Psychiatric Nursing
Mental Disorders, Therapeutic Communication & Defense Mechanisms
Defense Mechanisms
Unconscious psychological strategies to protect the ego from anxiety.
Denial
Refusing to accept reality. "I don't have a drinking problem."
Projection
Attributing own feelings to others. "You're the angry one, not me."
Rationalization
Making excuses. "I failed because the test was unfair."
Displacement
Redirecting emotions. Yelling at spouse after bad day at work.
Regression
Reverting to earlier behavior. Adult throwing tantrum.
Sublimation
Channeling urges positively. Aggression into sports (healthy).
Repression
Unconsciously blocking painful memories.
Reaction Formation
Acting opposite of true feelings. Being overly nice to someone you dislike.
Therapeutic Communication Techniques
Therapeutic (Use)
- Active listening: Full attention
- Open-ended questions: "How do you feel?"
- Reflecting: "You seem sad."
- Clarifying: "What do you mean by that?"
- Silence: Allowing time to think
- Restating: Repeating key words
- Summarizing: Review main points
Non-Therapeutic (Avoid)
- Giving advice: "You should..."
- False reassurance: "Everything will be fine"
- Changing subject: Avoiding the topic
- Judging: "That was wrong"
- Probing: Demanding answers
- Defending: "The doctor knows best"
- Disagreeing: "You're wrong"
Major Mental Disorders
Positive symptoms: Hallucinations, delusions, disorganized speech
Negative symptoms: Flat affect, avolition, social withdrawal
Medications: Antipsychotics (Haloperidol, Risperidone, Olanzapine)
Mania: Elevated mood, decreased sleep, grandiosity, pressured speech
Depression: Sadness, hopelessness, changes in sleep/appetite
Medications: Lithium (therapeutic: 0.6-1.2 mEq/L), Valproate, Carbamazepine
Symptoms: Depressed mood, anhedonia, weight changes, fatigue, worthlessness
Duration: 2+ weeks
Medications: SSRIs (Fluoxetine, Sertraline), SNRIs, TCAs
Types: GAD, Panic disorder, Phobias, OCD, PTSD
Medications: SSRIs, Benzodiazepines (short-term), Buspirone
Psychiatric Medications
Lithium Toxicity Signs
- Mild: Nausea, diarrhea, fine tremor, polyuria
- Moderate: Coarse tremor, confusion, muscle twitching
- Severe: Seizures, coma, cardiac arrhythmias
Monitor sodium and hydration - dehydration increases toxicity!
Antipsychotics Side Effects
- EPS: Dystonia, akathisia, parkinsonism
- Tardive dyskinesia: Involuntary movements
- NMS: Fever, rigidity, altered consciousness (emergency!)
SSRI Considerations
- Takes 2-4 weeks for effect
- Don't stop abruptly
- Monitor for suicidal ideation (especially youth)
- Avoid with MAOIs - serotonin syndrome risk
Suicide Risk Assessment
SAD PERSONS Scale
S - Sex (male higher risk)
A - Age (<25 or >45)
D - Depression
P - Previous attempts
E - Ethanol abuse
R - Rational thinking loss
S - Social supports lacking
O - Organized plan
N - No spouse
S - Sickness (chronic illness)
Always take suicidal statements seriously. Ask directly: "Are you thinking of hurting yourself?"