NOTES ABOUT MENTAL STATUS EXAMINATION
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)

Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines

SCHIZOPHRENIA

: Characterized by individuals who exhibits manifestations which are considered bizarre and inappropriate
Etiology:
1. Psychoanalytic
2. Genetics
3. Dopamine hypothesis
4. Other neurotransmitters
Classic Signs of Schizophrenia:
(Bleuler’s Concept of Schizophrenia)
o Looseness of Associations
o Autism
o Inappropriate Affect
o Ambivalence

Confirmatory symptoms:
• Hallucinations
• Delusions

TYPES OF SCHIZOPHRENIA
o Paranoid
o Disorganized
o Catatonic
o Undifferentiated
o Residual

Types of Symptoms:
1. Hard
o Hallucinations
o Delusions
o Echopraxia
o Flight of Ideas
o Perseveration
o Associative looseness
o Ideas of Reference
o Ambivalence

2. Soft
o Apathy
o Alogia
o Flat affect
o Blunt affect
o Anhedonia
o Catatonia
o Lack of volition

Hallucinations Common to Schizophrenic Clients:
o Auditory Hallucination (most common and should be validated)
o Command Hallucination
o Tactile Hallucination
o Olfactory Hallucination
o Gustatory Hallucination
o Cenesthetic Hallucination
o Kinesthetic Hallucination

Delusions Common to Schizophrenic Clients:
o Paranoid Delusions
o Ideas of Reference
o Grandiose Delusions
o Somatic Delusions
o Religious Delusions

Prognosis of the disease process
1. Good
o Late onset
o Positive Symptoms
o Obvious precipitating Factos
o Good premorbid, sexual and work histories
o Mood disorders
o Married
o Family history of mood disorders
o Good support systems
2. Poor
o Young onset
o Sudden onset
o No precipitating factors
o Poor work, sexual or social histories
o Withdrawn, autistic
o Single, divorced, widow
o Family history of schizophrenia
o Poor support systems
o Negative symptoms
o Neuro symptoms
o No remissions in 3 years
o No relapses
o History of assault

Nursing Interventions:
1. Safety
2. Set limits
3. Present Reality
4. Depends on the manifestations of the client
5. Psychopharamcology
6. Behavioral Therapy
7. Milieu Therapy

Medications:
a. Typical b. Atypical
Chlorpromazine (Thorazine) Clozapine (Clozaril)
Trifluoperazine (Trilafon) Risperidone (Risperdal)
Fluphenazine (Prolixin) Olanzapine (Zyprexa)

MENTAL STATUS EXAMINATION

NOTES ABOUT MENTAL STATUS EXAMINATION
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)

Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines

NEUROPSYCHIATRIC MENTAL STATUS EXAMINATION
A. General Description
–General appearance
–Level of consciousness
–Posture
–Gait
–Movements of limbs, trunk, and face
–Response to examiner
–Native or primary language

B. Language and Speech
a. Comprehension
b. Output Repetition

C. Thought
–Form
– Content

D. Mood and Affect

NEUROPSYCHIATRIC MENTAL STATUS EXAMINATION
E. Insight and Judgment
F. Cognition
–Memory
–Orientation
–Concentration
G. Abstraction
H. Roles and Relationships
I. Self Care Considerations
–ADLs
–Medications
–Sleep Patterns
–Eating Patterns

EATING DISORDERS

NOTES ABOUT EATING DISORDERS
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)

Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines

ANOREXIA NERVOSA
: Loss of appetite

•Signs and symptoms:
–Fear of becoming fat
–Body image disturbance
–Amenorrhea
–Depressed mood, social withdrawal, irritability and insomnia
–Preoccupation with thoughts of food
–Feelings of ineffectiveness
–Strong need to control the environment
–Constipation and abdominal pain
–Cold intolerance
–Lethargy
–Emaciation
–Hypotension, hypothermia, bradycardia
–Hypertrophy of salivary glands

