AUTONOMOUS UNIVERSITY OF GUERRERO

ACADEMIC NURSING UNIT Nº3

DEGREE IN NURSING.

LEARNING UNIT:
PSYCHIATRIC NURSING

TOPICS DEVELOPED:
UNIT III (ROLE OF NURSING IN MENTAL HEALTH) AND UNIT IV
(THERAPEUTIC MODELS)

PROFESSOR:
LIC. MARÍA ELENA ARCARAZ DOMÍNGUEZ

PRESENTS
RUTH PATRICIO SIXTO

OMETEPEC, WARRIOR. ON DEC 12 FROM 2012

 NURSING FUNCTIONS IN MENTAL HEALTH
Psychiatry as a practice has been present since the first civilizations, mentally ill
people have been treated differently according to the time; The people in
charge of their care have been priests and witches to specialists today. In the
past, psychiatric patients received inhumane treatment and were despised by
society. Psychiatric hospitals have always been related to religious communities
and house beggars, orphans, abandoned people, the elderly and of course the
mentally ill.
Mental health can be defined as a state of success at work, affect, decision
making and the ability to solve problems.
Mental illnesses are alterations and limitations at the psychological, affective,
cognitive, sensory-perceptive level that affect the person, family and
community.
Psychiatric nursing begins in Massachusetts; The first nursing school was
opened in a hospital for the mentally ill.
Mental health and illness are cared for holistically by nurses, respecting the
cultural patterns of patients, families and the community. Vast knowledge of
factors is required: predisposing, precipitating and perpetuating
Nurses have the obligation to know the laws that govern mental health work. All
nursing decisions must be based on deep ethical reasoning, which includes the
notion that the patient can make decisions about his or her health and well-
being, that the action will avoid committing intentional harm, and that the action
will serve the patient's best interests. .
Nurses always act in defense of their patients. Responsibilities include adapting
the environment to meet their needs: intimacy and social interaction. They
protect them temporarily, that is, while they are incapacitated, respecting their
rights.
Primary mental health care is responsible for Dx, prevention and Tx of mental
illnesses; Primary care is the gateway to the health system and is the main
means where the needs derived from mental disorders are satisfied.
Comprehensive and integrated care for the person is considered as a whole
and in the cultural, family and social context in which it is developed.

PSYCHOLOGICAL ASSESSMENT
It is an evaluation carried out by a mental health professional such as a
psychologist to determine the state of a person's mental health. A psychological
evaluation may result in a diagnosis of a mental illness. It is the mental
equivalent of a physical exam.

A PSYCHOLOGICAL EVALUATION CONSISTS OF THE FOLLOWING

STAGES:
a clinical interview.
the application of a psychological test.
the analysis of the results at a qualitative and quantitative level.
the opinion of the analysis that includes the aspects revealed as well as their
weighting with the relevant clinical elements within the framework of the
examination.
the conclusion and its communication to the person examined.
GOALS
The psychological assessment is carried out with the purpose of exploring in
depth the emotional aspects of the person evaluated, without leaving aside the
application of the intelligence test.
This type of assessment seeks to find a panorama, as broad as possible, of
how the person perceives themselves and their environment, in terms of family,
school and/or work and social matters.

NURSING DIAGNOSES
THE NURSING DIAGNOSIS

It is the presentation of a current or potential health problem that a nursing

professional is trained and authorized to treat.
NANDA: Clinical judgment about a person's, family's, or community's
responses to current or potential problems or life events.

NURSING DIAGNOSES IN MENTAL HEALTH

Acute confusion
Anticipated duel
Anxiety
Deficit in cleanliness and personal hygiene
Decision conflict
Poor fun activity
Knowledge deficit
Growth and development disorders
Disturbance in body image
Sleep pattern disturbance
Deficit in clothing and personal hygiene
Dysfunctional grief
Fear
Food self-care deficit
Hopelessness
Unbalanced nutrition: less than the body's needs
Altered adaptation
Altered memory
Altered parental capacity
Altered social interaction
Impaired verbal communication
Ineffective coping
Ineffective health maintenance
Ineffective sexuality patterns
Interrupted family processes
Breach
Post-traumatic syndrome
Impotence
Stress syndrome due to change of address
Risk of injury
Risk of loneliness
Risk of violence directed against third parties
Risk of violence directed against self
Social isolation
Spiritual anguish
Self-care deficit in elimination

NURSING DX
REAL DX
It represents a problem that has been clinically validated through compliance
with defining characteristics, that is, evidence of signs and symptoms typical of
Dx.
STATED IN THREE PARTS:

Diagnostic Label ɨ r/c related factors ɨ m/p signs and symptoms

EXAMPLE

Chronic pain related to its muscular degenerative process manifested by

alteration in the inability to continue with previous activities.

