117/ Psyche Lecture

CRISIS 3. Adventitious: it is a crisis that is unplanned

and accidental. This is not a part of an
Crisis everyday life.
- A period that will lead, or may lead to an - Example: Natural disaster, flood and
unstable and dangerous situation affecting earthquake, national war and riot, crime-
an individual, family or the community. The rape, murder and child abuse
negative changes that occur abruptly with a 4. Cultural: Arise when the tradition
little or no warning can change a person. transmitted, including the folkways and
- A disturbance of one’s equilibrium. mores and the religious beliefs no longer
- The individual is under stress and hazardous conform to the more secular interest and
event. practices of everyday life.
- Their coping mechanism is ineffective. - Example: Working/living away from home

Everyone encounters stressful situation in life.

CRISIS REACTIONS:
This is when the physical, psychological and 1. Behavioral:
social needs are not met or not responded to right 2. Emotional:
away. However, one manages to cope with their 3. Physiological:
stresses. 4. Cognitive: refers to which one thinks of
Example:
5. Spiritual: refers to one’s belief
- Changes in schedule, but the body can
adjust.
PHASES AND DESCRIPTION:
- Loss of love ones, but life has to go on.
1. Pre-crisis: A state where a person can cope
- Separation from family and love ones, going
with the stress of everyday life.
abroad and making friends.
2. Impact/shock: When a stressful event
- Earthquake, flood, airplane crushes, volcanic
occurs to a person. Confusion, anxiety,
eruption, entire population is in stress.
disorganized and chaos is observed.
3. Crisis: The person is unable to cope with the
Crisis Intervention:
conflict. If it worsens it will become a problem,
It is an attempt to resolve a problem or crisis when
on the other hand, if it is solved it proceeds to
a person’s life goals are obstructed and the usual
resolution. (time limit: 4-6 weeks)
problem-solving methods fails.
4. Resolution: Regaining control of the
situation and emotion. Able to solve problem.
4 TYPES OF CRISIS: 5. Post crisis: A person resume normal activity
1. Maturational/Developmental: This is
and increase level of maturity.
experience during puberty, adolescence,
adulthood, marriage and aging process. NOTE: -------------------------------------------------------
These are the normal process of growth and - A person who copes ineffectively may express
development where a person makes some hostility, depression, takes drugs and socially
changes. This is felt when a person arrives at maladjusted.
a new stage. - In the aspect of a CRISIS- we should focus on the
- Example: birth, entry to school, adolescent, Immediate Problem, why? Dahil ito ang dahilan
menopause, senility and death. kung bakit siya nahospital.
2. Situational: It is an event that affects an
----------------------------------------------------------------
individual during time of illness, accidents,
economic difficulty, divorce, death, abortion,
GOAL:
change of job and pregnancy. This involves a
1. Decrease emotional stress and protect the
loss that threatens a person self-concept.
victim from additional stress.
- Example: loss of love one, position, and
2. Assist the person to solve the crisis.
transfer of work.

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117/ Psyche Lecture
3. Help the person to obtain high level of *Crisis is not a psychiatric illness so pharmacological
functioning. intervention is not a choice. If symptoms occur like
anxiety, panic, sleep disturbances.
STEPS IN CRISIS INTERVENTION: *Anxiolytics/Antianxiety/Minor Tranquilizer are the
1. Assessment drug of choice (Xanax, Valium, Ativan, Klonopin)
2. Planning ----------------------------------------------------------------
3. Implementation
4. Resolution
SUICIDE
- Self-imposed death
SAD PERSON ACRONYM
SEX
- Female attempts (pero takot kaya mostly
ends up not doing it)
- Male attempts and commits suicide
(deretsahan, pag gusto--- tinutuloy)
AGE
- 18 to 25
- 45 above
DEPRESSION/ DEPENDENT PERSONALITY