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
•Refusal to maintain body weight
•Intense fear of gaining weight
•Overvaluing of shape or weight or denial of seriousness of loss of weight
•Absence of 3 consecutive menstrual cycles

TYPES OF ANOREXIA NERVOSA

Restricting type: (-) binge eating or purging
Binge-eating/Purging type: (+) binge eating/purging

Etiology:
•Biologic
-Obesity and diet
-Overprotective family
-beauty, thinness
-fitness and preoccupation of achieving ideal body
•Biochemical:
- Increased CSF levels of 5-hydroxyindoleacetic acid (5-HIAA)
•Psychoanalytical
(-)autonomy and identity
dissatisfaction of body image
possible childhood sexual abuse

•Onset:
Ages of 14 to 18 years old
Denies anxiety over appearance and gaining weight

•Treatment:
–Psychotherapy
–Psychopharmacology

BULIMIA NERVOSA
-(+) bingeing or purging episodes with strong emotions and followed by guilt, remorse, shame or self-contempt

SIGNS AND SYMPTOMS OF BULIMIA NERVOSA
•Recurrent episodes of bingeing and purging
•Compensatory behaviors
•Usually within normal weight range, possible underweight or overweight
•Depressive and anxiety symptoms
•Possible substance abuse
•Loss of dental enamel
•Menstrual irregularities
•Esophageal tears
•Fluid and electrolyte abnormalities

TYPES OF BULIMIA NERVOSA
Purging type: (-) binge eating or purging
Non-Purging type: (+) binge eating/purging

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
•Recurrent episodes of binge eating
•A feeling of lack of control over eating behaviors during eating binges
•Recurrent inappropriate compensatory behavior in order to prevent weight gain
•Twice a week for 3 months
•Self evaluation influenced by body shape

Etiology:
•Biologic
:Obesity
:Dieting at an early age
:Substance abuse
:History of personality disorders and anxiety disorders
B. Biochemical:
:serotonin and norepinephrine disturbances
:decreased hypothalamic glucose utilization
:a satiety center disturbance
C. Psychoanalytical
Dissatisfaction of body image
Inability to develop identity

•Onset:
–Late adolescents or early adulthood

Medical Complications of Eating Disorders
•Anorexia Nervosa:
–Arrythmias
•Bulimia Nervosa:
–Metabolic alkalosis
–Metabolic acidosis

Nursing Interventions for Bulimia Nervosa and Anorexia Nervosa:
•Weigh client daily.
•Basic nutritional needs.
•Harmful effects of dieting, bingeing and purging.
•Strengthened family ties.
•Acceptance of different personalities and constant affirmation of child.
•Importance of professional help
•Be alert for attempts to hide food or inflate weight.
•Journal
•Relaxation techniques.


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FOUNDATIONS OF PSYCHIATRIC NURSING

NOTES ABOUT MENTAL STATUS EXAMINATION
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)

Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines

FUNDAMENTALS OF PSYCHIATRIC NURSING

A. Theories of Personality Development

Sigmund Freud’s Psychosexual Development
Oral
Anal
Phallic
Latency
Genital

Erik Erikson’s Psychosocial Development
Trust versus Mistrust
Autonomy versus Shame and Doubt
Industry versus Inferiority
Role Identity versus Role Confusion
Intimacy versus Isolation
Generativity versus Stagnation
Ego Integrity versus Despair

Sullivan’s Interpersonal Relationship Development
Infancy
Childhood
Juvenile
Preadolescence
Early Adolescence
Late Adolescence
Young Adulthood

Jean Piaget’s Cognitive Development
Sensorimotor
Preoperational
Concrete Operations
Formal Operations

Hildegard Peplau’s Nurse Client Relationship
Phases of Nurse Client Relationship
Orientation
Working Phase
Termination Phase

CAUTION: The avoidance of transference and counter transference in important in the termination phase.

HANDOUTS FOR PSYCHIATRIC NURSING

NOTES IN PSYCHIATRIC NURSING WILL BE POSTED ON DECEMEBER 28, 2009.

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