The presence of signs and symptoms in the statement validates the existence
of a real DX.

Diagnostic examples 1
A 52-year-old man was diagnosed with acute heart failure and metabolic
acidosis. His most important symptom was the feeling of suffocation. The
medical history revealed two myocardial infarctions, chronic constipation, and
kyphosis. After completing the psychosocial assessment, the student analyzed
the data, including observations of clinical anxiety symptoms and a history
check. He validated the data with his clinical instructor and consulted a list of
defining characteristics of the suspected diagnoses. She then recorded the
following nursing diagnoses, relating to the patient's psychosocial needs.
Moderate anxiety, related to his physical condition and hospitalization,
evidenced by a tremulous voice, increased verbal expression with hurried
speech, trembling of the hands while speaking, and diaphoresis.
Ineffective coping related to separation from family and home, change in
physical status, and limited mobility
Disturbed sleep pattern related to anxiety secondary to physical illness,
evidenced by their inability to sleep
Ineffective sexual patterns related to fear and anxiety regarding sexual
functioning secondary to physical illness.
Diagnostic examples 2
A 45-year-old woman with congestive heart failure and lymphoma was admitted
for chemotherapy. His main symptoms were a feeling of suffocation, rapid
weight loss and fatigue. The student collected data on the patient's emotional
response, her clinical status, and her ability to cope with the diagnosis of a
terminal illness.
She then validated her psychosocial data with the head nurse and asked the
patient to verify the information given during the assessment. After confirming
the defining characteristics, he made the diagnoses…
anticipatory grief related to the terminal state, manifested by denial, anger and
the statement “I am not going to live much longer”
Low situational self-esteem related to alterations in body image, highlighted by
negative statements about oneself
Defensive coping demonstrated by increased use of suppression, projection,
dissociation, and denial.
Acute anxiety related to illness, hospitalization, and separation from her
husband, evidenced by restlessness, rapid pulse, and a large number of
questions about her illness.

NURSING CARE PLAN (PLACE)

OBJECTIVE: To have a methodological tool that serves as a basis for

structuring standardized care plans that contribute to improving the quality of
care and safety of the person, family and community, implemented in health
institutions of the National Health System.
PLAN DRAFTING
Individualize or personalize the care plan according to the nursing diagnosis...
“if that person who knew nothing about that patient read this plan. “What would I
come to know about their needs?”
Simple and understandable language to communicate information
Presentation of nursing interventions must be specific
Priority to nursing care
Specify the results corresponding to each diagnosis, considering the short and
long term objectives
Identify the person responsible for each intervention

EXECUTION OF THE MENTAL HEALTH NURSING PLAN

counseling interventions to help the patient improve or regain coping skills
maintenance of an environment or
therapeutic medium
structured interventions to promote self-care or well-being
physical and mental
education for health
interventions to promote mental health or prevent mental illness
ASSESSMENT
It focuses on the patient's status, progress toward achieving goals, and ongoing
reassessment of the care plan.
EVALUATION: possible results
The patient responds favorably or in the expected manner to the nursing
interventions, the short-term objectives are met, but the long-term ones are not,
the patient is unable to meet or achieve any results, new problems or needs are
identified that require the nurse. to modify or review the assistance plan.
 EXAMPLE OF A NURSING CARE PLAN

DX OF THE NANDA: 00136 DUEL

DEFINITION: Complex normal process that includes emotional, physical and
spiritual, social and intellectual responses and behavior through which
individuals, families and communities incorporate a real, anticipated or
perceived loss into their daily lives.