PREVIOUS ATTEMPT
ETHANOL, ALCOHOLOLICS
MANAGEMENT:
RATIONAL THINKER PSYCHOTIC
1. Display acceptance and concern.
SOCIAL SUPPORT IS LACKING
2. Discuss feelings.
ORGANIZED PLAN
3. Help the person understand the situation
NO SPOUSE
gradually.
SICKNESS
4. Explain that emotions are normal in reaction
to crisis.
5. Avoid assurance. ANXIETY
6. Do not encourage the person to place the Anxiety disorders are the most common of all
blame for the crisis on others. It prevents the mental health disorders. It makes a person feel
patient to face the truth. anxious most of the time, without any apparent
7. Set limits to destructive behavior or self- reason. The anxious feeling may be so
harm. uncomfortable that to avoid them, you may stop
8. Assist patient with ADL. some everyday activity. Occasional bouts of
9. Evaluate and modify nursing intervention if intense anxiety terrifies and immobilize a person.
necessary.
10. Focus on the immediate problem. (Clearly TERMINOLOGY:
identified) 1. Anxiety: It is a response to subjective or
11. Explore alternatives for coping with the crisis. internal danger. Afraid of the unknown
12. Let client participate in choosing an action 2. Fear: It is a response to objective threat or
plan and implement. (mutual goal planning) external danger. Afraid of the known
3. Phobia: It is an exaggerated, abnormal,
NOTE: ------------------------------------------------------- marked fear of non-dangerous object or
*Crisis is generally time limited which should last for situation.
4 to 6 weeks.

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117/ Psyche Lecture
4. Mild anxiety: It is a type of anxiety which is LEVEL OF ANXIETY
caused by the ordinary tension of daily life. 1. Mild Anxiety (+1): type of anxiety which
Perception is very high. caused by the ordinary tension of daily life.
- Character: alert, voice is calm, attentive, Perception is very high. Normal.
confident, calm, secured, relaxed and uses - Alert, voice is calm, attentive, confident,
adaptive coping mechanism. calm, secured, relaxed, and uses adaptive
5. Moderate anxiety: A type of anxiety where coping mechanism.
the patient’s perception continues to be high, 2. Moderate Anxiety (+2): type of anxiety
however, the patient begins to focus only on where the patient’s perception continues to
the situation he is into, excluding other be high, however, the patient begins to focus
issues. only on the on the situation he is into,
- Character: irritable, talk fast, muscle tension, excluding other issues. Narrowing of
frequent urination and sweating. perception.
6. Severe anxiety: A type of anxiety where the - Sympathetic nervous system/ fight or flight is
perception of the patient is inaccurate. The activated, irritable, talk fast, muscle tension,
problem solving is reduced and patient needs frequent urination, and sweating.
assistance. 3. Severe Anxiety (+3): the perception of the
- Character: disoriented, extreme tension, patient is inaccurate / “alanganin”. The
palpitation, hyperventilating, inefficient, problem solving is reduced and patient needs
disoriented, confused, withdrawal assistance/help. Put patient is a room,
7. Panic: A type of anxiety which is intense, separated from others.
disorganize a person functioning and distorts - Disoriented, extreme tension, palpitation,
perception. The patient must have immediate hyperventilating, inefficient, confused,
intervention. withdrawal, poor eye contact, sweating.
- Character: emotionally drained, helpless, 4. Panic (+4): intense, disorganize a person’s
desperate, clumsy, sleepless, and functioning and distorts perception. The
aggressive, exhausted, chest pain, patient must have immediate
negativistic, and hallucinate. intervention.Separate the patient from other
8. Primary gain: It is a way of allowing the patients at once and don’t leave patient in the
patient to relieve his own anxiety. room alone.
9. Secondary gain: It is a way of supporting or - Intervention (dependent): the doctor
helping others to relieve their anxiety. It is prescribes medicines for patient to be calm.
beneficial to the patient at times. - Intervention (independent): Pakalmahin
10. Burnout: physical exhaustion. muna bago mag-intervention.
- Emotionally drained, helpless, desperate,
DIFFERENT WAYS OF OBSERVING ANXIETY: clumsy, sleepless, aggressive, exhausted,
 Change in tone of voice. chest pain, negativistic, hallucinate,
 Tremors disorganized, distorted, terrorized.
 Increase RR
 Increase PR ETIOLOGY:
 Avoidance of topic 4-6 ang nasa ppt ni ma’am
 Blocking of communication 1. Biological factor
 Restlessness 2. Psychoanalytic theory
 Vomiting 3. Interpersonal theory
 Diarrhea 4. Increase of epinephrine and norepinephrine.
 Palpitation 5. The earliest emotional trauma felt by a
 Rate of speech person was during his birth.
 Frequent urination

