is experiencing suicidal thoughts, precautions and frequent monitoring are
needed.
-ECT can also be used to treat symptoms, especially if the patient is catatonic.
-Administer meds as ordered while assessing for side effects.
-Because of long-term treatment, side effects are common.
-Poor compliance is also a problem.
-Social rehabilitation is important when the disorder is chronic.
-Cognitive behavior therapy is used to cope with the symptoms as well as supportive
therapy for patients and families.
Generalized Anxiety Disorder (GAD) - ** -A group of disorders characterized as long-
term state of worry.
-The symptoms decrease one's participation in activities of daily life because of the
constant state of worry.
-Can vary from mild to a feeling of panic, with intensifying symptoms at each stage.
-Obsessive compulsive disorder adds repetitive thoughts (preoccupied with germs or
locking doors) and actions (repeatedly washing hands, rechecking doors multiple times)
to the anxiety and is a long-term disorder.
Signs and symptoms of generalized anxiety disorder - ** -Trembling
-Increased heart rate
-Cold hands/feet
-Sweating
-Palpitations
-Dizziness
-Sense of impending doom
-Irritability
-Fatigue
-Frequent urination
-Impaired concentration
-SOB
-Chest pain
-Vision changes
-Decreased attention span
-Muscle tension
-GI upset
Diagnostics for generalized anxiety disorder - ** -Based on clinical symptoms and DSM
categories.
-GAD is diagnosed if the patient's symptoms persist for more than 6 months
Complications of generalized anxiety disorder - ** -Panic disorder
-Suicidal thoughts
-Depression
Drug therapy for generalized anxiety disorder - ** -Benzodiazepines
,-SSRIs
Nursing care for patients with generalized anxiety disorder - ** -If the patient is
experiencing an anxiety episode, stay with them and use breathing techniques to help
them stay calm.
-Decrease stimuli.
-Administer meds as ordered.
-Refer the patient for cognitive therapy if needed.
Depression - ** -A group of clinical disorders characterized primarily by an abnormally
low mood that can develop at any age from childhood to adulthood.
-Mood is a pervasive feeling that is experienced subjectively and influences thoughts,
behaviors, physical sensations, and perceptions.
-A depressed mood is different from a brief passing sadness or grief after a loss.
-A decrease in the necessary levels of serotonin in the CNS combined with
environmental stressors is believed to be the cause.
Signs and symptoms of depression - ** Changes in mood:
-Sadness and despair
-a sense of emptiness
-Anhedonia (loss of ability to enjoy pleasure)
-Low self-esteem
-Excessive emotional sensitivity
-Pessimistic thinking
-Irritability
-Excessive guilt
-Indecisiveness
-Often, suicidal thoughts
Vegetative symptoms
-Disturbance of sleep
-Increase/decrease in appetite
-Weight gain/loss
-Lack of motivation
-Difficulty functioning in all aspects of life
Diagnostics for depression - ** -Clinical exam using the DSM.
-Many self-reports and structured interviews available to assist with diagnosis
Complications of depression - ** -Suicide
-Increased physical problems, especially in older adults
-Slower healing from surgery
Drug therapy for depression - ** -Antidepressants (SSRIs are used first)
-Antianxiety meds
-Sleep meds
, -If the patient is not responding well, an antipsychotic may be added to the
antidepressant.
Nursing care for patients with depression - ** -Provide safety.
-Develop a crisis plan if the patient's suicidal thoughts increase.
-Encourage involvement in therapy as well as adherence to medications.
-Cognitive behavior therapy to reduce depressive thoughts has been successful in
decreasing recurrences of depression by providing a problem-solving approach and
support therapy.
-Exercise and well-balanced meals are also important in preventing recurrences.
-Use of a full-spectrum light box is effective for seasonal affective disorder.
-Psychoeducation for the patient's family is important.
-Encourage involvement in self-help groups.
Bipolar disorder - ** -A disorder in which one's mood varies from manic to depressive
episodes.
-If the depressive episodes and manic episodes are very mild, the condition is labeled
cyclothymia.
Signs and symptoms of bipolar disorder - ** Mania:
-Euphoria
-Irritability
-Grandiosity
-Increased self-esteem
-Decreased need for sleep
-Racing thoughts and pressured speech
-Increased activity
-Poor judgment involving spending sprees, promiscuity, gambling, or other behaviors.
-Depressive symptoms are the same as in depression.
Diagnostics for bipolar disorder - ** -Based on symptoms of mania and depressive
episodes.
-Various depression scales may be used to help make a diagnosis.
Complications of bipolar disorder - ** -Erratic behavior can be harmful to the patient or
others.
-The patient may experience suicidal thoughts.
Drug therapy for bipolar disorder - ** -Mood stabilizers (lithium, SSRIs,
benzodiazepines)
-Antidepressants should always be ordered with a mood stabilizer to avoid activation of
mania.
-Poor compliance is often an issue.
Nursing care for patients with bipolar disorder - ** -Monitor the patient frequently and
closely because of rapid changes in mood.