NOC/ RESULTS NIC/: 5290

CRITERIA. ACTIVITIES 1:
FACILITATE GRIEF identify the loss
help the patient
13302 FACING identify the nature
PROBLEMS of the attachment
to the lost object
or person
INDICATORS
encourage
130201 IDENTIFY discussion of past
EFFECTIVE loss experiences
IMPROVEMENT
PATTERNS

1 2 3 4 5

130205 VERBALIZES
ACCEPTANCE OF
THE SITUATION

1 2 3 4 5

130207 MODIFIES
LIFESTYLE WHEN
REQUIRED

1 2 3 4 5

ESC: 1 never demonstrated, 2

rarely demonstrated, 3 times
demonstrated, 4 frequently
demonstrated, 5 always
demonstrated
IAS 2: 5270

NOC/OUTCOME EMOTIONAL SUPPORT

CRITERIA
2600 COPING

INDICATORS
2600066 INVOLVES
FAMILY MEMBERS

1 2 3 4 5
ACTIVITIES 2:
Provide support
260010 SEEKS during the denial,
ATTENTION FOR THE anger, bargaining,
NEEDS OF ALL and acceptance
MEMBERS OF ALL phases of grief.
MEMBERS OF THE discuss the
FAMILY emotional
experience with
1 2 3 4 5 the patient
Support the use
of appropriate
260002 THE FAMILY defense
ALLOWS MEMBERS mechanisms
TO PLAY FLEXIBLE
ROLES

1 2 3 4 5

ESC: 1 NEVER SHOWN,

2 RARELY SHOWN, 3
SOMETIMES SHOWN, 4
FREQUENTLY SHOWN,
5 ALWAYS SHOWN
MODULE FOR A NURSING CARE PLAN

 nursing diagnosis
 identification of results
 planning (formulation of a nursing care plan)
 execution of nursing actions or interventions

 assessment of the patient's response to interventions

PRIOR TO THE EXPLANATION; ACCORDING TO THE SCHEME BELOW,
THE WAY TO CARRY OUT A NURSING CARE PLAN IS VISUALIZED
 UNIT IV
THERAPEUTIC MODELS

1.- PSYCHOTHERAPEUTIC TREATMENT

APPROACHES AND MODALITIES IN PSYCHOTHERAPY

Definition and scope of psychotherapy
Psychotherapy is a treatment for problems of an emotional nature, in which a
trained person deliberately establishes a professional relationship with a patient,
with the aim of eliminating, modifying or delaying existing symptoms, changing
altered patterns of behavior and promoting growth and development. positive
personality.
Based on this definition, each of its components is described below:
Treatment for problems of an emotional nature . It states that emotional
problems are diverse and influence every facet of human functioning,
manifesting in distortions of the individual psyche, somatic and interpersonal
and communal life. The manifestations of emotional illness are multiple, so it is
arbitrary and inadequate to separate social and interpersonal difficulties from
psychological and psychosomatic disorders, which are always concomitant,
even if not always obvious.
Performed by a trained person . In search of help, the individual may establish a
relationship with a friend or authority, motivated by disabling symptoms and
realizing that his or her own happiness and productivity are sabotaged by inner
forces that he or she cannot understand or control.
Sometimes the consequences of this relationship are disastrous for both
participants, particularly when attempts are made to manage the emotional
turmoil that the patient is experiencing. Treatment of an emotional problem
requires a high degree of skill that is acquired only through professional training
and experience.
Deliberately establish a professional relationship . The relationship, the essence
of the therapeutic process, is deliberately planned and nurtured by the therapist.
Unlike non-professional relationships, which are part of man's social nature, this
is initiated and developed on a professional level and directed toward specific
therapeutic goals.
In order to eliminate existing symptoms . As a first step, therapy seeks to
eliminate the patient's suffering, as well as remove the difficulties imposed by
their symptoms.
Modify . Despite the desire to provide complete relief, inadequate motivation,
diminished ego strength, limitations on time or finances available to the patient,
impose restrictions on the help that can be provided and cause what is
achieved. be a modification of the patient's symptoms, rather than a cure for
them.
Delay . There are some malignant forms of emotional illness, such as
schizophrenic disorders, in which psychotherapy, no matter how well applied,
serves only to retard an inevitably deteriorating process.
This palliative effect is justified; However, it is necessary to help the patient
maintain contact with reality.
Modify altered patterns of behavior . The recognition that many occupational,
educational, marital, interpersonal and social problems are emotionally
determined has extended the use of psychotherapy to fields considered to date
belonging to the realms of the psychologist, teacher, sociologist, priest or
legislator. The notion that character structure is involved in all emotional illness
has expanded the goals of psychotherapy from mere symptomatic relief to the
correction of altered interpersonal patterns and relationships.
Promote positive growth and development of personality . The purpose of
psychotherapy is the maturation of the personality. This has introduced a new
dimension in the field of psychotherapy, which deals, on the one hand, with
problems of immaturity of the so-called "normal" person, and on the other, with
characterological difficulties associated with inhibited development, which were
previously considered inaccessible. to treatment. Psychotherapy aims to
resolve blockages to psychosocial development, so that the individual can have
more complete creative self-realization, promote more productive attitudes
toward life, and more rewarding relationships with people.
Approaches
There are various forms of psychotherapy that are based on different theoretical
frameworks, which are commonly called approaches. Below are three of those
used in the treatment of substance abuse and dependence problems. Likewise,
the most used psychotherapeutic modalities are presented.
1. Cognitive behavioral
This model originated to combat depression and anxiety (Beck). Its foundation
lies in the identification and modification of maladaptive thoughts, with a view to
reducing or eliminating negative behaviors and feelings, modifying the cognitive
processes that are associated with the behaviors and feelings of substance
users. To promote motivation, it is based on socio-psychological persuasion
techniques. Emphasizes empathy as an instrument to emphasize the
advantages and disadvantages of addictive behavior, exploring the patient's
goals and ambivalence through reflection, developing skills to face internal and
external stress, as well as learning the reasons for resuming addiction.
consumption. Likewise, it encourages and reinforces social skills and behaviors
to avoid drug use.
2. Systemic
This theory seeks to understand and analyze how a system sees itself within its
reality, based on the context that surrounds it, which includes principles, social
norms, values, education, etc., that is, the cultural elements in which it is based.
develops the family system. Based on these aspects, interventions are made to
recover resources that help the family clarify their way of living, taking into
account that in their
interpersonal relationships, they will build a new knowledge of interaction, with
which they will be able to face situations that are conflictive.
Therefore, intervention techniques and strategies are focused on influencing
family relationships with the world around them, and in turn on how these
influence their family interaction, so that the system reflects and decides the
way to interact between its members. members.
Regarding substance abuse and dependence, this model proposes taking up
alternatives based on the social resources that the family has and the
perception they have of their own problems, so that they themselves establish
or modify their own rules, principles and values that allow us to face the
consumption situation in another way, without this generating new conflicts that
further exacerbate the problem.
3. Psychodynamic
It is based on the theoretical-technical framework of psychoanalysis, which
could be presented schematically as follows: the human being has a psychic
apparatus that is structured and made up of instances or parts (ego, id and
superego), which interact with each other as a response. to both internal and
external stimuli. Its psychic functioning is determined by non-conscious
principles and mechanisms, which when put into action seek to maintain an
adequate interaction of the subject with their reality.
Psychodynamic psychotherapy with its techniques, aims to influence the
structure and functioning of said psychic apparatus, in order to adequately
regulate the formation of the personality of the human being, reflected in a
satisfactory and rewarding lifestyle.

