Schizophrenia and Other Thought Related Disorders

Schizophrenia
- a group of mental disorders characterized by psychotic features, inability to trust
others, disordered thought process, and disrupted personal relationships.
- characterized by a deteriorating personality
- Bleuler’s “split mind” because patients split from reality
- a thought disturbance and a functional illness
Etiology: UNKNOWN
Theories of Etiology:
1. Biologic theories
1.a ______________________
Twins
- Identical- 50% risk
- Fraternal- 15% risk
Parents
 One parent- 15% risk
 Both parents- 50% risk
1.b ______________________- there is lesser brain tissue and CSF
CT Scan- had shown enlarged ventricles and cortical atrophy

Positron Emission Tomography (PET)- had shown diminished glucose

metabolism and oxygen supply in the cortical structures of the
brain
Other studies- showed decreased brain volume and abnormal brain functions
in the frontal and temporal areas
1.c ________________________- there is malfunctioning of neuronal networks
Excess dopamine
Excess serotonin
1.d _________________________- exposure to viruses alters brain physiology due to
cytokine release which is believed to have a role in the
development of schizophrenia

1.e Other Factors based on studies

• Infections during pregnancy
• Post-influenza epidemics
• Crowded areas with cold weather

2. Psychological theories
2.a ________- it is due to weak ego thus, the person feels that he doesn’t belong to this
world which results to making of new world

2.b ________- it is due to childhood anxiety that has been reactivated in adult life, thus
the person will make his own world without the anxiety provoking
memory

2.c ________- it is the result persistent faulty reaction to the environment

- the person is tired of failures thus will make a world without failures

2.d ________- it is due to unhealthy child parent relationship during infancy

- mistrust will develop and carried until adulthood thus the person will
create a world where he can trust everyone

______________:
• Males- 15 to 25 years old
• Females- 25 to 35 years old
(The earlier the onset, the poorer the positive outcome.)