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117/ Psyche Lecture
6. Mostly universal of all emotions, warning of
danger. MEDICATION:
- Antianxiety/ Minor Tranquilizer/
WAYS OF COPING ANXIETY: Anxiolytics: Librium, Valium, Ativan, Serax
1. Adaptive: able to solve problem. Can cope. - Undesirable effects of Benzodiazepines 3
2. Pallative: temporarily decrease anxiety. D’S
Example: Sinabi ng teacher na next Monday 1. Drowsiness
may quiz. Si Tekla nagreview siya ng 2. Dizziness
Wednesday and Saturday. Pero night before 3. Decrease B/P
the quiz, may nagyaya kay Tekla na magbar
at uminom. Pumunta naman si Tekla.  No drug is totally safe and absolutely free of
Napuyat nga lang siya na pumasok sa school toxic effect.
kinabukasan. Nalate rin siya pero nakaexam  Toxic effect sometimes can be apparent after
pa din. Kaya niyang idecrease ung anxiety a week or months after taking the meds.
kasi nagreview naman siya ahead of time.  Check clients V/S it can cause orthostatic
3. Maladaptive: unsuccessful attempt to hypotension.
decrease anxiety without solving it.  If a client have a multiple physical and
Example: Sinabi ng teacher na next Monday
psychiatric problems frequently occur
may quiz. May nagyaya kay Mijo na mag
together, and may require several treatment
samgyup, pumunta naman siya without
with drugs, multiple drug therapy is referred
reviewing. Ngayon hindi nga nagreview si
to as “poly pharmacy”.
Mijo, at sinasabi nalang niyang “Okay lang
 Anxiolytics has a calming effect.
yan” kahit apagpullat or apagpasa lang ung
grade niya sa subject na ito.
 Factors altering drug response can be: age,
sex, body mass, environment, time of
4. Dysfunctional: unsuccessful way of
administration, psychological, genetic
relieving anxiety and decrease minimal
functioning.  It is not use for minor stresses of everyday
Example: Sinabi ng teacher na next Monday life, it can cause addiction.
may quiz. Alam ni Pia na may quiz  Avoid using with OTC drugs it may alter the
kinabukasan pero naglakwatcha pa rin siya potency of the drug.
the night before the quiz. Late siyang umuwi.  Avoid stopping the meds abruptly because of
Sa sobrang puyaty niya, d na siya the side effects
nakapagreview, d na rin siya nakapasok, d
na rin nakapag quiz. NURSING MANAGEMENT:
1. Accept patient’s behavior. (Trust)
NURSING DIAGNOSIS: 2. Provide calm and quiet environment.
 Altered family process Reduce stimulation. (Identify cause of
 Altered health maintenance anxiety)
 Altered nutrition: less/more than body 3. Discuss the feelings. (To increase
requirements. recognition to what is happening to them.)
 Decision conflict 4. Listening. (Trust and assess suicidal
 Decrease self esteem tendencies.)
 High risk for trauma 5. Plan an activity for the patient and use of
 Impaired adjustment hobbies. (Help patient release nervous
 Ineffective individual coping energy/ increase self-esteem)
 Impaired verbal communication 6. Promote relaxation technique. (Reduce
 Impaired social interaction anxiety)
 Powerlessness

