CARE OF CLIENTS WITH MALADAPTIVE
PATTERS OF BEHAVIOR
ANXIETY
Is influenced by various factors.
It is more linked to chemical imbalances in the
brain, specifically the neurotransmitters
Other neurotransmitters implicated in anxiety
include:
1. Serotonin
2. Norepinephrine
3.Dopamine
CLASSIFICATION OF ANXIETY
MILD
MODERATE
SEVERE
PANIC
ANXIETY D/O CAN BE CATEGORIZED AS:
Acute Stress D/O
Agoraphobia
GAD
OCD
PTSD
Panic D/O
Phobia
NURSING CARE FOR PATIENTS WITH ANXIETY.
A holistic care is necessary to address both the physical and emotional aspect of the patient.
ASSESSMENT:
Identify the s/s of anxiety
Assess the level of anxiety
Identify the cause of anxiety
Determine to what extent does the anxiety affect the patient’s ADL.
INTERVENTION:
1. Stay by the patient
2. Establish a good interpersonal relationship
3. Demonstrate genuine listening and empathy.
4. Emphasize confidentiality of information.
5. If anxiety is related to medical procedure and treatment,provide clear and concise explanation.
6. Provide information to decrease uncertainty and fear.
7. Teach patient about deep breathing techniques, relaxation exercises,progressive muscle relaxation
techniques or mindfulness.
8.Teach about negative thought stopping and positive self talk.
9. Refer patient to counseling services and support groups as need arises.
10. Ensure a therapeutic environment.
11.Administer prescribed medications.
12. Encourage healthy eating habits, exercise, rest and relaxation.
13. Provide information to family members and ways they can support the patient.
MOOD DISORDERS
Otherwise known as affective d/o, are
disturbances in the regulation of mood,
affect, and behavior.
Can have a profound impact on the
individual’s daily functioning and quality
of life, and can be disabling.
MOST COMMON TYPE OF MOOD D/O:
1.MAJOR DEPRESSIVE D/O
Also termed UNIPOLAR MAJOR
DEPRESSION
II.BIPOLAR D/O
BIPOLAR 1- manic episodes last for
at least 7 days, depressive episodes
CLASSIFICATION OF MOOD D/O ACCDG. TO
THE NATIONAL INSTITUTE OF MENTAL
HEALTH.
III. CYCLOTHYMIC D/O
Characterized by short periods of
mild depression alternating with
short periods of mania.
IV.DYSTHYMIC D/O
Also known as PERSISTENT
DEPRESSIVE D/O
A chronic form of depression
characterized by a prolonged period
of low mood that lasts for at least 2
years in adults ( or 1 year in
children and adolescents)
INDIVIDUALS WITH MOOD D/O MAY
EXPERIENCE SYMPTOMS AS:
1. Depression
2. Mania or Hypomania
The patients with mood d/o may
demonstrate abnormalities in affect
1. Full or appropriate affect
2. Blunted affect
3. Restricted affect
4. Flat Affect
5. Labile Affect
6. Inappropriate Affect
NURSING CARE FOR PATIENTS WITH
MOOD D/O
1. ASSESSMENT
1. Assess the patient’s mood, behavior , and functional status.
2. Monitor for mood changes to include frequency and interval.
3. Assess the sleep pattern, appetite changes, and medication s/e.
4. Assess for suicidal ideation.
II. INTERVENTION
1. Provide emphatic listening.
2. Create a safe space where client feel comfortable expressing his thoughts and feelings.
3. Administer medications. Monitor adverse reactions.
4. Educate the patient about their medication and the significance of strict adherence to the
treatment regimen.
5. Assist patient in developing coping measures.
6. Refer to therapist or counsellors.
7. Inform family members to keep away materials or gadgets that can be used by patient to harm
self or others.