A. _________________:
• Some may appear normal
 • No obvious concern for hygiene
• Wearing strange or inappropriate clothing
B. Motor Behavior
• Catatonia
• Purposeless gestures (stereotypic behavior)
• Odd facial expressions such as grimacing
• Echopraxia-__________________________________________
• Psychomotor retardation- general slowing of movements
• Immobility
• Fetal position
• Waxy flexibility-______________________________________
C. Speech
• Rambling speech may or may not have sense
• Neologisms-______________________________
• Word salad-______________________________
• Echolalia- ________________________________
• Speech may be slowed or accelerated
• Latency of response- refers to hesitation before client responds to questions
for 30-45 seconds which indicates client’s difficulty with
cognition or thought process
• Clang associations-_________________________________________
• Verbigeration / Perseveration-_________________________________
D. Mood and Affect
• Mask-like appearance (flat/blunted affect)
• Laughing apparent reason
• Inappropriate/incongruent affect
• Anhedonia
E. Thought Process and Content
• Thought blocking- __________________________________________
• Thought broadcasting- _______________________________________
• Thought withdrawal- _________________________________________
• Thought insertion- ___________________________________________
• Tangential thinking
• Circumstantiality
• Alogia- ___________________________________________________
• Magical thinking- belief that everything will because one wishes them to
• Ambivalence-_______________________________________________
• Associative looseness- _______________________________________
• Delusions- fixed, false beliefs
 Delusion of _____________- a belief that others are planning to harm
the client or are spying, following, ridiculing, or belittling him/her in
some way
 Delusion of _____________- characterized by the clients claim to
association with famous people or celebrities, or the client’s belief
that he or she is famous
 _____________ delusions- often center around the second coming of
Christ or another significant religious figure or prophet
 Delusions of ____________- a belief that everything in the
environment have special meaning for him/her
F. Sensorium and Intellectual Process
• Hallucinations- false sensory perceptions, or perceptual experiences that do
exist in reality
 ____________hallucinations- hallmark of schizophrenia
- hearing of sounds
- command hallucinations are dangerous
 ____________ hallucinations- second common type; seeing images
that do not exist at all
  ____________ hallucinations- involve smells or odors; often occurs in
patients with dementia, seizures, and CVA
 ____________ hallucinations- sensations such as electricity running
through the body or bugs crawling on the skin; often in patients
undergoing alcohol withdrawal and not common in patients with
schizophrenia
 ____________ hallucinations- taste lingering in the mouth or the sense
that food tastes like something else
 ____________ hallucinations- feeling of bodily functions that are
usually undetectable; example: sensation of urine forming
 ____________ hallucinations- occur when the patient is motionless
but reports the sensation of bodily movement such as floating above
the ground
• Illusion- misinterpretation or exaggeration of external stimuli
• Depersonalization- feeling of detachment from self or behavior
• Difficulty with abstract thinking
G. Judgment and Insight
• disturbed thought and misinterpretations of the environment
• failure in understanding the disease process
F. Self- concept
• Deterioration of self concept- due to weak ego
- evidenced by depersonalization,
derealization ( environmental objects seem
unfamiliar), and ideas of reference
H. Roles and Relationships
• Social isolation- due to positive symptoms
• Problems with trust and intimacy
• Low self-esteem
• Lacks confidence
• Success in school and work are compromised because of difficulty thinking
clearly, remembering, etc. (that’s why early onset of the disease has poorer
outcomes because they did not have the opportunity to succeed in these areas
before illness)
• Difficulty fulfilling family roles
• Apathy- feelings of indifference toward people, activities, or relationships
• Lack of volition- absence of will, ambition, or drive to take an action or
complete a task
I. Physiologic and Self-care Considerations
• No obvious concern for hygiene
• Malnourishment and constipation- due to failure to recognize sensations such
as hunger and thirst; paranoia that food and drink are poisoned; or unable to
sit down to eat because of agitation and pacing
• Hyponatremia leading to seizure
• Polydipsia- due to side-effects of medications
• Sleep problems-due to hallucinations and delusions
Positive Signs- hard signs; are embellishment to normal cognition and perception; due to
increase dopamine in the limbic system
Negative Signs- soft signs; absence of what should be; due to decrease dopamine in the cortex
Positive Signs Negative Signs
Ambivalence Avolition
Associative looseness Alogia
Delusions Anhedonia
Echopraxia Apathy
Flight of ideas Flat/Blunted affect
Ideas of reference Catatonia
Perseveration
4 A’s of Schizophrenia:
 Associative looseness
 Affect-blunt or flat
  Ambivalence
 Autism
Diagnosis: (by DSM-IV)
A. Characteristic symptoms (at least 2 of the following)
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms
B. Social or Occupational Dysfunction
• Work
• Interpersonal
• Self-care functioning
C. Duration
• Continuous signs of disturbance for at least 6 months
D. Schizoaffective and mood disorders are not present and are not responsible for the \
signs and symptoms.
E. Not caused by substance abuse or a general medical disorder
Types:
1. ___________________________
• abrupt in onset
• common in males 30-35 years old
• suspiciousness; cautiousness; vigilance
• delusion of persecution; auditory hallucination
• ideas of reference
2. ___________________________
• the most severe and gradual in onset
• personality disorganization
• regression
• inappropriate affect
• delusions and hallucinations
• grinning or laugh outbursts
• neologism
• looseness of association
3. __________________________
• abrupt onset
• precipitated by an emotionally disturbing behavior
Stages:
A. Catatonic _____________
 withdrawal
 negativism
 mutism
 echopraxia
 automatic response
 waxy flexibility
B. Catatonic _____________
 unpredictable (very dangerous)
 psychomotor excitement
 violent
 assaultive
 destructive
4. ___________________________
• characterized by mixed schizophrenic symptoms (of other types)
5. ___________________________
• characterized by at least one episode of positive symptoms (not current)
• social withdrawal
• flat affect
• looseness of association
Nursing Interventions
General Principles for developing a therapeutic relationship:
1. Be calm when talking to patients.
2. Accept patients as they are, but do not accept all behaviors.
3. Keep promises.
4. Be consistent.
5. Be honest.
6. Do not reinforce hallucinations and delusions.
7. Orient patients to time, person, and place.
8. Do not touch patients without warning them.
9. Avoid whispering or laughing when patients are unable to hear all of a conversation.
10. Reinforce positive behaviors.
11. Avoid competitive activities with some patients.
12. Do not embarrass patients.
13. For withdrawn patients, start with one-to-one interactions.
14. Allow and encourage verbalization of feelings (emotional catharsis).
15. Promote safety
16. Provide structured activities
17. Passive friendliness
Disruptive Patients:
• set limit on disruptive behavior
• decrease environmental stimuli
• escalating patients: low stimulus environment and give prn medications
• modify the environment
• when using restraints, provide safety by evaluating the patient’s status of
dehydration, nutrition, elimination, and circulation
Withdrawn Patients:
• arrange non-threatening activities that involve these patients in “ doing
something”; for example, a walk tour at a park, leather work, and painting
• decision making activities (e.g. selecting a menu for the next day’s meal)
• non-threatening socialization with the nurse on a one-to-one basis
• grooming and hygiene (assist first if needed)
• provide remotivation and resocialization group experiences
Suspicious Patients:
• be matter-of-fact when interacting with these patients
• do not laugh or whisper around patients
• do not touch suspicious patients without warning
• be consistent in activities (e.g. time , time, and approach) which promotes trust
• patients who fear of being poisoned should be allowed to open a can of food and serve
themselves
• maintain eye contact
• do not “slip” medications into juices or food without talking to patients because
catching the nurse in the act of doing this will reinforce their suspicions
Patients with impaired communication:
• let them make simple decisions
• be patient and do not pressure them to make sense
• do not place patients in group activities that would frustrate them and damage their
self-esteem
Patients with disordered perceptions:
• provide distracting activities
• monitor television selections by avoiding programs that will cause more problem
like horror movies
• monitor for command hallucinations that may increase the potential for patients to
become dangerous
• have staff members available in the dayroom so that patients can talk to real people
about real people and real events
Disorganized Patients:
• provide calm environment; the staff should appear calm
• provide safe and relatively simple activities
 • provide information boards with schedules and refer to them often so patients can
begin using them as an orienting function
• assist with grooming and hygiene
Hyperactive Patients:
• provide a safe environment and a place where patient can pace without bothering
other patients
Immobility:
• provide adequate diet, exercise, and rest
• maintain bowel and bladder function and intervene before problem arises
• observe patients to prevent victimization (physical and verbal)

