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
THEORIES OF PSYCHOPATHOLOGY
Relevant Theories of Psychopathology

1. Psychoanalytic Model
2. Psychosocial/Interpersonal Model
3. Humanistic Model
4. Behavioral Model
5. Cognitive Model
6. Sociocultural Model
7. Neurobiological Model
Theories of Psychopathology

 Psychoanalytic Model
 Founder: Sigmund Freud
 Freudian concepts:
1. Levels of consciousness
2. Structure of personality
3. Anxiety and defense mechanisms
4. Psychosexual theory of personality
development.
The Id, ego & superego in resolving conflicts

Stimulus Drive Response Resolution

Id: Eats cake & feels satisfied

momentarily. May become
“I must have it, now”
stimulus for guilt
_____________
_____________
Does not eat. May
Superego: become stimulus for sad
or angry feelings
“I must not eat”
Hunger,desire
_____________
for cake _____________
Ego:
“I would like to have
it now, but I have just Drive is reduced
eaten a big meal. I
will wait until later in
the day & have a
small portion”
Mental Illness

 Stems from childhood conflicts.

 If these conflicts remain unresolved in
the unconscious, eventually bring
about abnormal behavior during
adulthood.
Erikson’s Ego Theory
 Role of the ego.

 Culture and society exert significant

influence on personality.

 Emotional experiences beyond the first 5

years.

 Strengths and weaknesses; failures at one

stage could be rectified by successes at
later stages.
 Stage Psychosocial Significant Psychosocial Positive Negative
Crisis Relations/ Modalities Outcome Outcome
Factor
Infant Trust vs. Mother To get, to give Trust Fear & concern
(0-1 ½ ) Mistrust (Feeding) in return

Toddler Autonomy vs Parents To hold on, to Self-sufficiency Self doubt

(1 ½ -3) Shame and (Toilet training let go
doubt is not hurried)
Au-anal
To-ilet trng
No
My
Preschool Initiative vs. Family To go after, Discovery of Guilt from
(3-6) guilt Independence To play ways to initiate actions and
(If the child’s actions thoughts
sexual curiosity
is handled w/o
anxiety)
 Stage Psychosocial Significant Psychosocial Positive Negative
Crisis Relations/ Modalities Outcome Outcome
Factor
School-age Industry vs. Neighborhood and To complete, to Competence No sense of
(6-12) Inferiority school make things mastery
Industry School(if together
the child’s efforts at
learning is
supported)
Adolescence Ego identity Peer groups, role To be oneself, to Self awareness Identify roles in
(12-20) vs Role models share oneself life
confusion Peers “Who am I?”
If the adolescent’s
vocational decision
is supported
Young adult Intimacy vs. Partners, friends To lose and find Loving, sexual Fear of
(20-30) isolation Decision regarding oneself in relationships, relationships
love is supp another close friendships with others
 Stage Psychosocial Significant Psychosocial Positive Negative
Crisis Relations/ Modalities Outcome Outcome
Factor
Middle adult Generativity vs. Household, To make be, to Sense of Trivialization of
(30-65) Self absorption/ workmates take care of productivity one’s activities
stagnation Parenting (adult
enjoys support
from family)

Late adult Integrity vs Mankind or “my To be, through Sense of unity Regret over lost
(65 and above) despair kind” having been, to in life’s opportunities of
Satisfying past face not being accomplishmen life
recollection ts
Eight Ages of Man

 Developmental Tasks  Psychosocial Strength

1. Trust Hope
2. Autonomy Will
3. Initiative Purpose
4. Industry Self-worth
5. Identity Fidelity
6. Intimacy Love
7. Generativity Care
8. Integrity Wisdom
Implications for Psychiatric Mental
Health Nursing
 Partof patient assessment.
 Developmental framework

• Mental illness results from social

conflicts arising from feelings, parent-
child interactions and social
relationships.
Theories of Psychopathology
 Interpersonal Model

 Based on interpersonal relationships.

