🧠 New Lesson 28
Mental Health Disorders
Schizophrenia, bipolar, anxiety/OCD/PTSD, eating disorders, personality disorders, suicide.
Psychotic Disorders
Schizophrenia — Positive vs Negative Symptoms
| Positive Symptoms (Added) | Negative Symptoms (Removed — 5 As) |
|---|---|
| Hallucinations (all 5 senses) | Avolition (loss of motivation) |
| Delusions (persecution, grandeur, somatic) | Asociality (withdrawn from others) |
| Disorganized speech/behavior | Affective blunting (flat affect) |
| Perceptual distortions | Alogia (poverty of speech) |
| Illusions | Anhedonia (inability to feel pleasure) |
🏥 Nursing Approach for Schizophrenia:
✅ Safety is the PRIORITY — assess for risk of violence
✅ Provide quiet, soothing, low-stimulation environment
✅ Establish routine and clear boundaries
✅ Brief, simple, nonthreatening communication
✅ If frightened: INCREASE personal space, approach calmly, ONE nurse
❌ NEVER corner a frightened client
✅ Safety is the PRIORITY — assess for risk of violence
✅ Provide quiet, soothing, low-stimulation environment
✅ Establish routine and clear boundaries
✅ Brief, simple, nonthreatening communication
✅ If frightened: INCREASE personal space, approach calmly, ONE nurse
❌ NEVER corner a frightened client
Delusion Types
Persecution: "The government is tracking me" — belief of being conspired against
Grandeur: "I am God / I have special powers" — exaggerated self-importance
Somatic: "My organs are rotting" — false belief about body
Remember: Delusion = false FIXED BELIEF. Hallucination = false PERCEPTION.
Grandeur: "I am God / I have special powers" — exaggerated self-importance
Somatic: "My organs are rotting" — false belief about body
Remember: Delusion = false FIXED BELIEF. Hallucination = false PERCEPTION.
Mood & Anxiety
Bipolar Disorder
| MANIC Phase | DEPRESSIVE Phase |
|---|---|
| Decreased need for sleep | Prolonged sleep / fatigue |
| Grandiosity / inflated self-esteem | Hopelessness / worthlessness |
| Hypersexuality | Social withdrawal |
| Pressured speech / flight of ideas | Flat affect / anhedonia |
| Risk-taking behavior / poor judgment | Suicidal ideation |
🚨 SUICIDE WARNING SIGN — HIGHEST RISK:
A severely depressed suicidal client who SUDDENLY appears calm, purposeful, and resolved = DANGER. They may have made a decision to act. The relief of decision-making creates false "improvement." Initiate 1:1 safety precautions IMMEDIATELY.
A severely depressed suicidal client who SUDDENLY appears calm, purposeful, and resolved = DANGER. They may have made a decision to act. The relief of decision-making creates false "improvement." Initiate 1:1 safety precautions IMMEDIATELY.
Anxiety Disorders
| Disorder | Key Feature | Nursing Tip |
|---|---|---|
| Panic Disorder | Sudden intense terror + physical symptoms (SOB, chest tightness) | Quiet area, calm presence, breathing techniques |
| GAD | Persistent, uncontrollable worry >6 months | Reduce stimuli, CBT, medication management |
| OCD | Obsessions + compulsions (rituals) | NEVER abruptly interrupt rituals — increases anxiety |
| PTSD | Re-experiencing + Avoidance + Hyperarousal | Non-threatening environment, active listening |
Personality & Eating
Personality Disorders
| Disorder | Key Feature | Nursing Strategy |
|---|---|---|
| Borderline PD | Splitting, self-harm, fear of abandonment, unstable relationships | CONSISTENCY — whole team same limits |
| Antisocial PD | Aggression, no remorse, manipulative, impulsive | Clear limits, safety assessment |
| OCD PD | Perfectionism, rigidity, preoccupation with rules | Flexibility training, CBT |
Eating Disorders
| Feature | Anorexia Nervosa | Bulimia Nervosa |
|---|---|---|
| Weight | Severely underweight | Usually normal weight |
| Behavior | Restriction of food | Binge-purge cycle |
| Physical Signs | Lanugo, amenorrhea, bradycardia | Russell sign (knuckle calluses), enamel erosion, parotid enlargement |
| Priority Complication | HYPOKALEMIA → cardiac arrhythmias | Electrolyte imbalances → cardiac arrhythmias |
📖 Notes for Dummies
📖 Mental Health Explained Simply
🧠 Schizophrenia in Plain English:
Positive symptoms = something extra is happening (hearing voices, believing false things). Negative symptoms = something is MISSING (no motivation, no emotions, no words). Traditional meds fix the extra stuff. Newer meds fix both. Flashcard trick: "Positive = Plus something. Negative = Missing something."
😰 OCD in Plain English:
The compulsion is NOT about wanting to wash hands — it's about trying to escape the anxiety of the obsession ("if I don't wash, something terrible will happen"). The ritual works temporarily, so it keeps repeating. Never interrupt a ritual abruptly — you'll spike the anxiety and possibly trigger a crisis. Work with it slowly.
🍴 Eating Disorders in Plain English:
Russell sign = the knuckle calluses from repeatedly putting fingers in the throat to purge. Dental enamel erosion = from stomach acid coming up repeatedly. These are the body's physical evidence of bulimia. The cardiac arrhythmia risk is the priority — hypokalemia from all the purging can stop the heart.
🎭 Borderline PD in Plain English:
Splitting = today you are the BEST nurse ever, tomorrow you are the WORST. If the team isn't consistent — some nurses give special privileges while others enforce rules — the client will exploit that gap. The whole team responds exactly the same way, every time. No exceptions.
Positive symptoms = something extra is happening (hearing voices, believing false things). Negative symptoms = something is MISSING (no motivation, no emotions, no words). Traditional meds fix the extra stuff. Newer meds fix both. Flashcard trick: "Positive = Plus something. Negative = Missing something."
😰 OCD in Plain English:
The compulsion is NOT about wanting to wash hands — it's about trying to escape the anxiety of the obsession ("if I don't wash, something terrible will happen"). The ritual works temporarily, so it keeps repeating. Never interrupt a ritual abruptly — you'll spike the anxiety and possibly trigger a crisis. Work with it slowly.
🍴 Eating Disorders in Plain English:
Russell sign = the knuckle calluses from repeatedly putting fingers in the throat to purge. Dental enamel erosion = from stomach acid coming up repeatedly. These are the body's physical evidence of bulimia. The cardiac arrhythmia risk is the priority — hypokalemia from all the purging can stop the heart.
🎭 Borderline PD in Plain English:
Splitting = today you are the BEST nurse ever, tomorrow you are the WORST. If the team isn't consistent — some nurses give special privileges while others enforce rules — the client will exploit that gap. The whole team responds exactly the same way, every time. No exceptions.