Psychatric

1. CARE OF THE PATIENT WITH
WITHDRAWN BEHAVIOR
W.S.H.KARUNARATHNE
GRADE 1 NURSING TUTOR
SCHOOL OF NURSING
MULLERIYAWA

2. General outcome
• At the end of this session student should be
able to ;
Apply nursing care for patient with withdrawn
behavior

3. Specific outcomes
• At the end of this session student should be
able to;
Identify characteristics of withdrawn behavior
list out risk groups of withdrawn behavior
describe common causes for withdrawn
behavior

4. Specific outcomes……
explain impacts of withdrawn behavior
Identify strategies for prevention of
withdrawal symptoms among psychiatric
patients and risk groups
application of nursing care for psychiatric
patients with withdrawn behavior

5. Withdrawn Behavior - Definition
• An adaptive or coping behavior in
which a person physically pulls away
from or psychologically loses interest
in an anxiety-producing situation, a
person or a stressful environment
(Murray and Huelskoetter, 1983).

6. Cont…d
• Can manifest over short period of time linked
to;
- Event
- Disease
- Behavior
OR;
- Prolonged and extended

7. Expression of Withdrawal
• Decrease sensory perception
• Poverty of speech
• Decrease verbal communication
• Impaired physical mobility
• Self care deficit
• Avoidance of food
• Social isolation
• Prefer to have only superficial interactions with
others

8. Expression of Withdrawal…

9. Who are at high risk?
• Younger adults
• Elderly people
• Ethnic variation
• After stroke

10. Social inaction
• State where individuals choose or unable to
take part in social actions and are
disconnected from concept of “we – ness” and
civic society

11. Suffering Groups- in Psychiatry
• Chronic schizophrenia
• Dementia
• Depression
• Substance abuse

12. Signs Of Withdrawn Behavior
• Feel loneness
• Social inaction
• home-confined lifestyle;
• lack of motivation to attend school or work;
• absence of criteria for the other psychiatric
diagnoses such as agoraphobia, schizophrenia,
etc.
• attempted suicide
• anorexia, nutritional deficiency

13. Signs of Withdrawn Behavior
• Malaise, dyspepsia, mood swings
• Poor personal hygiene
• Untreated injuries
• Secretive behavior
• Tendency to blame others and rationalize
problems

14. When MSE……
General appearance and Behavior
Speech
Mood and Affect
Thought
Perception
Cognitive function
insight

15. loneliness
• Individual’s personal, subjective sense of
lacking connection and contact with social
interactions to the extent that they are
wanted or needed

17. Causes for withdrawn behavior
• Involuntary
• Stigma
• Lack of family interaction
• Discrimination by community
• Deterioration of mental capacity( e.g.-
hallucinations , delusions)
• Increase inflammatory response
• Recurrent hospital admissions
• Increase vulnerability to stroke, heart failure and
coronary heart disease

18. Causes for withdrawn behavior….
• Lower life satisfaction
• Alcoholism
• Addiction (chemical -Substance abuse,
behavioral - intensive use of the Internet or
video games )
• Physical deformities
• POOR DRUG COMPLIANCE

19. Loss Of Family Interaction

21. Impacts of withdrawn behavior
Worse mental health and negative health
outcome;
 Premature mortality
Excessive morbidity

23. Needs Of Withdrawn Patients
• Physical needs
• Psychosocial needs
• Recreational needs
• Spiritual needs

24. Physical Needs
• Personal hygiene
• Nutrition
• Sleep
• Elimination
• Exercises

25. Psychosocial Needs
• Decrease disturbed thoughts
• Improve socialization
• Enhance self concept
• Improve attention
• Improve family support

26. Recreational Needs
Promote
- music
- dance
- sports
- art

27. Spiritual Needs
• Spiritual activities
• Meditation
• Yoga

28. Management of Withdrawn Behavior
Pharmacological management
Non - pharmacological management
- ECT
- behavioral therapy
- psychotherapy

29. Non - pharmacological management
• Increasing connectedness( improve
interpersonal relationships/ social creatures)
• Group therapy( stress management, sleep
hygiene, recreation and spirituality )
• Behavioral therapy
• Psychosocial Rehabilitation

30. Nursing diagnoses regarding
withdrawn behaviors
• Lack of sensory perception(auditory, visual)
related to withdrawal behavior
• Impaired verbal communication related to
altered perception
• Self care deficit related to feeling of
worthlessness
• Impaired social interaction related to decrease
communication

31. Nursing Interventions

32. assignment
As a nurse;
• How to improve sensory perception in a
withdrawn client?
• What kind of strategies you suggest to
improve verbal communication in a
withdrawn client?

33. Assignment……
• Give your ideas to improve Self care of a
withdrawn client
• How to increase social interaction in a
withdrawn client?
 Paln short term and long term goals

34. Lack of sensory perception(auditory,
visual) related to withdrawal behavior
• Short term goals
• Long term goals

35. Impaired verbal communication
related to altered perception
• Short term goals
• Long term goals

36. Self care deficit related to feeling of
worthlessness
• Short term goals
• Long term goals

37. Impaired social interaction related to
decrease communication
• Short term goals
• Long term goals

38. Nursing interventions for withdrawn
behavior
• Maintenance of patient’ vital functions,
ensuring safety and comfort
• Take appropriate measures to suicidal
attempts and assaults
• Approach the patient in non – threatening
way

39. • Assess the client's appearance, mood and
psychomotor behavior and identify/respond
to inappropriate/ abnormal behavior
• Assist the client with achieving and
maintaining self-control of behavior (e.g., self
care, behavior modification)
• Assist the client to develop and use strategies
to decrease anxiety

40. • Orient the client to reality
• Participate in group sessions (e.g., support
groups)
• Incorporate behavioral management
techniques when caring for a client (e.g.,
positive reinforcement, setting limits)
• Evaluate the client's response to treatment
plan

41. SUMMARY