Psychotherapeutic modalities
Individual psychotherapy
This modality allows us to deepen the psychic and historical exploration, as well
as to carry out corrective emotional experiences, which can be carried out
better in this Therapeutic modality.
The power of individual therapy lies, in part, in the patient's ability to resolve
transferences, especially negative ones. This requires that the therapist not
address certain behaviors that, however helpful, may interfere with the patient's
ability to bring out precisely the deepest, most irrational patterns of negative
attitudes, and which are the ones most in need of resolution. Thus, the therapist
must not give advice, but must decide how to support the ego, being able to
choose between education, realistic interpersonal feedback and reinforcement
for optimal psychological growth. This therapy is an ideal terrain for intrapsychic
integration previously denied, but only once there is a demand in certain
specific conditions and characteristics, there may or may not be treatment.
Psychodynamic therapy is based on the transference relationship, that is, the
space and device through which the work of analysis, elaboration and resolution
of intrapsychic conflicts, postulated as the cause of the subject's dependency
and functioning, occurs. That is, of the origin, of why one is, and of how one is.
Psychotherapy as a treatment process must consider relapses as elements of
analysis, elaboration and resolution, since in general, they can be defined as
patient actions, which are characteristics of addicted subjects, linked to
unconscious impulses in distressing situations.
The main aspects to work on in individual psychotherapy are the following:
 The reasons that lead the patient to psychotherapy and those that can
make him stay in it.
 Psychological conditions of the patient in relation to dependence, that is,
to their history (temporality, history of substance use, frequency of
consumption and situations or circumstances in which it occurs).
 The place that the patient occupies and plays in his interaction with
others and in the therapeutic relationship (transference).
 The meaning and function that the drug has in the connection between
the psychic-emotional field and external reality.
 The meaning or meanings that the act of taking drugs has for the patient.
 Other desires that the patient has, which can make him stop taking
drugs.

