Care of Patients with Maladaptive

Patterns of Behavior
 Psychiatric Mental Health Nursing 8th Edition
 Sheila Videbeck
NEGATIVE STIGMA
 Continue to be a source of shame for many people
(emotional & psychological problem)
 Result: keep their psychological pain in private
HISTORY
OLD TIMES
 Punishment, shame, blame
 Evil spirit
 Asylums (prolonged confinement)
 Continuously restrained in straitjackets
 Treated more like criminals
 In the Beginning

 No known treatment for the mentally ill

 Mental illness perceived as incurable
 Only “reasonable” intervention
 The Problems That Remain
 The mentally ill comprise a great majority of the
homeless population

 Many persons with chronic mental illness end up in jails

 Not enough community services/facilities to provide

adequate care for mental illness

 Medicaid, Medicare, and other 3rd-party payers do not

reimburse mental health services at the same rate as
medical services

 Continuing stigma of mental illness

MENTAL HEALTH
 Culturally determined
 Defined differently in different parts of the
world
 Behavior that might be abnormal in one
culture may be accepted and encouraged in
another culture
MENTAL HEALTH
 Successful performance of mental function, resulting
in productive activities, fulfilling relationships, and the
ability to adapt to change and cope with adversity.
 Provides people with the capacity for rational
thinking, communication skills, learning, emotional
growth, and self-esteem
 Mental health

The successful adaptation to stressors from the internal or

external environment, evidenced by thoughts, feelings, and
behaviors that are age-appropriate and congruent with local
and cultural norms.
 Mental illness

Maladaptive responses to stressors from the internal or

external environment, evidenced by thoughts, feelings, and
behaviors that are incongruent with local and cultural
norms, and interfere with the individual’s social,
occupational, and/or physical functioning.
FACTORS INFLUENCING MENTAL
HEALTH
 GENETIC

 LIFE CIRCUMSTANCES
 CHILDHOOD EXPERIENCES
 Facts about Mental Illness
Has nothing to do with
intelligence
Can happen to anyone
Chronic but not contagious
Difficult to diagnose and to
treat
Treated but not cured
Mentally ill are not all
dangerous
Should not be confused
with terms psychopath
(criminals, murderers, no
conscience) or sociopath
(personality disorder, weak
conscience, antisocial)
 General Signs of Mental Illness
 Behavior Changes
 Confusion
 Flat Affect
 Disoriented
 Withdrawn
 Darting looks
 Sad or anxious mood
 Talking to self  Panic
 Poverty of Speech  Psycho somatic complaints
 Pressured speech (physical symptoms
 Poor hygiene  caused by mental or
 Inappropriate attire  emotional disturbances)
What is mental illness like?
Mental illness is a
physical condition just
like asthma or arthritis.

But still society believes

that a person who is
mentally ill needs to
show more willpower -
to be able to pull
themselves out it.
…..It is also like telling a
person who has an
amputated leg to run
across the room.

But a person who has mental health issue

has a “broken brain”.
Myths of Mental Illness
 Mental illness is caused by bad parenting.
Fact: Most diagnosed individuals come from
supportive homes.

 The mentally ill are violent and dangerous.

Fact: Most are victims of violence.

 People with a mental disorder are not smart.

Fact: Numerous studies have shown that many
have average or above average intelligence.
CONCEPTS OF MENTAL
HEALTH/MENTAL ILLNESS
1. MH AND MI LIE IN A CONTINUUM

SEVERE PEAK
ILLNESS WELLNESS

The continuum changes considering the culture

of an individual
2. MH & MI ARE IN THE STATES OF
ADAPTATION
Adaptive – healthy
Maladaptive – pychosis/mentally ill
ex. Culture shock, war shock
3. MH AND MI ARE DYNAMIC
Everchanging

MH – ill potential
- has always the chance of being
mentally ill
MI – health potential
- has always the chance of being
mentally healthy
CRITERIA OF A MENTALLY HEALTHY
INDIVIDUAL
1. The person must have a realistic attitude towards the
individual self

Self-awareness
Knows strength & limitations
Confident
Self-esteem
Self-Acceptance
Personal Construct Theory-George Kelly
(Comparison of Actual & Ideal Self)
 2. Presence of growth, development &
self-actualization
What a person does with his abilities and potentialities
SELF-
ACTUALIZATION
SELF-
ESTEEM

LOVE

SECURITY & SAFETY

PHYSIOLOGICAL
3. Integrative Capacity

Ability to integrate the 3 Psychic factors:

1. ID
Man is naturally ID
with inborn needs
LIBIDO (Latin word “I desire”)
Operates on PLEASURE PRINCIPLE
Not in contact with reality
Continuation…3 Psychic Factors
2. EGO
Conscious
Relates to the world/reality to satisfy the demands of the
ID
Operates on REALITY PRINCIPLE
Uses problem solving
Mediates between ID and superego
a. Pre-conscious
-forgotten memories, recalls at will
b. Conscious
- aware of here and now
c. Unconscious
- Iceberg (below: unconscious, forgotten)
-Memories/emotions associated with trauma
- Dreams, slips of the tongue, jokes
Continuation…3 Psychic Factors
3. SUPEREGO
- Not complete until 7 years of age
- Standards of society
- Taboos
- Ideals
- Conscience
 Psychoanalytic: Levels of Operation
information in
awareness information within recall, but not in
awareness
(tip of tongue)

Obsessive Compulive,
Anorexia Nervosa

inaccessible, the most important level of

operation

Want-eat, sleep, urinate,

defecate
Principle:pleasure;
avoid:pain
Manic, Antisocial,
Narcissistic
Continuation…Criteria…
4. Autonomous Behavior
- Ability to make own decisions based on your
convictions
- Despite outside pressure
- Responsible for own actions
Continuation…Criteria…
Autonomous Behavior

5 FREEDOMS
 F to hear and see what is here than what was,
what will be or should be.
 F to say what one feels, & thinks instead of what
one ought to
 F to ask what one wants instead of always asking
for permission
 F to feel what one feels instead of what one
ought to
 F to take risks in one’s own behalf instead of
choosing only to be secure and not rocking the
boat (“play safe”)
Continuation…Criteria…
5. Realistic perception toward
events, environment & others
a. Sound judgment
b. Good Memory (recent & remote)
c. Appropriate Affect
Continuation…Criteria…
6. Mastery of the environment

Ability to adapt
Ability to cope up with stress
Achieve satisfaction with relationships in
work, love and play
INDICATORS OF
MENTAL ILLNESS

1. Dissatisfaction with one’s own

characteristics, abilities and achievements
2. Dissatisfaction with one’s own place in
the world
3. Ineffective IPR
4. Ineffective coping or adaptation
HUMAN BEHAVIOR
It is a complicated phenomenon
Influenced by many factors
DYNAMICS OF HUMAN BEHAVIOR
1. Behavior refers to the way in which an organism
responds to a stimulus from the environment
(smile=smile)
2. Reflex action (automatic response to a stimulus)-
approaching vehicle
3. Goal-directed
a. Presence of a need within the individual
b. Presence of a goal outside the individual/external
environment
Cont. Dynamics of Human Behavior.
Goal-Directed
Example:
Hunger
(Change in internal environment)

Search for Food

(Goal)

Resources
(From external environment to satisfy the need)

Ingesting the food

(will change his internal environment)
Cont.Dynamics of Human Behavior

4. All behaviors are purposeful, meaningful and can be

understood
- Has a reason
- May be a response to frustration


Determination makes failure

impossible
THANK YOU