Therapies:
1. Individual therapy- gives patient opportunity for social contact
2. Group therapy- gives patient opportunity for social contact
3. Family therapy- family inclusion promotes better outcome
4. Remotivation therapy- to increase patient’s productivity

Medical Management:

_________________________________________
- decrease dopamine and serotonin levels in the brain
- immediate desired effect is decrease in patient’s assaultiveness and manage symptoms
- they do not cure schizophrenia but only manage the symptoms

A. ________________________________
• dopamine antagonists
• target positive signs only
 ___________________ (commonly used)
 Chlorpromazine (Thorazine)
 Trifluoperazine (Stelazine)
 Fluphenazine (Prolixin)
 Perphenazine ( Trilafon)
 Triflupromazine ( Vesprin)
 Thioridazine ( Mellaril)
 ___________________ (most potent antipsychotics thus
usually given as an initial dose)
 Haloperidol ( Haldol; Serenace)
 ____________________
 Chlorprotixene (Taractan)
 Thiothixene (Navane)
B. __________________________
• both dopamine and serotonin antagonists
• decrease in serotonin will liberate dopamine in the cortex
• target both positive and negative symptoms
• have lesser side-effects than the conventional types
 Risperidone (Risperdal)
 Olanzapine ( Zyprexa)
 Clozapine (Clozaril)
 Ziprasidone (Geodon)
 Full effect- 3-6 weeks
 Observable responses- 7-10 days