Psychodynamic therapy
Experience has shown that the motives and reasons why a large percentage of
presumed patients present for treatment are linked to the anguish and demand
of another (family member, friend, institution, etc.). The fact that they do not
come on their own makes it impossible to carry out treatment with them, which
is not required, since they do not occupy their place as a patient, which is
essential.
The above leads to the fact that in the first sessions work has to be done with
the demand, to locate its function and the place that would correspond to it in a
truly therapeutic relationship, which is that of being a patient.
As long as the condition of dependent is not assumed as a subject, it will be
difficult to accept the position of patient, which is a therapeutic slip that allows
the dependence on the drug to change to the therapist, in a temporary and
decisive manner. Therefore, it must be managed as such, maintaining it
strategically, since this type of relationship makes possible a treatment that
would not otherwise occur. The transference relationship will be resolved by
clarifying it, ending the treatment.
What the drug means to the addict and the function it has been fulfilling is the
reason for its use and dependence. It is essential to address and analyze that
meaning and its function, in order to eliminate or replace those meanings based
on mere fantasy.
(happiness, power, creativity, lucidity, etc.), to give it its real and true meaning,
that is, to redefine the drug object and why and what it is used for.
Getting high as an act replaces something that has not been possible to
articulate in words. The patient, by speaking it, with the help of the
psychotherapist and through his interventions, gives rise to its verbalization and
with it to knowledge, which will give meaning to the previous, merely impulsive
acts, which are in general terms a call for attention that demands the presence
of another. The therapist is a support to address separation and unexplained
losses, among them, mainly that of the mother and now that of the drug object.
As long as there are meaningless actions, that is, acts that are not symbolized,
the patient will be at risk of relapse.
The construction of autonomy and separation of previous objects in the patient
are possible from the construction of their own place based on a particular
desire different from wanting to get high.
Cognitive therapy
Cognitive therapy is a system that attempts to reduce excessive emotional
reactions and counterproductive behaviors by modifying the erroneous or
defective thinking and maladaptive beliefs that underlie these reactions (Beck,
1976).
One of the basic ideas of cognitive therapy is to help the patient reduce the
intensity and frequency of drug urges by disconfirming underlying beliefs and
teaching him specific techniques to control and manage his urges. Specifically,
it aims to reduce pressure and increase control.
In the treatment of substance abuse, this therapy is characterized by the
following aspects: a) it involves collaborative work based on trust, b) it is active,
c) it relies heavily on guided discovery and empirical verification of beliefs, and
d) tries to view drug or drink consumption as a technical problem, for which
there is a concrete solution.
Many individuals have conflicting beliefs regarding the pros and cons of using a
drug. Sometimes, they are so locked in the struggle between both opposing
beliefs that, paradoxically, they will seek out drugs in order to relieve the tension
that this conflict generates.
The therapeutic application of this model, which consists of modifying the
individual's belief system, goes beyond teaching them to avoid or confront high-
risk situations.
Family therapy
This modality considers the family as the patient and the addicted member as
the symptom for which treatment is sought. The processes of family dynamics,
such as communication, roles, emotional involvement, rules and discipline,
control, performance of tasks, values and ideals, constitute a therapeutic
approach model to detect the factors that promote and maintain addictive
behaviors, favoring the clarification of interpersonal and family relationships that
lead to the solution of the conflict.
The different theoretical orientations of this modality include: structural-
systemic, strategic, psychodynamic and behavioral approaches. Interventions
can focus on the patient, the nuclear family, the spouse, and simultaneous
multifamily and social network treatment.
One of the proposals for working in family therapy with addictions was
developed by Stanton and Todd in 1982, which suggests a structural-strategic
approach, where the strategic is the axis or guide, but also integrates many
structural elements. The most specific procedure is to resort to Minuchin's
structural theory as a guide; work structurally within the sessions, through the
current connection of new patterns, and apply structural techniques such as
joining, accommodation, limit testing, restructuring, among others, and resort to
Haley's strategic model in terms of its emphasis on a specific plan, extra-
session cases, symptom change, collaboration between the treatment system,
among others.
Different practices that prevail in the field of drug abuse place a continued
emphasis on the active involvement of the addict's family of origin in therapy ,
even if he is not living with them. Typically, these families are not able to
successfully navigate this stage and instead remain stuck in a cycle in which the
addict enters, leaves, or remains inappropriately attached to their family. For the
good of the entire group, the therapist can help them move forward correctly. In
this sense, they are asked to go back to one of the early stages where they had
not negotiated successfully, to do it "right" this time. In addition, parental control
is restored gradually and appropriately. It should be noted that this process
often intensifies the total experience of the family, making them more united as
members. Sometimes the result of that "understanding" is insistence on
separation with much less ambivalence than before. During this period the
therapist should try to prevent the process from its normal course to lighten and
plan the patient's departure.
From this approach, family therapy attempts to include all the members who live
in the home, or those who are in the immediate vicinity. The rule of the game is
to see how family members interact before concluding the sessions. On the
other hand, companions can serve numerous functions, they can act as allies to
the addict and help him assert himself more appropriately. Likewise, peers
provide additional data about family interactions from which therapists can take
advantage.
legal or school authorities and of course, a special team of drug treatment
professionals.
Reyes (2002) suggests some techniques aimed at searching for alternative
patterns, derived from the structural and strategic vision:

