Chapter 3Chapter 3

Represents an individual typical way of responding to a threatening, anxiety-producing stimulus. Appearance Behaviors Communication

Behavior pattern is a syndrome or complex of symptoms observed in the actions, feelings, and thoughts of clients are acting out. The individual symptom symbolizes the conflictive

and defensive elements of an emotional conflict. They provide clues of what the person have been

and is thinking, feeling and experiencing and responding to in his struggle to resolve the conflict as well to meet his deprivations and needs.

During period of conflict, frustration, and anxiety, some clients act out a pattern of behavior having a dominant characteristics, such as withdrawal or aggression.

The ways of reacting have been learned in attempts to adapt to life situations, but they may become grossly pathological in both their appearance and effects.

When attempts to resolve mental conflicts are not successful, frustration and anxiety increase.

SYMPTOMS THAT MAY BE PART OF A PATTERN:

Waxy Flexibility Waxy Flexibility An overt response to a stimulus of a suggestive

nature is observed. A body posture is imposed by another is readily

accepted and maintained rigidly for a prolonged period of time by a patient who may be perceiving an overwhelming emotion of threatening stimulus such as fear or hallucinations.

The joins of the individual’s extremities may be flexed or extended during catatonic episodes just as ones bends a soft candle into position.

Pathologic Limb Rigidity

the introjections of a high level of anxiety and other emotions perceived in response to a threatening situation.

It may symbolize withdrawal from emotionally painful reality with an associated need communications.

Compulsions Ritualistic displacement of anxiety

through repetitive actions carried out against the patient’s conscious wishes, such as repetitive hand washing, counting, checking, touching which have a symbolic relationship to underlying conflict.

This includes reenacting the event or putting oneself in situations that have a high probability of the event occurring again. This "re-living" can also take the form of dreams, repeating the story of what happened, and even hallucination.

Examples of COMPULSIONS

Examples of Obsessivepreoccupation on an idea

Echopraxia Compulsive replacement of anxiety

through automatic duplication of the immediately observed movements and gestures made by another individual in the patient’s presence.

imitation of an action: the compulsive imitation of the actions of others, often a sign of a psychiatric disorder.

May be a security achieving operation which is stronger than one’s conscious control.

Echolalia Representing the speech of another, like a resounding echo, as if experiencing a compulsion to respond.

May be a security achieving operation or the pathologic suppression of data which is emotionally painful to verbalize.

Impulsiveness Sudden, unpredictable outburst of activity,

such as striking physically at someone without thinking about the rationale and effects of the behavior.

A fearful hallucinating client might project hostility upon a person who approaches and interrupts his hallucinatory behavior and to whom the client may attribute the voices being heard.

Tics and Spasm Involuntary jerking and twitching of some part

of the body, usually localized in the neck, face and head.

This behavior appears to be of organic etiology but may be of psychic origin.

Anxiety is displaced through such actions as intermittent eye blinking and spasmodic movements of the mouth or neck which are motivated by unconscious emotional conflicts.

Punning The injection of witty or clever remarks into

a conversion, or the humorous use of a word in such a way as to suggest a different meaning.

or the use of words having the same sound, but different meanings, which attract the listeners attention and gain for the patient the control of the immediately environment.

Rhyming Rhyming of phases or whole sentences in a

lyrical poetic manner during conversation or writing which may symbolize the conflictual elements and needs associated with a mental conflict. “I am knitting a halter for Walter to lead

me to the altar.”

Clang Association a linkage of similar word sounds, such as

seven, heaven, eleven to compensate for defects in memory and communication which may be of psychic or organic origin.

Neologisms

the coining of new words that have symbolic meaning, or the conferring of new meanings upon words that are used commonly; Eisenhead (Eisenhower), newspulp (newspaper).

Blocking sudden stopping of speech

which occurs when the trend of thought has been lost owing to anxiety producing thought association.

Irrelevance verbal responses

which are not pertinent to or related to the immediate communication content, giving the impression of distractibility or a defect in comprehension and thought processes.

Circumstantiality The inclusion in conversation by a highly

anxious individual of many unnecessary details, scattered thoughts and explanations.

The pressure of invading thoughts and feedings tend to disorganize the communications and delays the reaching of the goal points of the conversation. When asked about a certain recipe,

could give minute details about going to the grocery store, the shopping experience, people there, and so on.

Flight of Ideas A continuous stream of

conversation with rapid shifts in topics owning to pressure of thoughts, sometimes characterized as topic jumping.