Contraindications:
CNS depression
Bone marrow suppression
Side-effects:
 Anticholinergic effects
 __________________
• Sedation
• Drowsiness
 Orthostatic hypotension
 __________________- failure of the bone marrow to produce adequate
white blood cells
 Photosensitivity- unique to antipsychotics
 ________________
 Extrapyramidal symptoms (EPS)
• occur 1-5 days after taking antipsychotics
• affects voluntary muscles

 Dystonia / _________________________
 earliest EPS to occur
 1-5 days after intake
 frightening spasms of major muscle groups

Signs and Symptoms:

o oculogyric crisis-______________
o torticollis-___________________
o gagging
o cyanosis
o respiratory distress
o asphyxia
o protrusion of the tongue

 Pseudoparkinsonism / __________________
 1-4 weeks after intake

Signs and Symptoms:

o akinesia- ____________________
o bilateral fine hand tremors / pill-rolling
o mask-like face- _________________
o shuffling gait- Robot like / Zombie like
movements
- quick, small steps

 _________________
 1-6 weeks after intake
 happens when antipsychotic is started or increased
 “ ants in the pants”

Signs and Symptoms:

o restless movement
o pacing
o inability to remain still
 ________________
 due to long term use
 abnormal, involuntary movements

Signs and Symptoms;

o lip smacking
o tongue protrusion
o chewing
o grimacing
Management of EPS:
__________________________________
 • unknown action but they are known to improve physical
mobility in patients with Parkinson’s disease

 Benztropine (Cogentin)
 Trihexyphenidyl (Artae)
 Biperidin (Akineton)
 Procyclidine (Kemadrine)
 Diphenhyramine (Benadryl)

Adverse Reaction:
_____________________________
 serious and frequently fatal condition because it affects smooth
muscles
 may or may not occur
 hours / 1-3 days after intake
 thus, the most crucial period when taking antipsychotics is the first
3 days
Signs and Symptoms:
Early
o low grade fever- first sign
o fluctuating BP
o rigidity
o drooling
o tremors
o unstable pulse
Late
o altered consciousness
o respiratory distress/dyspnea- due to bronchial muscle
involvement

Management:
Potent muscle relaxants
 Dantrolene Sodium (Dantrium)
 Bromocriptine (Parlodel)
Nursing Interventions:
1. Monitor vital signs.
2. Administer with foods or milk to decrease gastric irritation.
3. Inform the client that phenothiazines may cause a harmless change in
urine color to pinkish to red-brown.
4. Instruct the client to use sunscreen, hats, and protective clothing when
outdoors.
5. Instruct client to avoid alcohol or other CNS depressants.
6. Instruct the client to change position slowly to prevent orthostatic
hypotension.
7. Instruct client to report signs of Agranulocytosis, including sore throat,
fever, and malaise.
8. When discontinuing antipsychotics, the medication dosage should be
reduced gradually to avoid sudden reoccurrence of psychotic
symptoms.
Other Psychotic Disorders:
A. __________________________
 the duration of all schizophrenic symptoms is less than 6 months
and a return to normal functioning is possible
B. __________________________
 dominant schizophrenic symptoms are accompanied by some
major or manic syndrome
C. __________________________
  psychotic symptoms appear shortly after a stressful event or
series of events and the duration is 1 month or less than a month,
with recovery to normal level of function
D. ___________________________
 a delusional system develops because of a close relationship with
a person who already has a psychotic disorder with delusions
E. ___________________________
 similar to schizophrenia because they hold unusual or bizarre
beliefs and cannot be reasoned with regarding these beliefs
 only delusions
 no hallucinations and other symptoms of schizophrenia

DISSOCIATIVE DISORDERS

Dissociation: _______________________________________________________________
_______________________________________________________________

Dissociative disorders: _______________________________________________________

_______________________________________________________________
: Often interferes with one’s relationships, ability to function and ability
to cope with realities of an abusive or traumatic event
: may include periods of forgetfulness, memory loss of past stressful
events, Feeling disconnected from daily events or an emergence of distinctly different
Personalities
: ONSET may be sudden or gradual, transient or chronic

