Stages of Personality Development

Freud’s Psychosexual Development
0 – 18 mo	Oral	Oral gratification
18 mo – 3 yr	Anal	Independence and control (voluntary sphincter control)
3 – 6 yr	Phallic	Genital focus
6 – 12 yr	Latency	Repressed sexuality; channeled sexual drives (sports)
13 – 20 yr	Genital	Puberty with sexual interest in opposite sex

Sullivan’s Interpersonal Theory
0 – 18 mo	Infancy	Anxiety reduction via oral gratification
18 mo – 6 yr	Childhood	Delay in gratification
6 – 9 yr	Juvenile	Satisfying peer relationships
9 – 12 yr	Preadolescence	Satisfying same-sex relationships
12 – 14 yr	Early adolescence	Satisfying opposite-sex relationships
14 – 21 yr	Late adolescence	Lasting intimate opposite sex relationship

Erikson’s Psychosocial Theory
0 – 18 mo	Trust vs. mistrust	Basic trust in mother figure & generalizes
18 mo – 3 yr	Autonomy vs. shame/doubt	Self-control/independence
3 – 6 yr	Initiative vs. guilt	Initiate and direct own activities
6 – 12 yr	Industry vs. inferiority	Self-confidence through successful performance and recognition
12 – 20 yr	Identity vs. role confusion	Task integration from previous stages; secure sense of self
20 – 30 yr	Intimacy vs. isolation	Form a lasting relationship or commitment
30 – 65 yr	Generativity vs. stagnation	Achieve life’s goals; consider future generations
65 yr - death	Ego integrity vs. despair	Life review with meaning from both positives and negatives; positive selfworth

  

Mahler’s Theory of Object Relations
0 – 1 mo	1. Normal autism	Basic needs fulfillment (for survival)
1 mo – 5 mo	2. Symbiosis 3. Separation – individuation	Awareness of external fulfillment source
5 mo – 10 mo	– Differentiation	Commencement of separateness from mother figure
10 mo – 16 mo	– Practicing	Locomotor independence; awareness of separateness of self
16 mo – 24 mo	– Rapprochement	Acute separateness awareness; seeks emotional refueling from mother figure
24 mo – 36 mo	– Consolidation	Established sense of separateness; internalizes sustained image of loved person/object when out of sight; separation anxiety resolution

  

Pepleu’s Interpersonal Theory
Infant	Depending on others	Learning ways to communicate with primary caregiver for meeting comfort needs
Toddler	Delaying satisfaction	Some delay in self-gratification to please others
Early Childhood	Self-identification	Acquisition of appropriate roles and behaviors through perception of others’ expectations of self
Late Childhood	Participation skills	Competition, compromise, cooperation skills acquisition; sense of one’s place in the world

Mental Health and Mental Illness: Basics - 2

Theories of Personality Development

Psychoanalytic Theory

Sigmund Freud, who introduced us to the Oedipus complex, hysteria, free association, and dream interpretation, is considered the “Father of Psychiatry.” He was concerned with both the dynamics and structure of the psyche. He divided the personality into three parts:

• Id – The id developed out of Freud’s concept of the pleasure principle. The id comprises primitive, instinctual drives (hunger, sex, aggression). The id says, “I want.”
• Ego – It is the ego, or rational mind, that is called upon to control the instinctual impulses of the self-indulgent id. The ego says, “I think/I evaluate.”
• Superego – The superego is the conscience of the psyche and monitors the ego. The superego says “I should/I ought.” (Hunt 1994) 

Topographic Model of the Mind

Freud’s topographic model deals with levels of awareness and is divided into three categories:

• Unconscious mind – All mental content and memories outside of conscious awareness; becomes conscious through the preconscious mind.
• Preconscious mind – Not within the conscious mind but can more easily be brought to conscious awareness (repressive function of instinctual desires or undesirable memories). Reaches consciousness through word linkage.
• Conscious mind – All content and memories immediately available and within conscious awareness. Of lesser importance to psychoanalysts.