8. Encourage exercise, good nutrition, and adequate rest and sleep.
9. Teach about stress management techniques, mindfulness, or relaxation .
10. Provide immediate intervention during acute episodes or crises.
11. Develop safety plans, and make emergency contacts available.
12. Ensure a regular follow up or check up of the patient.
13. Provide information to the patient and family on the early warning signs of mood changes.
14. Inform patient and family on how to access resources and support system.
PERSONALITY D/O
Group of mental health condition characterized by pervasive
patterns of thinking , behavior and emotional regulation.
CLUSTERS OF PD:
CLUSTER A- ODD OR ECCENTRIC BEHAVIORS
PARANOID PD
SCHIZOID PD
SCHIZOTYPAL PD
CLUSTER B- DRAMATIC, EMOTIONAL, OR ERRATIC
BEHAVIORS
- ANTISOCIAL PD
- BORDERLINE PD
- HISTRIONIC PD
- NARCISSISTIC PD
CLUSTER C- ANXIOUS OR FEARFUL BEHAVIORS
-AVOIDANT PERSONALITY D/O
- DEPENDENT PD
- OCD PD
TREATMENT:
- PSYCHOTHERAPY with CBT
- DIALECTICAL BEHAVIORAL THERAPY
CBT- integration of individual goals of
cognitive and behavioral therapy.
CBT TECHNIQUES
- Behavioral Activation
- Mindfulness- staying present in the “here and now”
even when the present is painful.
- Cognitive restructuring- Main strategies used in
CBT.
- Stress management- Equipping one’s self with
coping skills to handle stressful situations.
- Problem solving
- Relaxation training
- Goal setting
- Assertiveness training
- Journaling and thought logs
- Cognitive distraction
DIALECTICAL BEHAVIORAL THERAPY
- Used to managed chronically suicidal patients diagnosed with Borderline PD.
NURSING CARE FOR PATIENTS WITH PD:
-ASSESSMENT:
1. Conduct a thorough assessment of the patient’s signs and symptoms, medical, and health
history, and current functioning.
2. Evaluate for the presence of other mental health issues such as mood d/o.
- INTERVENTIONS:
1. Establish good interpersonal relationship.
2. Define professional boundaries for a structures and therapeutic relationship.
3. Provide a consistent care by a constant carer to gain trust.
4. Implement behavioral therapies like DBT for Borderline PD or CBT for other types of PD.
5. Provide emotional support through emphatic listening and validation of patient’s feelings.
6. Assist in managing interpersonal conflicts.
7. Facilitate patient in developing coping skills.
8. Administer prescribed medications.
9. Monitor for any adverse effects of medications.
10. Develop safety plans.
11. Collaborate with other members of the health team
12. Encourage healthy lifestyle.
13. Ensure consistent follow up/check up .
SOMATIC SYMPTOMS AND RELATED D/O
TYPES:
1. SOMATIC SYMPTOM D/O
2. ILLNESS ANXIETY D/O(Hypochondriasis)
3. CONVERSION D/O
4. FACTITIOUS D/O(Munchausen Syndrome)
NURSING CARE FOR PATIENTS WITH SOMATIC
SYMPTOMS AND RELATED D/O:
1. ASSESSMENT
1. Obtain a detailed medical, psychiatric,and psychosocial history, focusing on the nature,
duration, and impact of physical symptoms.
2. Perform PE to rule out any underlying medical conditions.
3. Determine co-existing mental health concerns, such as depression or anxiety which
accompany somatic symptoms and related d/o.
II. INTERVENTIONS:
1. Manage physical symptoms that is supportive and non-judgmental.
2. Administer prescribed medications.
3. Monitor for symptoms of adverse reactions.
4. Facilitate access to psychotherapy.
5. Assist the patient in managing stress.
6. Teach relaxation techniques.
7. Promote healthy lifestyle.
8. Educate family members.
9. Involve family members in therapy sessions.
FEATURES OF SOMATIC SYMPTOMS AND
RELATED D/O
1. Pain, fatigue, dizziness, GI distress, or
neurological symptoms.
2. High levels of anxiety, depression, or pre
occupation with illness.
3. Repeated doctor visits, tests, and seeking
reassurance, or avoiding medical care d/t fear.