Word Salad a disconnected flow of communication made up of a

mixture of words, phrases, and sentences which sound meaningless and as if the product of dissociations and the pressure of invading thoughts. “ this is the atomic age and I will see the light. You

could be Helen of Troy. Or are you? Blue, yellow, green red is a rainbow in the sky. I am dedicated toa acause. My father was cremated in a barrel. Last night there was a thunder and I was poisoned. The golden rule is broken. One, two, three, four. That fellow they said is mental. Who did it?” (patient laughs without cause.)

“It’s a sure thing. You’re telling me?”

Mutism The state of being silent or

voiceless. In the absence of organic

etiology mutism is of psychic origin. It may be the result of early life frustrations experienced when attempts were made to use verbal language or it may symbolize a need to communicate.

Euphoria an abnormal exaggerated (extreme) feeling

of wellbeing which is out of proportion to environmental and interpersonal stimuli.

It may represent a pathological reaction-formation (overcompensation) to an opposite feeling state.

It may precede an emotionally exciting phase of illness and is revealed in statements such as: “I feel great! Terrific! Absolutely Jim

Dandy!”

Elation An effective reaction extending

beyond a state of euphoria, It is characterized by increased anxiety and psychomotor activity in which the person’s thinking, communications, and body movements escalate.

Apathy a dulling or reduction

of emotional response to stimuli so that one reacts with less interest, attention, and feelings than normal.

Blunting a flattening of affect or loss of the

capacity to experience and express emotion at normal intensity.

It may progress from a loss of feeling of sympathy toward a relative and to a loss of such primitive emotions as fear, rage, and the sexual drive.

Blunting is not considered a favorable prognostic sign.

Even an unfavorable emotional response is considered more desirable because it indicates the presence of an affective capacity which can be stimulated with the hope of effecting a behavior response and charge.

Ambivalence the coexistence of two opposing drives, desires,

feelings or emotions. wanting and also fearing an anticipated hearing.

One of the components of ambivalence is usually repressed but gives rise to feelings of guilt and anxiety which may be projected.

Lability sometimes characterized as

emotional instability. Owing to the sharp influence of rapidly changing thoughts and feeling tones, the patient manifest quick shifts in emotional responses, as if gliding from on into another affect. Pleasantness may be

followed in quick succession by show of irritability.

Irritability Feeling emotionally out

of harmony with a situation. “I don’t want to talk.

Don’t bother me”.

Suspicion A lack of trust in others,

often accompanied by an anxiety producing anticipation of a response from others or a helping that is feared.

Insight being able to recognize

and accept the fact that one is ill even though the dynamics of the illness are not understood.

Disorientation Being unaware of the correct date,

time, place, etc. “This isn’t a hospital. It’s a

concentration camp!” A dissociative process related to

memory impairment which may be organically caused of the result of acute mental conflict with highly affective related factors involved.

Comprehension Having an ability to

understand communications as well as what is taking place in one’s environment.

Distractibility The interference of anxiety

and environment stimuli with one’s ability to focus attention upon communications and occurrences. The a door opens, and

patient turns his attention from the immediate act or conversation.

Impairment of Judgment

Inability to adequately size up a situation or recognize the logic of explanations owing to intellectual impairments caused by organic changes or psychic conflict.

Attention Being able to focus

one’s senses and intellectual responses upon communication and environment situation for a period of time.

Suggestibility being readily responsive

to stimuli of a suggestive nature.

Accepting an imposed body posture (waxy flexibility) and carry out a posthypnotic suggestion.

Preoccupation persistent introspection

and inward reflection, thus internalizing instead of externalizing intellectual activity and affect. It is a manifestation of the defense mechanism introjections.

Hallucinations Impairment of the special

senses ( olfactory, visual, tactile, auditory) by which the patient perceives in response to his own inner stimulation, that is his beliefs, delusions, feelings, unfulfilled wishes and needs.

Illusions A misinterpretation of an

external stimulus by any of the special senses.

Hearing thunder and identifying it as a bomb

Seeing a shadow on the wall and identifying it as a mammal.

Delusions a false belief motivated by the

affective aspect of the personality to which the patient clings.

For that reason delusion cannot be changed through intellectual appeal approaches, such as, attempts to reason with the individual.

There are many type of delusions: Delusion of persecution –

“they’re out to get me” Guilt – “I’ve done terrible things

to hurt so many people” Poison – “This food is poisoned” Grandeur – “I live like a country

squire” Unworthiness – “I don’t deserve

to eat” Infidelity – “My wife has another

man”

Ideas of reference a belief held by the patient that something

in the environment has a meaning especially intended for him.

A patient hears two night nurses whispering while making rounds and says, “they’re plotting against me. I heard them”.

He may read a newspaper item and interpret it as a message intended for him.

Alien control a belief held that one is under the stronger

influence of another person or force. A patient explains his destructive action by

projecting the blame. “God told me to do it.” “I’m being dictated to from another world”

Cosmic Identification expressing the delusion that one has

abilities which may be likened to the powers of a supreme being.