Mental Health and Mental Illness: Basics - 1

General Adaptation Syndrome (Stress-Adaptation Syndrome)

Hans Selye (1976) divided his stress syndrome into three stages and, in doing so, pointed out the seriousness of prolonged stress on the body and the need for identification and intervention.

• Alarm stage – This is the immediate physiological (fight or flight) response to a threat or perceived threat.
• Resistance – If the stress continues, the body adapts to the levels of stress and attempts to return to homeostasis.
• Exhaustion – With prolonged exposure and adaptation, the body eventually becomes depleted. There are no more reserves to draw upon, and serious illness may now develop (e.g., hypertension, mental disorders, cancer). Selye teaches us that without intervention, even death is a possibility at this stage.

CLINICAL PEARL: Identification and treatment of chronic, post-traumatic stress disorder (PTSD) and unresolved grief, including multiple (compounding) losses, are critical in an attempt to prevent serious illness and improve quality of life.

Fight-or-Flight Response

In the fight-or-flight response, if a person is presented with a stressful situation (danger), a physiological response (sympathetic nervous system) activates the adrenal glands and cardiovascular system, allowing a person to rapidly adjust to the need to fight or flee a situation.

• Such physiological response is beneficial in the short term: for instance, in an emergency situation.
• However, with ongoing, chronic psychological stressors, a personcontinues to experience the same physiological response as if there were a real danger, which eventually physically and emotionally depletes the body.

Diathesis-Stress Model

The diathesis-stress model views behavior as the result of genetic and biological factors. A genetic predisposition results in a mental disorder (e.g., mood disorder or schizophrenia) when precipitated by environmental factors.

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PSD) is defined as an experiencing of a traumatic event in either daytime reveries or dreams. Natural and / or mad-mad disaster are usually the stress experiences.

Symptoms:
The symptoms of Posttraumatic Stress Disorder are likely same as anxiety, depression and organic mental disorder. Assess the following symptoms when caring of posttraumatic stress disorder patients:

• Substance abuse
• Headache
• Memory (attention deficit)
• Pain

Beside of symptoms I mentioned above, psychosocial and cultural of the client should be assess too.

• Feeling of detachment and guilt
• Inability to feel emotions
• Impulsive behavior
• Anxiety of depression
• Nightmares
• Emotional lability
• Acting out, reliving traumatic experience

Planning:

• Safe and effective care environment
• Physiological integrity (to reduce or eliminate physiological symptoms of stress)
• Psychosocial integrity

Implementation:
There are four stages of implementation regarding Posttraumatic Stress Disorder patients:

1. Recovery: to assist patient to realize that he/she is safe
2. Avoidance: to provide support while patient attempts to suppress thought of traumatic experiences
3. Adjustment: to assist patient to alter environment if needed.

Abnormal Motor Behaviors

Abnormal motor behaviors are activities displayed by the mentally ill patient and occur as a result of a psychiatric disorder.

There are types of abnormal motor behaviors as I mention here:

Akathisia

• Displaying motor restlessness and muscular quivering
• Patient is unable to sit or lie quietly

Echolalia
Repeating the speech of another person

Echopraxia
Repeating movement of another person

Parkinson-like Symptoms
Making masklike faces, drolling, and having shuffling gait, tremors, and muscular rigidity

Waxy Flexibility
Having one’s arm or legs place in a certain position and holding that same position for hours

Dyskinesia
Impairment of the power of voluntary movement

Abuse and Neglect: Shaken Baby Syndrome

Shaken baby syndrome (SBS) is a form of physical abuse that mostly caused by rigorous shaking. There are three risk factors of shaken baby syndrome: gender, financial stress, and mental-health problems.