group psychotherapy
Group therapy allows the multiple transferences (to mother, father, siblings and
grandparents) that all patients experience, and which can be explored
simultaneously, to be resolved directly in the group. Group therapy has the
power to immediately remove resistance, since the first thing that is asked of
patients is to spontaneously express all their feelings. Thus, fundamental
character resistances come out involuntarily in each session such as: isolation,
suspicion, seduction, intellectualization, being absorbed, arrogance, and
impulsivity, are examples of what must be resolved.

2.- PSYCHOPHARMACOLOGY:
The great advances made in the field of psychopharmacological research , or
the study of the effects of drugs on the mind and behavior, revolutionized the
treatment of people suffering from serious disorders: For practical purposes, we
will divide drugs into three groups: antipsychotics, antidepressants and
anxiolytics.

ANTIDEPRESSANTS
Antidepressants have been used for many years. These drugs increase vital
energy, reduce agitation and restore tranquility.
Indicated in case of:
Obsessive compulsive disorders, phobic anxiety
Types of antidepressants according to their effects:
The classics, MAOIs (monoamine oxidase) and selective serotonin reuptake
inhibitors (SSRIs).
MAOIs: monoamine oxidase inhibitor antidepressants, continue to be
particularly effective for the treatment of depression due to their effective
energizing effect, resulting in greater initiative and increased appetite.
Selective serotonin reuptake inhibitors (SSRIs): This group has achieved
the preferences of psychotherapists thanks to its antidepressant effectiveness
and, especially, for lacking the typical adverse effects of other antidepressants.

MOST USED ANTDEPRESSANTS AND RECOMMENDED DOSE

CHEMICAL FAMILY DRUG DOSE

Classics Imipramine 75-300 Mg/day

Classics Clomipramine 75-300Mg/day

IMAOS Phenelzine 30-90 Mg/day

SSRI Fluoxetine 20-60 Mg/day

SSRI Paroxetine 20-60 Mg/day

SSRI Sertraline 100-300 Mg/day

SSRI Citalopram 20-60 Mg/day

SSRI Fluvoxalin 100-200 Mg/day

ANSIOLYTICS
Until 1960, the substances used for the treatment of anxiety disorders exerted
their pharmacological action with a clear predominance of their secondary
effects over the anxiolytic effect. The appearance of bienzodiazepines allowed
anxiolysis at therapeutic doses with a low sedative effect and also with large
safety doses. The popularity and diffusion achieved by bienzodiazepines since
their discovery have been enormous. Even though their prescription, and
specifically diazepam, have decreased in recent years, they continue to be the
best-selling psychotropic drugs in the world. In 1966 a second previously known
group of substances, beta-adrenergic blockers, showed a clear anxiolytic effect.
In one of the second generation of anxiolytics, the so-called aprazolan stands
out, one of the most effective drugs in panic attacks.
Clinical use of anxiolytics: There is no doubt that a certain degree of anxiety is
always present in our daily lives and plays an obvious role in the general
adaptive response to stress. This emotional threshold, or “normal level of
anxiety”, allows us to improve our performance and activity. However, when it
exceeds a certain limit, it causes a noticeable feeling of discomfort and a
deterioration in performance.