4. Symptoms caused disruption in social,
occupational, or daily functioning.
NEURODEVELOPMENTAL D/O:
- conditions that originate during the early development.
1. ASD
- Common signs:
1. Difficulty appreciating their own and other’s
emotions.
2. Difficulty with social interactions
3. Delayed speech or language development, or unusual
speech patterns.
4. Repetitive behaviors
5. Overly sensitiveghts or textures
NEURODEVELOPMENTAL D/O:
2. ADHD
3. INTELLECTUAL Disabilities-
4. DYSLEXIA
-Common signs:
1. Difficulty with phonemic awareness
2. Slow and inaccurate reading.
3. Trouble with spelling and writing.
4. Avoidance of reading tasks or activities.
COGNITIVE D/O:
- affects cognitive functions like memory, thinking,
problem-solving and attention.
1. DEMENTIA
-Symptoms:
memory loss, confusion, impaired judgment, difficulty
with language and changes in mood and behavior.
2.DELIRIUM
- characterized by confusion, disorientation, and
impaired thinking accompanied by restlessness and
agitation.
COGNITIVE D/O:
3. MILD COGNITIVE IMPAIRMENT
4. SEVERE COGNITIVE IMPAIRMENT
SEXUAL D/O:
1. DESIRE D/O
2. AROUSAL D/O
3. ORGASMIC D/O
4. PAIN D/O
SCHIZOPHRENIA
-chronic mental d/o that affects how a person thinks,
feels,and behaves.
-characterized by various impairments(WHO 2022)
1. Persistent delusions
2.Persistent hallucinations
3. Disorganized thinking
4. Highly disorganized behavior.
5. Negative symptoms like very limited speech, inability
to experience interest of pleasure, social withdrawal.
6. Extreme agitation or slowing of movements
SCHIZOPHRENIA
-TYPES:
1. PARANOID
2. DISORGANIZED(HEBEPHRENIC)
S/S :disorganized behavior (unusual posture, silly or inappropriate
behavior) disorganized speech( incoherent, looseness of association)
3.CATATONIC
- may neglect personal needs, or mimic other’s words or actions.
4. UNDIFFERENTIATED
-represent a mixed of symptoms like hallucinations, disorganized
thoughts and speech and behavior.
5. RESIDUAL
-mild hallucinations and delusions, lack of motivation, anhedonia
SCHIZOPHRENIA
-POSITIVE SYMPTOMS NEGATIVE SYMPTOMS
1. Hallucinations 1.Alogia
2. Ideas of reference 2. Blunted affect
3. Perseveration 3. Catatonia
4. Echopraxia 4. Flat affect
5. Delusions 5. Inattention
6. Bizarre behavior 6. Anhedonia
7. Flight of Ideas 7. Apathy
8. Ambivalence 8. Asociality
9. Associative looseness 9. Avolition
SCHIZOPHRENIA
- COGNITIVE SYMPTOMS AFFECTIVE
SYMPTOMS
1. Poor problem solving skills 1. Dysphoria
2. Poor decision making skills 2. Suicidality
3. Inattention- easily distracted
3.Hopelessness
4. Illogical thinking
5. Impaired judgment
EMERGING MENTAL D/O
1. INTERNET GAMING D/O
2. SOCIAL MEDIA ADDICTION
3. NOMOPHOBIA( Fear of being without a phone)
4. CLIMATE CHANGE ANXIETY(Eco-anxiety)
5. HIKKOMORI(Extreme Social Withdrawal)
6. COMPASSION FATIGUE-(Secondary Traumatic
Stress)
7. CYBERCHONDRIA
EMERGING MENTAL D/O
6. COMPASSION FATIGUE-(Secondary Traumatic Stress)
- Often experience by a healthcare professional, caregivers, or
people exposed to other’s sufferings.
- Occurs when emotionally drained from continuously caring
others.
-Symptoms:
1. emotional exhaustion
2. detachment or numbness
3.decreased empathy
7. CYBERCHONDRIA- excessive online searching for medical
information, leading to increase anxiety about one’s health.