Sign and Symptoms:

• Poor feeding
• Bulging fontanels
• Lethargy
• Seizures
• Apnea
• Retinal detachment

Nursing Interventions:
Assure and teach parent about age-appropriate play of the infants that will not cause injuries

Abuse and Neglect: Child Abuse

Signs of Physical Child Abuse:

• Unexplained bruise or welts
• Unexplained burns
• Unexplained fractures (multiple or in various stages of healing)
• Unexplained lacerations or abrasions (mouth, eyes, and external genitalia)
• Expresses fear of going home
• Appears frightened of parents
• Reports of being injured by parents
• Exhibits extreme aggressiveness or withdrawal
• Acts wary of contact with adults
• Becomes apprehensive when other children cry

Signs of Physical Child Neglect:

• Inappropriate dress
• Always hungry
• Poor hygiene
• Uncared for medical or physical problems
• Begging or stealing food
• Abandonment
• Early arrival and late departure from school
• Fatigue
• Listlessness
• Reports lack of a caretaker
• Delinquency

Why the parent becomes an abusive parent? Here are the risk factors that parent become an abuser:

1. Under significant stress
2. Abused as a child
3. Deficient in social and financial resources
4. Lack of impulse control
5. Uses inappropriate coping skills
6. Anger and hostility
7. Ambivalent toward parenthood
8. Mental illness
9. Marital problems
10. Lack of knowledge regarding children development
11. Substance abuser

Nursing Interventions:

• Assess the patient, family, and significant others about the signs of an impending crisis and effective problem solving techniques to manage crisis
• Assess the patient, family, and significant others about the signs of abuse and neglect, and to access help immediately if abuse or neglect are suspected
• Assess caregivers about coping strategies to prevent abuse and neglect

Abuse and Neglect: Sexual Abuse

The case of sexual abuse may range from sexual harassment to molestation and rape.

Patients with rape usually deal with the consequences from physical injury, pregnancy and sexually transmitted disease, and rape trauma syndrome. The rape trauma syndrome includes high level of anxiety, difficulty making decision, flashbacks, violent dream, preoccupation with future danger, and problems with intimate relationships.

In the long-term, the victims of sexual abuse may experience posttraumatic stress disorder (PTSD). In this case, the sexual abuse victims:

• Uses denial, repression, and suppression to cope with anxious feelings
• Shows symptoms including flashback, intrusive memories of the event, hopelessness, depression, night-mares, and outbursts of anger and rage.

Nursing Interventions:

• In children sexual abuse, assess for sexualized behavior characteristic: seductive behavior used to gain affection, unusual curiosity regarding genitalia, decreased personal boundaries, extreme reaction to bathing, extraordinary fear of the opposite sex, unwillingness to participate in age appropriate physical or social activity.
• In the emergency department: gather evidence with permission of the victim following policies of facility and low enforcement.
• Give the victim a control as much as possible during the assessment.
• Treat physical injuries appropriately
• Advice patient about potential for pregnancy and STDs
• Encourage patient to discuss feeling about the assault
• Provide the information about community services

Abuse and Neglect: Elder Abuse

Elder abuse is the term that includes both abuse and neglect. It may be physical harm, sexual or verbal intimidation, emotional, or physical neglect, and or economic exploitation.

Elder victims are often reluctant to reveal abuse out of fear of abandonment or retaliation from abuser. The abusers are usually family member.

Signs and Symptoms of Elder Abuse:

• Dehydration and malnutrition
• Unexplained bruising, burns, or injuries
• Oversedation
• Unmet physical and medical needs
• Bruises, wounds, and pressure ulcers
• Fearfulness
• Report of restraints or being locked in a room
• Conflicting stories from client and caregiver or family member

Nursing Interventions:

• Assess for signs of abuse or neglect
• Treat and manage the existing injuries
• Report abuse to appropriate authorities
• Refer to community agencies (respite for caregivers, support groups for caregiver)

Abuse and Neglect: Spouse / Partner Abuse

Spouse or partner abuse occurs as emotional, physical, economic, sexual, or combination. This abuse happens most frequently that a male on a female.

Victims of spouse or partner abuse are more likely to abuse alcohol or drugs and to commit suicide.

Attacks escalate in severity and frequency over time.