Etiology / Cause : (associated with traumatic events)

1. ___________- an individual reacts to trauma by “splitting off” from the memory
of the event,this disorder is seen in clients with PTSD
2. ___________- a result of severe traumatic abuse in early childhood, memories
are repressed because they are too painful to acknowledge , associated with high
co-morbidity rate with substance abuse and depressive disorders
3. ______________________________________________________
-early abuse has been found to affect neurodevelopment, especially in the left
hemisphere and limbic system
- alterations in normal brain development are associated with problems
involving mood, memory, and aggressive behavior
4. _________- 3-9 times more common in women

DSM-IV-TR SUBTYPES OF DISSOCIATIVE DISORDERS:

1. ______________________
- inability to recall important personal information, because creates anxiety
Assessment:
a. Localized: clients blocks out all memories about a specific period
b. Selective: recalls some but not all memories about a specified period
c. Generalized: loss of all memory about past life

2. _______________________
- client may suddenly assume a new identity in a new environment
Assessment:
a. client drifts from place to place ( may suddenly leave home, office, travels to
another city and unable to remember her identity )
b. develops few social relationships
c. when fugue lifts, client returns home and is unable to recall fugue state

3. ________________________: aka- Multiple Personality Disorder

 - 2 or more fully developed distinct and unique personalities exist within a
person
- Personalities may take full control of the client one at a time, may or may
not be aware of each other
Assessment:
a. may have an inability to recall important information ( unrelated to ordinary
forgetfulness)
b. transition from one personality to the other is r/t to stress and is sudden
c. dissociation is used as a method of distancing and defending self from
anxiety and traumatizing experiences

4. _________________________________
- an altered self perception in which one’s own reality is temporarily lost or
changed
Assessment:
a. feelings of detachment
b. intact reality testing

What is FALSE MEMORY SYNDROME? _________________________________

NURSING INTERVENTIONS:

I. Promote client’s safety

- discuss self harm thoughts
- help client develop plan for going to a safe place when having destructive
thoughts or impulses

II. Help Client Cope With Stress and Emotions

-___________________________ reminds the client that she is in the present, is as
an adult and is safe
- validate client’s feelings of fear but try to increase contact with reality
- during dissociative symptoms or flashback, client usually is in a defensive position
( curls up) help client change position gradually
- use supportive touch if client responds well
- Encourage DBE and relaxation techniques
- use distraction techniques such as exercise, listening to music, etc..
- Plan for individual, group or family psychotherapy to integrate dissociated aspects
of personality or memory to expand self-awareness

III. _____________________________________
- refer to the client as “survivor” and not the “victim”
- establish social support system in the community
- make a list of people and activities in the community for client to contact when
help is needed

THE ELDERLY

I. Psychosocial Concerns
1. Adjustment to deterioration in physical and mental well-being
2. Threat to independent functioning and fear of becoming a burden to loved ones
3. Adjustment to retirement and loss of income
4. Loss of skills and competencies developed early in life
5. Coping with changes in role function and social life
6. Diminished quantity and quality of relationships and coping with loss
7. Dependence on government and social systems
8. Access to social support systems
9. Costs of health care and medications

Psychosocial Development: Erickson: “Ego Integrity Vs. Despair”

Ego Integrity Despair

 -views life with a sense of wholeness - believes that they have
made poor choices
- views death as an acceptable completion of life - inability to accept one’s fate,
wish to live longer
- accepts one’s one and only life cycle -gives rise to feeling of
frustration,
discouragement
- brings serenity and wisdom and a sense that life has been
worthless

II. Mental Health Concerns

1. Depression: the increased dependency that older adults may experience can lead to
helplessness, lowered sense of control, decreased self-esteem and
self worth, these changes can interfere with daily functioning and lead
to depression
2. Isolation: client is alone and desires contact with others but is unable to make contact
3. Grief: Client reacts to perception of loss, including physical, psychological, social and
spiritual aspects
4. Suicide: All threats should be taken seriously
III. Common Problems
A. Abuse to the Older Adult
1. Involves physical, emotional, or sexual abuse and can also involve neglect or economic
exploitation.
2. Individuals at risk are those dependent because of immobility or altered mental status
3. Victims are often isolated by their abusers.
4. Victims may attempt to dismiss injuries as accidental, and abusers may prevent victims
from receiving proper medical attention to avoid discovery

