Represents an individual typical way of responding to a threatening,
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
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.
Waxy FlexibilityWaxy Flexibility
An overt response to a stimulus of a suggestive nature is
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
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
It may symbolize withdrawal from emotionally painful
reality with an associated need communications.
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
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
Compulsive replacement of anxiety
through automatic duplication of the
immediately observed movements and
gestures made by another individual in the
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
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
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
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
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
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
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
the coining of new words that
have symbolic meaning, or the
conferring of new meanings
upon words that are used
sudden stopping of speech which
occurs when the trend of thought has
been lost owing to anxiety producing
verbal responses which
are not pertinent to or
related to the immediate
giving the impression of
distractibility or a defect
in comprehension and
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
characterized as topic jumping.
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
“ 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
“It’s a sure thing. You’re telling me?”
The state of being silent or
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.
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!”
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
a dulling or reduction of
emotional response to
stimuli so that one reacts with
less interest, attention, and
feelings than normal.
a flattening of affect or loss of the capacity to
experience and express emotion at normal
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
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
the coexistence of two opposing drives, desires, feelings or
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.
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
Pleasantness may be followed
in quick succession by show
Feeling emotionally out of
harmony with a situation.
“I don’t want to talk. Don’t
A lack of trust in others, often
accompanied by an anxiety
producing anticipation of a
response from others or a helping
that is feared.
being able to recognize and
accept the fact that one is ill even
though the dynamics of the
illness are not understood.
Being unaware of the correct date, time,
“This isn’t a hospital. It’s a concentration
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.
Having an ability to understand
communications as well as what is
taking place in one’s environment.
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
Being able to focus one’s
senses and intellectual
environment situation for a
period of time.
being readily responsive to
stimuli of a suggestive nature.
Accepting an imposed body
posture (waxy flexibility) and
carry out a posthypnotic
persistent introspection and
inward reflection, thus
internalizing instead of
externalizing intellectual activity
and affect. It is a manifestation of
the defense mechanism
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
A misinterpretation of an
external stimulus by any of the
Hearing thunder and identifying
it as a bomb
Seeing a shadow on the wall and
identifying it as a mammal.
a false belief motivated by the affective
aspect of the personality to which the
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
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
He may read a newspaper item and interpret it as a
message intended for him.
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”
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.
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
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
The mechanisms of denial and identification are manifested in this
There is dissatisfaction with the true self and the need to be
dissociated from the discomforts and anxiety of the realities of
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 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
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.
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.
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
false logic of a fantastic nature that is
motivated by a low self esteem and
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
Human beings have common physical and emotional
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
Ideation; feelings, moods, and actions constitute
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
Basic Psychiatric Concepts
and Principles in Nursing
General Principles of
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
Patient’s need to be allowed to expression of negative emotions.
Reassurance must be given subtly and in a manner acceptable to the
An intellectual, rational approach to patient’s problem with him is
Anything that produces or increases patient’s anxiety is not good for
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
Intimate relationship with the patient is not conductive to a therapeutic
Nursing should center on the patient as a person not on the control of
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.