This kind of abuse usually follow a cycle or pattern: escalating tension, abuse, and then remorse (honeymoon period). In remorse pattern, the abuser apologizes and promises that it will never happen again, professes low for partner, often engages in romantic behaviors, and tension-building phase begins again.

The victim may leave the abuser, and this condition is most dangerous to both of them.

Nursing Interventions:
1. Identify possible victims, use SAFE question:

• Stress/safety: Do you feel safe:
• Afraid/abused: Are you ever afraid in your relationship?
• Friend/family: Are they aware you have been hurt?
• Emergency plan: Do you have a safe place to go and the resources you may need?

2. Refer to the appropriate resources such as police or legal aid, local shelters, and support groups.

Abuse and Neglect: Assessment Questions Guide

When caring patient with abuse or neglect, this Assessment Questions Guide will help you to give care properly.

1. Sometimes women (or men or children) are forced into sexual activity. Has this ever happened to you? Has anyone ever suggested they wish to engage you in sexual activity even when you’ve resisted?
2. If the client is pregnant—Since you have been pregnant, have you been hit, slapped, kicked, or physically hurt in any other manner by someone?
3. Has anyone failed to help you when you needed help?
4. I noticed that you have a number of bruises. Can you tell me how they happened? Has anyone hurt you?
5. You seem anxious. Has anyone ever hurt you or threatened to do so? Are you ever afraid of anyone close to you, such as your
6. partner, caretaker, or any other family member?
7. Sometimes clients tell me that they have been hurt by someone at home or work. Is this happening to you?
8. Has anyone ever prevented you from seeing your friends or family members?
9. Have you ever been pressured to sign papers you did not understand or did not wish to sign?

Care With Abused / Neglected Patient: Key Concepts

Here are the key concepts in caring patient with abuse or neglect:

• Both of abuse and neglect can occur as physical, sexual, and psychological. They can come to all ages and affect both genders from all socioeconomic, ethnic, and cultural groups.
• The nurse should ask direct questions during assessment and should be in private.
• All disabled and elderly clients should be asked for possible abuse or neglect.
• Domestic violence: child abuse, elder abuse, and abuse of women and men.
• Abuse or neglect is rarely a one-time occurrence, it usually continues and escalates in severity.
• Sexual abuse in female: have more health problem and undergo more surgeries than nonvictims
• Sexual abuse in childhood: they will experience more chronic depression, posttraumatic stress disorder, morbid obesity, marital instability, gastrointestinal problems, headaches, and greater reliance on health care services than nonvictims
• Abused risk factors are high levels of stress or alcoholism in caregivers, high emotions, evidence of violence, financial dependency or physical dependency
• Symptoms of client with abuse: suicide attemps, drug and alcohol abuse, frequent emergency department visits, multiple injuries, unexplained injuries, vague pelvic pain, depression, and insomnia



• Symptoms of client with neglect: poor hygiene, hunger, dehydration, pain, unkempt appearance, inadequate clothing or shoes, unfilled medication prescriptions, missed appointments with healthcare provider, and lack of ancillary devices
• Nurse roles in caring patient with abuse: documents the event, provides drawings or photos of injuries, examine the entire surface of patient's body, assessess patient's interactions with others, and performs a mental status examination
• Nurse's primary attention is the safety of the patient: separated from abuser, support the patient, and collaboration with interdisciplinary team
• The nurse should evaluates the response of patient, family and significant others to every interventions and do updates if necessary

Substance Abuse: Opioid Abuse

Opioid is a chemical substance that has a morphine-like action in the body. It is use mostly for pain relief. Opioid works by binding to opioid receptors in the central nervous system and the gastrointestinal tract. The receptors in these two organ systems mediate both the beneficial effects, and the undesirable side effects.