ANTIPSYCHOTIC DRUGS:
The success of chlorpromazine in sedating experimental animals was
demonstrated in 1951.
The clinical use of antipsychotics, especially used in the treatment of
schizophrenic disorders or manic attacks, requires special attention to the side
effects of antipsychotic substances, the physical state of the patient and the
preponderance of certain symptoms in each case.
The intramuscular route is recommended in agitated schizophrenics for whom
rapid sedation is required, and in those who refuse to take substances orally.
Once the initial symptoms have subsided, patients not treated with antipsychotic
drugs relapse more frequently than those receiving these drugs.
Antipsychotics are also indicated in manic attacks at similar doses used in
schizophrenia. In these cases, it is recommended to treat patients
concomitantly with lithium carbonate or carbamazepine and once the acute
condition has subsided, progressively reduce antipsychotics and follow
maintenance treatment with lithium or carbamazepine.
The mineral lithium seems to have preventive effects on manic excesses and
enhances the action of antidepressants. Carbamazepine is an antiepileptic
(anticonvulsant) that has similar effects.

INITIAL AND MAINTENANCE DOSE OF ORAL ANTIPSYCHOTICS

ANTIPSYCHOTIC ACUTE PHASE MAINTENANCE

(MG/DAY) (MG/DAY)

Chlorpromazine 3000- 2.000 50-400

Levopromazine 300-2.000 50-400

 Clotiapine 120-320 20-60

Thiodyrazine 300- 800 50-400

Perphenazine 16-72 8-240

Trifluoperacin 15-50 4-15

Haloperidol 10-80 3-8

Risperidone 6-9 3-6

3.- PSYCHOANALYSIS AS THERAPY

In the strict sense, psychoanalysis can be defined as a method and technique
of psychotherapeutic treatment based on the exploration of the unconscious
through free association . Unlike methods that are based on exercises, training
or learning (such as behavioral techniques ) or explanations on a cognitive
level, psychoanalysis is among the discovery or revelation techniques that
attempt to help the patient achieve a deep understanding of the circumstances
(generally unconscious) that have given rise to their conditions, or are the cause
of their suffering or psychological discomfort. Although this is frequently
associated with introspection , it is a misunderstanding to expect a rational
understanding of causal relationships as an essential objective of
psychoanalytic therapy. Rather, it is about achieving a broader restructuring of
the personality, especially of the emotional life and particularly in those areas
that contribute and maintain the formation of symptoms, or of defensive forms
that cause harm or discomfort.
Classical psychoanalysis is developed over a few years with a frequency of
three to five times a week. In the classic setting , the patient lies on a couch and
talks, as much as possible without censorship, about everything he feels and
thinks, putting into words every idea that comes to mind. This technique is
called free association and is the fundamental rule. The analyst who is seated
behind him listens, maintaining an evenly floating attention and communicates
to the patient his interpretations, made on the basis of the material that appears
during the analytical process. The analyst delivers these interpretations to his
patient as many times as he considers appropriate and in the situations he
decides. In particular, the analyst will capture and interpret the emotional
patterns and psychic functioning, the typical mechanisms that the patient
repeats in the relationship with him in the form of transference and, basically,
the formations of the unconscious that arise in the course of the analysand
throughout the life. your analysis.
Regardless of the variations that exist in the different schools after Freud, where
many of them modify this setting or classic framework , the central axis of
psychoanalysis as a therapeutic technique is free association. Since the time of
Freud and until today, the so-called "fundamental technical rule" has been
assigned a demarcating character between what is called psychoanalysis and
what is a therapy different from it. 3