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THERAPY: 6. Plan an activity for the patient.
- Recreational 7. Acceptance of positive or negative feeling of
- Relaxation the patient.
- Group therapy 8. Develop adaptive coping responses. To
practice new behavior to face their problem.
ANXIETY DISORDER-- TYPES OF ANXIETY:
A. Generalized Anxiety Disorder (GAD) MEDICATION:
B. Panic disorder - Minor tranquilizer. (Ativan)
C. Phobic disorder - Antidepressant (Tofranil)
D. Post-traumatic stress disorder
THERAPY:
A. *GAD: “FREE FLOATING ANXIETY” - Recreational (decrease tension)
- Excessive unrealistic anxiety of 6 months - Relaxation (promote comfort)
period or years. - Group therapy (focus in stress mngt.,
ETIOLOGY: SAME AS IN ANXIETY problem solving to increase self-esteem)
18 SYMPTOMS OF GAD
 shaky  easy fatigability B. PANIC DISORDER:
 dry mouth  chills - It is an intense fear of discomfort which last
 hot flashes  insomnia for few minutes. Attack occur “out of the blue”
 muscle aches  shortness of the severity will make the patient unfit and
 nausea and breathing incapable.
abdominal  irritability
distress  hot flashes ETIOLOGY:
 frequent urination  difficulty of Hereditary increased in serotonin
 restlessness concentrating
 dizziness  difficulty of SYMPTOMS:
 startled response swallowing  Same as GAD
 sweating  Chest pain
 Choking feeling
 Going crazy
NURSING DIAGNOSIS:  Numbness
 Alteration in concentration  Unable to move and suicidal.
 Altered role performance
 Anxiety NURSING DIAGNOSIS:
 Distractibility SAME AS GAD
 Distress  Alteration in concentration
 Fear  Altered role performance
 Guilt  Anxiety
 Social isolation  Distractibility
 Distress
NURSING MANAGEMENT/CARE:  Fear
1, 2, 4, 6, 8 ang nasa ppt ni ma’am  Guilt
1. Calm and quiet environment.  Social isolation
2. Stay with the patient and talk about their
fears. NURSING MANAGEMENT/CARE:
3. Decrease level of anxiety. 1. Stay with the patient.
4. Listen to the patient. 2. Allow pt. to cry.
5. Support your patient. 3. Provide calm/safe environment.

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4. Communicate with the pt. SYMPTOMS: Same as Panic disorder.
5. Speak in short, simple sentence and give one  Same as GAD
direction at a time.  Chest pain
6. Ask perception or fear.  Choking feeling
 Going crazy
MEDICATION:  Numbness
- Antidepressant  Unable to move and suicidal.

THERAPY: NURSING DIAGNOSIS:

- Recreational  Alteration in nutrition
- Relaxation  Anxiety
- Allow pt. To walk  Impaired social interaction
- Jog  Impaired verbal communication
- Play basketball  Ineffective breathing pattern
- Volleyball  Ineffective individual coping
 Powerlessness
C. OBSESSIVE COMPULSIVE DISORDER:  Risk for injury
- A recurrent and persistent thoughts, ideas  Self-esteem disturbances
and impulse that are experienced as  Sleep pattern disturbances
senseless.
- Obsession: a recurrent thoughts, ideas, and TYPES OF PHOBIA:
impulses that are inappropriate. 1. Agoraphobia: fear of being in public, open
- Compulsion: it is a repeated performance spaces, situation where escape is difficult.
where a person is compelled to do so to 2. Social Phobia: fear of being humiliated,
decrease his anxiety. Kung want ulitin ng scrutinized, embarrassed in public.
patient ung iniisip niya, make her do it earlier 3. Simple/Specific: fear of specific of object or
kaysa sa time na gusto niya- kunwari want situation.
niya ulit maghugas ng 10pm. Make her do it
earlier para walang mabulabog na other NURSING MANAGEMENT:
patients. 1. Acceptance of the patient and his fear with a
- Remind the patient that nobody is perfect and non-critical attitude.
that everybody makes mistakes. 2. Provide activity.
3. Help patient with regards to safety and
NURSING MANAGEMENT/CARE: comfort.
1. Limit but do not interrupt the compulsive act. 4. Help patient recognize that his behavior is
2. Teach alternate coping method. one method of coping with his anxiety.
3. Be clear and consistent in the approach of
care. MEDICATION:
4. Permit time for the rituals. - Antidepressant (blocks panic attack)
5. Tell patient that is alright to commit mistakes.
To decrease striving for perfection. THERAPY:
- Social skills group
D. PHOBIA: - Behavioral
- Female are more affected. - Flooding
ETIOLOGY: - Desensitization
Hormonal functions or activity of the
neurotransmitters in the CNS.