Physical signs Psychological signs

- malnourishment/ dehydration - possible physical and mental impairment
- fecal or urine smell in the person - aggressive or submissive behavior
- dirt,fleas or lice in the person - fearful of reporting abuse
- pressure ulcers,sores,rashes - dependency on caregiver
- bruises,abrasions,fractures - feelings of low self esteem
- hematomas,grip marks on arma - feelings of hopelessness
- multiple injuries in various stages of healing

Nursing Interventions:
-Be patient and allow the client enough time to discuss the situation
-Respect client’s dignity and avoid being judgemental
-Discuss options for ensuring the client’s safety such as placement in a safe home

B. Confusion/ Dementia
- organic syndrome with progressive deterioration in normal functioning
- characterized by multiple cognitive deficits that include memory
impairment and at least one of the following disturbances: aphasia,
apraxia,agnosia or a disturbance in executive functioning
- deficits must be severe enough to cause impairment in occupational or
social functioning
S/Sx: Aphasia: loss of language ability: speech is impoverished; client may have difficulty
finding right words
Apraxia: impaired ability to carry out motor activities despite intact sensory function
Confabulation: filling in memory gaps with detailed fantasy believed by the affected
individual
Sundown Syndrome: increased disorientation and confusion at night
Perseveration Phenomenon: repetitive behaviors

Comparing Delirium and Dementia in the Elderly Client

Delirium Dementia
Onset acute, rapid (hours-days) Gradual, insidious (months –years)
Duration brief (hours –days) Progressive deterioration
LOC impaired,fluctuates not affected
Memory short term memory short-then long term memory impaired
eventually destroyed
Speech slurred, rambling, pressured normal in early stage, progressive
aphasia in later stage;
Irrelevant Thought Processes
temporarily disorganized Impaired thinking, eventual loss of thinking
abilities

Perception visual or tactile hallucinations often absent, can have paranoia,

hallucinations, Delusions
illusions
Mood Anxious, fearful if hallucinating depressed, anxious in early stage,
Labile mood, Weeping, irritable
restless, angry outbursts in later
stages

Dementia of the Alzheimer’s Type:

- irreversible but treatable form of senile dementia from nerve cell
deterioration
- individuals with AD experience cognitive deterioration and progressive
loss of ability to carry out activities of daily living
- client experiences a steady decline in physical and mental functioning

S/sx: Agnosia-(inability to recognize objects or family members)

Amnesia-( loss of memory due to brain degeneration)
Aphasia-( inability to express in words)
Apraxia-( inability to perform ADL)
Anomia-( inability to name objects)

DOC: Cholinesterase Inhibitor : Tacrine or Cognex ( given to retard the

progression of symptoms)

Nursing Interventions:
- Provide safety( due to cognitive and memory deficits): remove or lock up objects
or cleaning agents that can harm the client, secure doors, windows,
throw rugs and extension cords
- Spend time with the client
- Acknowledge client’s feelings
- Provide continuity of care
-Orient and re orient client to time, date, person( primary need)
- Allow client to reminisce the past ( to lessen his isolation and loneliness)
- Use memory aids: Have clocks, lists, labels or calendars in the environment ( to
provide reorientation)
- Provide consistent routines- a highly structured environment decreases the burden
of decision making
- Avoid activities that tax the memory
- use constant encouragement and step by step approach
- provide activities that distract and occupy time such as listening to music,
coloring, watching tv
- provide mental stimulation with simple games and activities

For wandering clients:

