Care of Clients with Maladaptive Behaviors – Comprehensive Study Notes

Mental Health: Core Definitions

  • Mental Health: Ability of individuals, couples, families, and communities to respond adaptively to internal & external stressors.
  • Mental Illness / Mental Disorder (APA):
    • Psychological or behavioral manifestations ± functional impairment.
    • Etiology can be social, psychological, genetic, physical/chemical, or biologic.
  • Comparison – Mental Health vs Mental Illness
    • Reality testing: refined & tested vs distorted/illogical thinking.
    • Emotional responses:
    • Defeat/Loss → Sadness → Withdraw.
    • Gain → Elation → Goal-directed activity.
    • Threat → Anxiety → Withdraw/Freeze/Defense prep.
    • Anger → Attack.
    • Mediated by primal cognitive processes.

Psychiatric-Mental Health Nursing

  • Definition: Interpersonal process promoting & maintaining behaviors that enable integrated functioning.
  • Combines human-behavior theory (science) + purposeful use of self (art).
  • Eight Human Response Processes:
    1. Activity
    2. Cognition
    3. Ecological
    4. Emotional
    5. Interpersonal
    6. Perception
    7. Physiologic
    8. Valuation

Populations at Risk for Mental Illness

  • Familial / genetic predisposition.
  • Poor access to health care.
  • Disadvantaged homeless & poor.
  • Substance misuse.
  • Lifestyle changes (e.g., pregnancy, adolescence).
  • Victims of violence.
  • Elderly poor.

Assessment Data for Clients with Psychiatric Illness

History of Present Illness (HPI)

  • Onset, duration, evolution of symptoms.
  • Stressful events/losses (death of loved one, job loss, financial problems).

Personal History

  • Developmental milestones & early development.
  • Childhood temperament.
  • Significant family events (death, separation, divorce).
  • History of neglect/abuse.
  • Early parental relationships.

Social History

  • Social life (loner? relationship difficulties?).
  • Alcoholism or antisocial behavior.
  • Personality changes noted by others.
  • Marital status.
  • Employment history (number of jobs & termination reasons).
  • Military record (highest rank, disciplinary actions, combat experience).

Family & Psychiatric History

  • Relatives with psychiatric hospitalization, other treatments, suicide attempts, alcohol problems, antipsychotic use.
  • Recurrence of prior problems & previous treatments.
  • Substance use/abuse (alcohol, illicit drugs).

Mental Status Examination (MSE)

Appearance

  • Dress, grooming, unusual features, gestures.

Attitude Toward Examiner

  • Hostile, cooperative, etc.

Behavior & Psychomotor Activity

  • Mannerisms, agitation, inability to sit still, bizarre postures.
  • Automatisms: purposeless, repetitive (e.g., drumming fingers, pacing).
  • Psychomotor retardation: global motor slowing.
  • Waxy flexibility: maintains awkward posture for long time.
  • Echopraxia: purposeless imitation of others' movements.

Speech

  • Rate: rapid / slow / halting.
  • Amount: lacking spontaneity / grandiose.
  • Tone: monotone / singsong / slurred.
  • Impairments: stuttering, echolalia, aphasia.

Communication/Thought Process Abnormalities

  • Loosening of associations.
  • Neologism.
  • Mutism (extreme negativism).
  • Word salad.
  • Circumstantiality vs Tangentiality.
  • Blocking.
  • Perseveration.
  • Echolalia.
  • Flight of ideas.
  • Verbigeration.
  • Pressured speech.
  • Clang associations.
  • Stilted language.
  • Poverty of speech.
  • Latency of response (30–45 s hesitations).

Mood & Affect

  • Mood: internal emotional state.
  • Affect: outward expression.
  • Labile, flat, restricted, inappropriate, elation, anhedonia, ambivalence.