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E. POST TRAUMATIC STRESS DISORDER NURSING MANAGEMENT:
(PTSD): 1. Develop trust. (Suspicious, withdrawn)
- Pinakagrabeng type 2. Offer great deal of empathy and support.
- Withdraw from others because they cannot (I have not been through it but the more you
live with them or because of the tell me the better I will understand your
embarrassment. situation and experience.)
- 3. Help reestablish relationship that can
ETIOLOGY: provide support and assistance. (Family,
- War couple counselling)
- Natural or man-made disaster 4. Safe environment. (outburst/ out of control)
- Fires 5. Encourage participation in sports,
- Accidents recreational activities or any healthy
- Illness outlet for stress. (Healthy outlet for stress)
- Rape 6. Educate him with regards to his medication.
- Assault 7. Recapitulation of each memory from least to
- Major personal losses in business the most painful.

SYMPTOMS: MEDICATION:
 Avoidance - Minor tranquilizer (decrease painful
 Numbness emotions)
 Shortness of breathing - Lithium
 Restlessness - TCA
 Dizziness - MAO
 Sweating
 Palpitation THERAPY:
 Rapid speech - social activity (rebuilt social skills)
 Withdrawal - recreational
 Pacing - exercise program group
 Irritability
 Restlessness NOTE: -------------------------------------------------------
 Nightmares *Psychotic medicines + alcohol = BIG BIG NO
 Survivors guilt ----------------------------------------------------------------
 Hallucination
F. ACUTE STRESS DISORDER:
NURSING DIAGNOSIS: - Symptoms are similar to PTSD but develop
 Alteration in nutrition within the first month after the extremely
 Anxiety threatening situation.
 Impaired social interaction
 Ineffective breathing pattern MEDICATION:
 Ineffective individual coping - Antianxiety (Minor tranquilizer/ Anxiolytics)
 Powerless Serax, Librium, Valium, Ativan
 Risk for injury  It has a calming effect
 Sleep pattern disturbances  It is not use for minor stresses of
everyday life, and can cause addiction.
COMMON DEVELOP PROBLEMS:  IV meds 1 to 5 minutes
 suicidal ideas or attempt  IM 15 to 30 minutes
 substance abuse

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EFFECTS OF BENZODIAZEPINES 3 D’S 
Management: Acupuncture, Physical
1. Drowsiness therapy, Relaxation & pain management
2. Dizziness technique.
3. Decrease B/P c. Hypochondriasis
 Check VS, it can cause orthostatic  Physical symptoms are interpreted as
hypotension severe and can cause the client’s life.
 Example: prick lang sa finger, feel nila

SOMATOFORM DISORDER: ikakamatay na nila.