This is a pathological identification defense that may be used when one has experienced personal failure and feelings of helplessness.

Depersonalization

verbalizing the belief that one no longer exist or experiences the former normal feeling reactions but is instead perceiving as if one were something inanimate or unreal and had lost the capacity to perceive as a living being.

It symbolizes a losing of one’s personal identity and escape from the reality of an emotional intolerable situation by an insecure and self observing personality.

It may be a reaction formation defense (over-compensation) against anxiety, rage or deprivation when other defenses have failed, such as hypomania.

“I don’t feel like I used to anymore” “I’m like a ghost, an empty shell” “I’m not my real self”

Transfer of Personality The client believes that he is someone else, and he

acts like that other person. The mechanisms of denial and identification are

manifested in this behavior. There is dissatisfaction with the true self and the need

to be dissociated from the discomforts and anxiety of the realities of living.

Repression is also part of this defensive behavior. a client who assumes the mannerisms of a prominent

movie star, adopted her well-know style of behavior, hair fashion and name .

Memory impairments Memory defects vary in degree and type and may be of

organic, emotional, or mixed origin and sharply circumscribed in limits of time.

Experience and recollection are split off and become consciously inaccessible.

A loss of memory for recent events is known as anterograde amnesia. this may be associated with a senile psychosis, as a

temporary effect of electrotherapy, or an aftermath of a catastrophe, such as an earthwake, fire, or flood.

Forgetting events in one’s life is known as retrograde amnesia. May be observed following a long interpersonal struggle

which terminates ina crisis situation. It demonstrates the use pathological repression and

dissociation of the present with one’s past life.

Stupor a reduction in mental

alertness and awareness which may vary in degree and depth from drowsiness to comatose states and the appearance of pathological body reflexes.

in the absence of organic causes the origin may be psychic, as is observed in catatonic stupor which is a dissociative reaction to an overwhelming emotion.

Confabulation

falsification of facts or distortion of memory which is not deliberate but the result of mental deterioration which produces gaps in memory that motivate defensive compensatory actions.

Pseudologica Fantastica

false logic of a fantastic nature that is motivated by a low self esteem and weak superego.

Impersonation of celebrities, pathological lying, and the writing of false signatures are abnormal uses of the mechanism of identification.

Basic Psychiatric Concepts and Principles in Nursing

Principles in the care of the Psychiatric

clients.

There is an interrelationship between mind and body.

Every individual has intrinsic worth and dignity Every living organism possesses a Dynamic life-

giving force. Human beings have common physical and

emotional needs. Communication is the basis of social exchange. Perceptions of reality are individualistic. Self-concepts are influence by social

interchanges. Self-awareness influence one understands of

other persons.

Ideation; feelings, moods, and actions constitute behavior.

All behaviors is never static. All behavior is meaningful and purposeful. Emotional equilibrium (homeostasis) may alter

with internal and external changes and demands.

Stress and strain maybe produced by both internal and external changes and demand.

Coping with stress and strain is an individualistic ability.

Illness can be a learning experience.

Interests and aptitudes represent growth potentialities.

Human growth and personality development represent the result of a complex process.

Knowledge of personality development structure provides a framework for studying behavior.

Individual concepts of specific illness may be of cultural social or familiar origin.

Changes which alter or threaten the capacity functioning of the human body evoke physical and emotional reaction.

Basic Psychiatric Concepts and Principles in Nursing

General Principles of Psychiatric Nursing:

Patients need to be accepted exactly as they are. Nurses can use self-understanding as a therapeutic tool. Consistency can be used effectively to contribute to

patient’s security. Patient’s need to be allowed to expression of negative

emotions. Reassurance must be given subtly and in a manner

acceptable to the patient. An intellectual, rational approach to patient’s problem

with him is useless. Anything that produces or increases patient’s anxiety is

not good for the patient. Patient’s behavior should not be interpreted to them. Discussion of personal relationship and personal values

should be initiated only by the patient.

An explanation of routine procedures should always be given on the patient’s level of understanding.

Verbal and physical force should be avoided if humanly possible.

The observation of mentally ill patients should be directed towards analysis of why the patient’s behaves as he does.

Reasonable objectively towards the patient’s behavior should contribute to the effective use of interpersonal relationships as a therapeutic atmosphere.

Intimate relationship with the patient is not conductive to a therapeutic atmosphere.

Nursing should center on the patient as a person not on the control of symptoms.

Many procedures may require modification in method to meet the needs of patient with behavior problems, but basic principles are not altered.

The social structure of the institution and the ward unit should be organized to promote social participation on the part of the patient.

The End