Classes of opioids:

1. natural opiates, alkaloids contained in the resin of the opium poppy including morphine, codeine and thebaine, but not papaverine and noscapine which have a different mechanism of action;
2. semi-synthetic opiates, created from the natural opioids, such as hydromorphone, hydrocodone, oxycodone, oxymorphone, desomorphine, diacetylmorphine (Heroin), nicomorphine, dipropanoylmorphine, benzylmorphine and ethylmorphine;
3. fully synthetic opioids, such as fentanyl, pethidine, methadone, tramadol and propoxyphene;
4. endogenous opioid peptides, produced naturally in the body, such as endorphins, enkephalins, dynorphins, and endomorphins.

Effect of Substance:
Temporary sense of well being, drowsiness, poor coordination, light-headedness, impaired thought processes, memory difficulty, confusion

Effect of Withdrawal:

Anxiety, gastrointestinal distress, nausea, insomnia, muscle pain, fever and chills, runny nose and eyes, sweating, tachypnea, coma, pintpoint pupils

Treatment:

• Detoxification
• Drugs: Opiate antagonis naloxone (Narcan) IV in emergency situation.
• In morphine and heroin addicts can use methadone daily to stabilize patient.
• In other opioid addicts, slowly taper the abused opioid.
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain airway
• Maintain safety
• Do not leave patient unattended because of risk of lapsing into coma quickly
• Monitor and assess for pulmonary edema
• Monitor vital sign and neurologic status and report to physician any abnormal redings
• Provide a quiet environment
• Encourage patient to express fears and anxiety

Substance Abuse: Nicotine Abuse

Nicotine is the drug in tobacco leaves. It a poisonous volatile alkaloid derived from tobacco (Nicotiana spp.) and responsible for many of the effects of tobacco. It first stimulates (small doses), then depresses (large doses) at autonomic ganglia and myoneural junctions.

Nicotine in inhaled tobacco smoke or in smokeless tobacco applied to buccal or nasal mucosa enters the circulation within seconds, causing an increase in heart rate, ventricular stroke volume, and myocardial oxygen consumption, as well as euphoria, heightened alertness, and a sense of relaxation. Nicotine use is powerfully addictive, readily leading to habituation, tolerance, and dependency. Withdrawal from nicotine causes restlessness, irritability, anxiety, difficulty concentrating, and craving for nicotine. Addiction to nicotine is the reason for most tobacco use and is thus directly responsible for the resulting morbidity and mortality.

Nicotine: Tobacco smoking, chewing, and dipping.


Effect of Substance:
Mild euphoria, feeling of relaxation, anorexia, hypertension, tachycardia

Effect of Withdrawal:
Restlessness, irritability, difficulty in concentrating, depression, insomnia, increased appetite, weight gain

Treatment:

• Detoxification
• Drugs: nicotine gum, nicotine nasal sprays, and nicotine patches.
• Behavior therapy
• Psychotherapy
• Support groups

Nursing Intervention:

• Maintain safety
• Monitor vital sign and neurologic status and report to physician if any abnormal readings
• Provide support to patient, family, and significant others
• Encourage patient to express fears and anxiety

Substance Abuse: Methamphetamines

Methamphetamine is a member of the family of phenylethylamines. Methamphetamine acts as a dopaminergic and adrenergic reuptake inhibitor and in high concentrations as a monamine oxidase inhibitor (MAOI). Since it stimulates the mesolimbic reward pathway, causing euphoria and excitement, it is prone to abuse and addiction.

Methamphetamines: amphetamine (Benzedrine), dextroamphetamine (Dexedrine), MDMA (Ecstasy), methylphenidate (Ritalin)

Effect of Substance:
Increased attention, increased activity, decreased fatigue, decreased appetite, euphoria, hyperthermia, tachycardia

Effect of Withdrawal:

Insomnia, restlessness, irritability, panic, paranoia, confusion, homicidal behavior, depression with suicidal ideation, hallucination, vomiting, nausea, chills

Treatment:

• Detoxification
• Drugs: small doses of diazepam IV or haloperidol to combat CNS hyperactivity
• Treat seizure with benzodiazepines
• Activated charcoal for overdose
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain airway
• Maintain safety
• Monitor for suicide attempts
• Calm, cool, and quiet environment
• Monitor vital signs and neurologic status and report to physician if any abnormal readings
• Encourage patient to express fears and anxiety

Substance Abuse: Cocaine Abuse

Cocaine is a crystalline alkaloid obtained from the leaves of Erythroxylon coca (family Erythroxylaceae) and other species of Erythroxylon, or by synthesis from ecgonine or its derivatives.