d. Conversion Disorder
ANXIETY RELATED DISORDER  A loss or change in bodily function. “la
- A somatic symptom disorder manifests a belle” indifference” is unconcerned about
physical symptom that suggest illness or the symptoms.
injury but cannot be explained by a general  Example: Witness a murder but claimed
medical condition and are not attributed to she is blind.
another mental disorder.  S/sx: mutism, paralysis, tremors,
- A disorder where the patient feels the blindness, deafness and headache.
presence of physical symptoms that is with a  Management: Recognize the symptoms
negative organic basis. of the patient because they experience it.
- The patient feels the pain and distress which Promote relief.
causes them to function limitedly. e. Body Dysmorphic
- A disorder that avoids responsibility and are  Preoccupied with a physical image defect
manipulative. in appearance where there is o
- “DOCTOR SHOPPERS”: Visits different abnormality.
doctors. People who goes for a check-up  Example: Onting wrinkled lines lang sa
because they believe that there is something face, pupunta na sa doctors para
wrong and painful. But every assessment magpaganda.
and diagnostic test results to negative of any  S/sx: frequently check flaws, easily
sickness/symptoms. They are normal, but embarrassed, isolation.
still insists that something is wrong. They are  Management: avoid challenging client,
not contented of the results so they visit other apply coping techniques, increase social
doctors as well, seeking the right result as activity.
that will confirm what they feel.  Medication: Placebo (sugar pill),
Analgesic (for pain), TCA/ tricyclic
5 TYPES xxx antidepressant ( decrease somatic
a. Somatization Disorder pains)
 Characterized by multiple somatic
symptoms that cannot be explained Primary gain: relieves anxiety by themselves to
medically. Begins at 30 years old. feel better.
Symptoms will last within a year. Secondary gain: relieves anxiety by the help of
 S/sx: recurrent pain on the heart, others.
musculoskeletal, respiratory, G.I, &
integumentary problem. Fatigue can NOTE: -------------------------------------------------------
disable the client. * Persistent “somatizers” are dependent, emotional,
b. Pain Disorder needy, frustrated, chronically resentful person,
 Severe and prolonged unrelated to a seeking attention. They want to punish relatives and
medical disease. doctors for not meeting their needs
 S/sx: pain is felt for 6 months more ----------------------------------------------------------------
exaggerated back pain.

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DISSOCIATIVE IDENTITY DISORDER: - Behavior: “switching” (blinking & rolling of
ANXIETY RELATED DISORDER eyes, headache, covering/hiding of face,
- The most extreme manifestation of a twitching) occurs from one alter to another.
dissociative disorder and it involves multiple
parts of the personality existing within one MANAGEMENT:
person. These have evolved as separate 1. Interact with the patient. (trust)
personality states as the only feasible way for 2. Keep them safe. (decrease anxiety)
a child to cope with ongoing trauma and 3. Provide non-demanding, simple routines.
abuse. (decrease anxiety)
- It is the “splitting off” an idea or emotions from 4. Encourage to do things for them self.
one’s consciousness. (thrill seeker)
- Defense Mechanism (DM) is repression, 5. Assist in decision making. (decrease
because the conscious personality cannot stress)
handle anxiety. 6. Stress management

TYPES OF DISSOCIATIVE DISORDER:

1. Dissociative amnesia: sudden inability to
recall personal information.
- Causes: severe stress, physical injury, death
- Behavior: confused, disoriented, wandering
around
- Types of Amnesia:
a. Selective: The person recalls only a part
of the event.
b. Generalized: The person cannot recall
anything in his entire life.
c. Localized: The person cannot recall,
short period of time. After a traumatic
event (hours).
d. Continuous: The person cannot recall
successive events as they are.
2. Dissociative fugue: “flight” fleeing from your
own identity. Sudden expected travel to other
places accompanied by an inability to recall
past identity.
- Causes: traumatic event, war, conflict,
rejection, marital quarrels
- Behavior: confused memory loss, recovery
is fast but client can’t recall.
3. Depersonalization: an alteration in one’s
self. “Like living in a dream”
- Causes: Over whelming stress & anxiety
- Behavior: Feels “detached from self” but
reality testing is intact. Robot feeling.
4. Dissociative Identity: having two or more
distinct personality or identities (alters).
- Causes: Childhood physical & sexual abuse
(flashbacks, nightmares)

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