- provide a safe environment
- provide close supervision
- have patient wear an ID band
- close and secure doors
Communication Considerations:
- Call client by name, remember client’s names( to demonstrate respect)
- DO NOT shout ( Increased frequency of voice makes hearing difficult)
- Use a calm and reassuring voice
 - Stand directly in front of the client and maintain eye contact
- Use short words and simple sentences
- Ask only one question at a time, give one direction at a time

PSYCHOSEXUAL ALTERATIONS

A. Sexuality
1. One’s sense of being as a sexual individual
2. Includes how one looks, behaves and relates to others
3. Sexual Health involves the integration of somatic, intellectual, and social aspects of
sexual being
4. Sexual expression is influenced by a variety of factors, including:
a. Age, health status, physical attributes
b. Cultural, social and religious views
c. Environment and personal choice of a sexual partner as a result of personality
5. Normal sexual behavior- an act by 2 consenting adults that is lack in force and
performed in a private setting In the absence of unwilling observers
6. Sexual activity is legally unacceptable when it involves nonconsenting individuals, a
child, or use of objects
7. The sexual response cycle includes phase of desire, excitement, orgasm and
resolution

B. Sexual Expression- others refer abnormal expressions as Gender identity disturbance

- Client has a sense of discomfort about his/her gender and wishes to be that
of the opposite sex
- There is a disagreement in the medical community as to whether gender
discomfort is a physical condition, psychosocial condition
or both

Heterosexuality: male-female sexual relationships

Homosexuality: sexual attraction to a member of the same sex
Bisexuality: sexual attraction to and activity with both sexes
Transvestism: Obsession with wearing clothing of the opposite sex

C. Sexual Disorders
1. Sexual dysfunction – disturbance in the sexual response cycle
Subtypes:
a. Sexual Desire Disorder- has little or no desire to sexual contact
b. Sexual arousal disorder- cannot maintain physiologic requirements for sexual
intercourse
( men: erectile dysfunction: women: difficulty with lubrication-swelling
response)
c. Orgasmic Disorders: client cannot achieve orgasm
d. Sexual Pain Disorders: client experiences pain before, during or after intercourse
e. Sexual dysfunction due to general medical condition ( e.g. DM)

2. Paraphilias- disorders characterized by sexual fantasies, urges or behavior involving

non human objects ,
Suffering or humiliation, children or other non consenting individuals
a. ________________: exposure of genitals to strangers
b. ________________: using non living objects for sexual gratification
c. _______________: desiring sexual activity with a child under age 13
d. _______________: sexual gratification that involves receiving pain
e. _______________: sexual gratification that involves inflicting pain
f. _______________: sexual gratification through observing others disrobing or
engaging in sexual activity
g. _______________: intense sexual arousal or desire for contact with animals
h. _______________: intense sexual arousal or desire when rubbing against a non
consenting person
i. _______________: sex on the phone
j. _______________: tongue brushing the anus
 k. _______________: tongue brushing the vulva
l. _______________: inserting the penis into the mouth
m. _______________: urinating on the sexual person
n. _______________: smearing feces on the partner

D. Causes of Sexual D/O

1.Sexual Dysfunctions
a. Biologic Factors: altered levels of testosterone and serum prolactin
: medical illness( DM and Vascular insufficiency can cause
orgasmic dysfunction)
: medications( Anti hypertensives, anti psychotics, anti depressant,
antianxiety, Anti convulsants,substance abuse)
b.Cognitive-Behavioral Theory: strongly negative emotions become associated
with sexual activity

2. Paraphilias: may be attributed to biological factors or a host of interrelated factors(

system theory)
a. though evidence is inconclusive, possible destruction of the limbic system or
disorders involving the temporal lobe may be a factor

b. result of multiple interrelated factors, genetics, past learning, stress, physiologic,

psychological and sociocultural factors

Nursing Interventions:

1.) Assess sexual history and precipitating event for the sexual disorder
2.) Behavior Modification – extensive evaluation of the specific problem and the client’s
relationship dynamics coupled with education and
supportive psychotherapy
3.) Encourage client to explore personal beliefs
4.) Provide a non judgmental attitude
5.) Provide supportive psychotherapy