Jean-Martin Charcot teaching at the Salpêtrière in Paris : showing his students

a woman ("Blanche" (Marie) Wittman) in a "hysterical state."
The history of psychoanalysis corresponds largely to the history of its founding,
elaboration, revision and dissemination by its greatest figure, the Viennese
doctor and neurologist Sigmund Freud.
It is considered a key antecedent for the birth of psychoanalysis that Freud
became a student of Jean Martin Charcot at the Salpêtrière hospital in Paris
between 1885 and 1886 . 8 Freud would thus become familiar with the research
carried out on hysteria which showed that through hypnosis all kinds of
symptoms present in hysterical conditions could be induced, suppressed and
exchanged, suggesting a psychological and not an organic etiology. 9 The
hysterics who were subjected to such an experience did not retain what
happened in consciousness, that is, they did not remember, although the
hypnotic suggestion continued to act once the hypnotic trance was undone.
Back in Vienna and in collaboration with his friend and colleague, the
physiologist Joseph Breuer , 10 he applied the cathartic method discovered by
him, which he would later gradually modify until it gave shape to
psychoanalysis. eleven
After years of clinical experience, Freud proposed the theory that hysterical and
neurotic symptoms were caused by traumatic nuclei repressed in the
unconscious because they were morally unacceptable to the subject's ego. 12
Freud postulated that these pathological nuclei consisted of "one or several
events of early sexual experience, belonging to the earliest childhood." 13
In his 1914 article Remember, Repeat, Rework , Freud briefly outlines the
history of his method, dating back to its predecessor, hypnosis. When referring
to this, in particular the "Breuerian catharsis", he mentions that it focused on the
reproduction of the psychic processes of the situation in which the neurotic
symptoms were acquired "so that they would have their course through
conscious activity." . 14 It was assumed that the symptoms referred to these
repressed processes. Along with recollection, abreaction was another of the
goals aimed at using this technique, for which the patient was induced into a
hypnotic state.
At a later point, Freud decides to abandon hypnosis, which is usually explained
by simply saying that it was not a technique with which he was particularly
comfortable, as well as that it is not in itself capable of being applied in all
cases. On the other hand, a failure is attributed to the fact that after a recovery
period, after having been applied, the symptoms returned again, imposing the
task of repeating the treatment. On the other hand, it is also said that this
method does not allow the patient's "resistance" to access the analytical work.
In any case, the technique aimed, then, to "gather from the free occurrences of
the analysand what he refused to remember. The aim was to overcome
resistance through interpretive work and the communication of its results to the
patient." 15
Thirdly, Freud abandons the focus on a specific problem, contenting himself
with "studying the psychic surface that the patient presents each time, and uses
the interpretive art, in essence, to discern the resistances that arise in the
patient and to address them." conscious". fifteen
In 1897, coinciding with the death of his father, Freud, he applied the
accumulated clinical experience to himself and began an in-depth study of his
memories, desires and emotions that allowed him to reconstruct his childhood.
This systematic scrutiny of his psyche, considered the founding act of
psychoanalysis, 16 is known as his self-analysis.
Slips are erroneous acts for consciousness, in which a discharge from the
unconscious is manifested. For Freud, it expresses a relevant personal motive,
unknown to the conscious personality. Often the lapse is not obvious and is
revealed only after a long chain of associations.
A second area exploited by free association is that of dreams, considered the
"royal route to the unconscious." For psychoanalysis, dreams are always (at
least this is what is postulated in The Interpretation of Dreams ) fulfillments of
desires, 30 which are generally disguised because they are unacceptable for the
conscious organization of the individual. Freud distinguishes in the structure of
the dream: the manifest content , which generally seems incoherent and
meaningless but which presents some kind of narrative story; and the latent
content , which refers to the associations that unfold from the manifest dream.
The dream (the sequence of its manifest contents) is a formation produced by
the work of the dream that transforms the latent material through condensation ,
displacement , disorder into its opposite and various treatments that the
unconscious representations receive, by virtue of their structure. , and which
Freud designated as dream disfigurement . 31 The direction of the work of
analysis is precisely in the opposite direction to that of the dream work since it
obtains the latent content where it was manifest. Dreams are figurations
capable of accessing consciousness, since in this situation of rest (sleeping) is
when censorship is most relaxed and resistance is weakened. The longings and
desires that are prohibited from accessing conscious states have an opportunity
to escape behind the veil of dream disfigurement.
Psychoanalysis also finds one of the paradigmatic manifestations of the
unconscious in jokes ( Witz in German ).
Freud stated that the neurotic individual, whose childhood erotic needs
remained unsatisfied, will be able to orient his libidinous requirements towards a
new person who emerges on his horizon, it being very likely that the two
portions of his libido (the conscious and the unconscious) will participate in this
process. . It is therefore perfectly normal and understandable that a charge of
libido is also directed towards the psychoanalyst. This process gives rise to
what in psychoanalysis is called transference .
When we talk about "transference" in therapy, it is considered that the patient
transfers or reissues on the figure of the analyst libidinal demands experienced
in childhood in relation to people who were important or significant at the time.
The transference offers the opportunity to put into action the infantile conflicts
and cognitive structures that led to the repressions and the different formations
of their neuroses; and it also provides the subject with the conditions to rectify
those events that took place in childhood and that, because they remained
unconscious, had remained refractory to their previous attempts to influence
them. 32
The countertransference will be that set of unconscious reactions of the analyst
towards the person of the analysand and towards the transference. It is
considered a very important element in analytical work because each person
has in their own unconscious an instrument with which they can interpret the
expressions of the unconscious in others.