Cocaine is a potent central nervous system stimulant, vasoconstrictor, and topical anesthetic, widely abused as a euphoriant and associated with the risk of severe adverse physical and mental effects.

Cocaine: cocaine hydrochlororide (sniffed) free-base cocaine (smoked), crack cocaine (small rocks that are smoked), cocaine that may be injected intravenously

Effect of Substance:

Euphoria, risk taking behavior, feeling of confidence, anorexia, inappropriate sexual behavior, tachycardia, tachypnea, nervousness, hypertension, dilated pupil, agitation, fever, inability to concentrate.

Effect of Withdrawal:
Psychosis, delusion, hallucinations, paranoia, depression, ideas of persecution, aggressiveness, tremor, hypervigilance, insomnia, fatigue, muscle pain, nausea, vomiting, general malaise, suicidal ideation

Treatment:
Detoxification
Drugs: antidepressant, antipsychotic
Charcoal to treat ingested cocaine
Behavior therapy
Psychotherapy
Halfway houses
Day or night hospitalization
Twelve-step support groups

Nursing Intervention:
Maintain and ensure the airway and ventilation
Maintain safety
Monitor and assess patient for using of alcohol and benzodiazepine
Control seizure
Treat hyperthermia
Monitor cardiovascular status
Quiet environment
Encourage patient to express fears and anxiety

Substance Abuse: Benzodiazeipnes

The benzodiazepines are a class of psychoactive drugs with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties, which are mediated by slowing down the central nervous system. The drugs are useful in treating anxiety, insomnia, agitation, seizures, and muscle spasms, as well as alcohol withdrawal. Using of benzodiazepines in long term can cause physical dependence.

Types of Benzodiazepines are Diazepam (Valium) and Lorazepam (Ativan)

Effect of Substance:
Sleepiness and deep sleep, poor coordination, slurred speech, falling, poor thought processes, memory difficulty, weak comprehension, poor judgment, mood swings, constricted pupils, nystagmus, and tachypnea.

Effect of Withdrawal:

Anxiety, rage, insomnia, panic attacks, depression, night-mares, nausea, constipation, diarrhea, shaking, muscle pain, sweating, tachycardia, paresthesia, seizure, and death if combine with alcohol.

Treatment:

• Detoxification
• Drugs: antagonist fumezenil (Romazicon), slowly taper the abused benzodiazepine.
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support group

Nursing Intervention:

• Maintain safety
• Monitor vital sign and neurologic status and notify physician if abnormal readings
• Monitor for alcohol abuse
• Monitor for dysrhythmias
• Encourage patient to express fears and anxiety, Provide a quiet environment
• Implement seizure precaution

Substance Abuse: Barbiturate

Barbiturates are a group of drugs known as sedative-hypnotics, which generally describes their sleep-inducing and anxiety-decreasing effects.

Person uses barbiturates as abused mostly to reduce anxiety, decrease inhibitions, and treat unwanted effects of illicit drugs. Barbiturates can be extremely dangerous because the correct dose is difficult to predict. Barbiturates are also addictive and can cause a life-threatening withdrawal syndrome.

There are many different kind of barbiturate: Amobarbital (Amytal), pentobarbital (Nembutal), Secobarbital (Seconal), Phenobarbital, and Tuinal

Effect of Subtance:
Sluggish coordination, emotional lability, faulty judgment, aggressiveness, nystagmus, strabismus, diplopia, decreased reflexes, ataxic gait, bradycardia, respiratory depression, stupor, decreased tendon reflexes.