 Harry Stack Sullivan
 Goal-directed behavior
 Fulfillment of two needs, the need for
satisfaction and the need for security
 Dynamisms to relieve tension
SULLIVAN’S INTERPERSONAL THEORY

 Sullivanexplained six developmental stages

called "epochs" or heuristic Stages in
Development.
 Sullivan’s Interpersonal Theory
Stages Age Characteristics
Infancy 0-18months Gratification of needs

Childhood 18months- Delayed gratification

6 years
Importance of
Interpersonal Juvenile 6-9years Formation of peer group
relationships
Pre-adolescence 9-12 years Developing relationships
w/ same gender
Early Adolescence 12-14years Identity

Late Adolescence 14-21years Forming lasting, intimate

relationships
3 Types of Self

Good Me Bad Me Not me

• Based on • Refers to
• Based on social the
social appraisal unknown
appraisal • and the • Repressed
anxiety component
that results of the self
from
negative
feedback
Theories of Psychopathology

 Security operations: those measures that the

individual employs to reduce anxiety and
enhance security.
 apathy, somnolent detachment, selective
inattention, and preoccupation

 The self-concept is the result of reflected

appraisals of significant others : “good me,”
“bad me,” “not me.”
Theories of Psychopathology
 Humanistic model

 Focuses on a person’s positive

qualities.
 Human potential and capacity to
change.
 Choice, self-esteem, personal growth,
capacity for self-actualization.
 Abraham Maslow
 Self-actualized personality
Hierarchy of Needs

 Basic
needs as “D-motives” or “deficiency
needs.” – basic survival.

 “B-motives” or “being needs.” – growth

motivation.

 CarlRogers: clients do “the work of

healing, and within a supportive and
nurturing client-therapist relationship
Love, affection,atention
Actual self vs Ideal self

that love seems to only come when

certain conditions are met.
 conditions necessary
for the growth of a healthy
personality:
1. genuiness
2. acceptance
3. empathy

Client centered
Maslow’s
Hierarchy of Self Actualization

Needs Need to be self-fulfilled, learn, create, understand and

experience one’s potential

Self-esteem
Need to be well thought of by oneself as well as by others

Love
Need for affection, feelings of belongingness, and meaningful
relations with others

Security and Safety

Need for shelter and freedom from harm and danger

Physiologic
Oxygen, food, water, rest and elimination. The need for sex is
unnecessary for indl survival but nec for human kind
Mental Illness

 Ifour natural growth toward self-

fulfillment is blocked by negative
criticism/thinking and conditions of worth
→ negative SC, that obstructs our growth
and distorts our view of the world.
Theories of Psychopathology
 Behavioral Model
 Personality as a learned response– if
behavior changes, so does personality.

 Behavior
can be modified in a particular
environment.

 Conditioninginvolves pairing a behavior

with a condition that reinforces or
diminishes the behavior’s occurrence.
Theories of Psychopathology

 Operant Conditioning (Skinner)

A desired behavior can be increased

through positive and negative
reinforcement.

 Behavioris decreased through punishment

and extinction.
 Exhibitionism

Notices erection
Paraphilias:
Sexual abuse
Transfer to a less attractive incarceration
setting

Emetic, shock

Stops behavior (foul odor)

Theories of Psychopathology
 Cognitive Model

 Albert Ellis Rational Emotive Therapy – focus on “here

and now” issues ; to live fully in the present & look
forward to the future.

 Aaron Beck – how people feel and behave is

determined by the way in which they think about the
world and their place in the world.

“Unless, I do everything perfectly, I’m a failure.”

Mental Illness

 Abnormal behavior as a result of distorted

or irrational thinking that leads to
inappropriate and self-defeating behaviors.
Theories of Psychopathology
 Sociocultural Model

 People’s behavior is shaped by family,

society and cultural influences.

 The kinds of stresses and conflicts people

experience(abuse, poverty)

 Mental illness is an attempt to adjust to

an unjust society.
 Theories of Psychopathology
Neurobiological Model

 Abnormal behavior as part of a disease

process or a defect; usually in the limbic
system of the brain and the synapse
receptor sites of the CNS.

 Psychotropic drugs control the main

symptoms of the mental illness or disorder.

 Brain Imaging Techniques

Brain Imaging Techniques

 Computed tomography (CT) – x-ray images

of the brain “slices” serial x-rays of brain.

 Magneticresonance imaging (MRI) –

magnetic field to the brain “sections” radio
waves from brain detected from magnet
Diagnostic Examinations

 Positron-emissiontomography (PET) –
radioactive substance is injected to the
brain “bright spots” radioactive tracer
injected into bloodstream and monitored as
client performs activities.

 Single photon emission tomography (SPECT)