Perception

  • Hallucinations (no external stimulus):
    • Auditory (voices commenting, commanding, criticizing).
    • Visual (e.g., aliens).
    • Gustatory/Olfactory (often unpleasant odors).
    • Tactile – formication (insects crawling).
    • Kinesthetic (out-of-body/floating experience).
  • Illusions (misinterpretation of real stimuli):
    • Déjà vu (unfamiliar → familiar).
    • Jamais vu (familiar → unfamiliar).

Thought Content

  • Delusions (fixed false beliefs):
    • Persecution.
    • Reference.
    • Influence/control.
    • Thought broadcasting.
    • Grandiose.
  • Obsessions (intrusive, recognized as irrational).
  • Compulsions (ritualistic acts to relieve obsessional anxiety).
  • Magical thinking.

Motor Activity (Catatonia etc.)

  • Catatonic stupor (immobility).
  • Catatonic posturing.
  • Catatonic rigidity.
  • Catatonic excitement.
  • Waxy flexibility.
  • Echopraxia.

Personality & Levels of Consciousness

Personality

  • Aggregate of physical & mental qualities manifested in environmental interactions.

Levels of Consciousness (Freudian)

  1. Conscious: present awareness, here & now.
  2. Preconscious/Subconscious: partially remembered experiences, easily recalled.
  3. Unconscious: vast storehouse of life experiences, especially painful ones; not voluntarily accessible.
  • Unconscious activity examples: slips of tongue/pen, motivated forgetting, accidents, dreams.

Structures of Personality (Freud)

  • Id: primitive drives (pleasure principle); instinct, aggression, sexuality; immediate gratification; no regard for social rules.
  • Ego: conscious self; reality principle; mediator between Id & Superego.
  • Superego: conscience; moral/ethical values; parental standards; censors Id impulses.

Major Theories of Personality Development

  1. Sigmund Freud – Psychosexual (libido energy).
  2. Erik Erikson – Eight life-span psychosocial stages.
  3. Harry Stack Sullivan – Interpersonal (mother–infant relationship).
  4. Jean Piaget – Cognitive developmental stages.
  5. Adolf Meyer – Psychobiologic.
  6. Carl Jung – Analytical psychology.

Ego Defense Mechanisms

(Operate unconsciously except suppression)

  • Purpose: reduce anxiety, protect self-esteem, distort/deny reality.
  • Repression: exclude painful thoughts → unconscious.
  • Suppression (conscious) – voluntary exclusion (“I’d rather not talk about it”).
  • Regression – revert to earlier developmental behaviors.
  • Undoing – symbolic reversal (guilt relief).
  • Reaction Formation – act opposite to unacceptable impulse.
  • Displacement – shift emotion to safer target.
  • Substitution – accept easier/less gratifying alternative.
  • Sublimation – channel unacceptable impulse → socially acceptable (e.g., art).
  • Compensation – exaggerate trait to mask inferiority.
  • Identification – adopt admired attributes.
  • Introjection – internalize others’ opinions (e.g., persecution ideas).
  • Conversion – emotional conflict → physical symptom.
  • Projection – attribute own unacceptable feelings to others (blaming).
  • Symbolization – represent impulse via symbol (e.g., hand washing → guilt).
  • Denial – refuse to acknowledge reality (“Wala akong sakit”).
  • Rationalization – logical but false excuses.
  • Fantasy – daydreaming to satisfy wishes; pathological if replacing reality.
  • Isolation – separate idea from emotion.
  • Resistance – antagonism to processing painful material.
  • Dissociation – temporary alteration in consciousness/identity.
  • Splitting – extremes of good vs bad (common in Borderline PD).
  • Intellectualization – over-reasoning to avoid emotion (illness research, breakup).

Common Defense Mechanisms in Disorders

  • Paranoid → Projection.
  • Phobia → Displacement.
  • Amnesia → Dissociation.
  • Anorexia → Suppression.
  • Bipolar Disorder → Reaction Formation.
  • Borderline → Splitting.
  • Schizophrenia → Regression.
  • Substance Abuse → Denial.
  • Depression → Introjection.
  • Obsessive–Compulsive → Undoing.
  • Catatonic → Repression.