Effect of Withdrawal:
Irritability, anxiety, tachycardia, tachypnea, nausea, tremors, muscle pain, confusion, hallucination, seizures, insomnia, vivid dreaming, coma, death.

Treatment:

• Detoxification
• Drugs: slowly taper the abused barbiturate, sodium bicarbonate (promotes excreation of barbiturates, and activated charcoal for overdose.
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain airway
• Maintain client safety
• Monitor for alcohol abuse
• Monitor vital signs and neurologic status and notify physician if any abnormal readings
• Orient client to place, person, and time
• Provide a quiet environment with a light switched on
• Control combative behavior
• Encourage patient to express fears and anxiety
• Implement seizures precautions

Substance Abuse: Alcohol Abuse

Alcohol abuse is a psychiatric diagnosis describing the use of alcoholic beverages despite negative consequences. Alcohol abuse is different from alcohol dependence means by the lack of symptoms such as tolerance and withdrawal.

Effect of Substance:
Drunkenness, drowsiness, behavioral changes, poor judgment, coordination difficulty, slurred speech, inappropriate sexual behavior, aggression, memory problems, nystagmus, poor attention span, stupor, coma.

Effect of Withdrawal:
Altered consciousness, agitation, aggressiveness, anxiety, fear, confusion, delusions, disorientation, hallucinations, insomnia, blackouts, profuse sweating, acute psychosis, tachycardia, hypertension, tachypnea, anorexia, nausea, grand mall seizure, abdominal cramps, tremors, and vomiting.

Treatment:

• Detoxification
• Drugs: benzodiazepines, anti-seizure dugs.
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain client safety
• Orient patient to place, person, and time
• Monitor vital signs and neurologic status, and notify physician if any abnormal value.
• Quiet environment with a light on
• Record intake and output
• Encourage patient to express fears and anxiety

Schizophrenia 1: Definition, Signs, and Symptoms

Schizophrenia is a group of mental disorders characterized by abnormalities in perception, content of thought, and thought processes (hallucinations and delusions) and by extensive withdrawal of interest from other people and the outside world, with excessive focusing on one's own mental life.

Schizophrenia is the most prevalent psychosis, affecting some 2 million Americans. The annual cost of the disease to the U.S. economy is estimated at $65 billion, of which $46 billion reflects lost productivity of patients and their caregivers

The term of schizophrenia was coined by Bleuler, synonymous with and replacing dementia praecox. This disorder disturbances in affect, mood, behavior, and though process.

Signs and Symptoms of Schizophrenia:

POSITIVE SYMPTOMS

• Excess or distortion of normal functions
• Delusions (persecutory or grandiose)
• Conceptual disorganization
• Hallucinations (visual, auditory, or other sensory mode)
• Excitement or agitation
• Hostility or aggressive behavior
• Suspiciousness, ideas of reference
• Pressurized speech
• Bizarre dress or behavior
• Possible suicidal tendencies

NEGATIVE SYMPTOMS

• Diminution or loss of normal functions
• Anergia (lack of energy)
• Anhedonia (loss of pleasure or interest)
• Emotional withdrawal
• Poor eye contact (avoidant)
• Blunted affect or affective flattening
• Avolition (passive, apathetic, social withdrawal)
• Difficulty in abstract thinking
• Alogia (lack of spontaneity and flow of conversation)
• Dysfunctional relationship with others

DISORGANIZED SYMPTOMS

• Cognitive defects/confusion
• Incoherent speech
• Disorganized speech
• Repetitive rhythmic gestures (such as walking in circles or pacing)
• Attention deficits

Diagnostic Characteristics:

• Evidence of two or more of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms
• Above symptoms present for a major portion of the time during a 1-month period
• Significant impairment in work or interpersonal relations, or self-care below the level of previous function
• Demonstration of problems continuously for at least a 6-month interval
• Symptoms unrelated to schizoaffective disorder and mood disorder with psychotic symptoms and not the result of a substance-related disorder or medical condition

Continued to Schizophrenia 2