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ABNORMAL MOTOR BEHAVIORS Automatisms: repeated, purposeless behaviors often indicative of anxiety such as drumming fingers, twisting locks

of hair, or tapping the foot Psychomotor retardation: overall slowed movements

Echopraxia - Repeating the movements of another person Echolalia Repeating the speech of another person

Waxy flexibility: maintenance of posture or position over time even when it is awkward or uncomfortable; Having ones arms or legs placed in a certain position and holding that same position for hours

Parkinson-like symptoms Making mask like faces, drooling and having shuffling gait, tremors, and muscular rigidity. Seen in people who are on antipsychotic medication, such as phenothiazines Akathisia Displaying motor restlessness, feeling of muscular quivering; at its worst, patient is unable to sit still or lie quietly

Dyskinesia Having distortion of voluntary movements, such as involuntary muscular activity(eg. Tic, spasm or myoclonus)

SUMMARY OR ABNORMAL THOUGHT PROCESSES Ambivalence opposing impulses or feelings directed toward the same person or object at the same time Circumstantiality Digression of inappropriate thoughts into ideas, eventually reaching the desired goal;

Before getting to the point or answering a question, the patient gets caught up in countless details and explanations.

TangentialityAssociation disturbance in which the speaker goes off the topic. When it happens frequently and the speaker does not return to the topic, interpersonal communication is destroyed. Neologisms Words a person makes up that have meaning only for the person himself, often part of a delusional system Looseness of association Thinking is haphazard, illogical and confused . Connections in thought are interrupted. Seen mostly in schizophrenic disorders.
Loose association pattern of speech in which a persons ideas slip off track onto another that is completely unrelated or only slightly related (Keltner)

Flight of ideas Constant flow of speech in which the person jumps from one topic to another in rapid succession. There is a connection between some topics, although it is sometimes hard to identify. Characteristically seen in manic states. Blocking sudden cessation of a thought in the middle of a sentence. Person is unable to continue his train of thought. Often sudden new thoughts crop up that are unrelated to the topic. Can be disturbing to the individual.

Perseveration Involuntary repetition of the same thought, phrase, or motor response to differtent questions or situations. Associated with brain damage. Confabulation Filling in a memory gap with detailed fantasy believed by the teller. The purpose is to maintain self-esteem; seen in organic conditions, such as Korsakoffs psychosis.

Word salad Mixture or words and phrases that have no meaning. Hallucination A sense of perception for which no external stimuli exists.

Summary of Preoccupation in Thought Content Delusions A false belief held to be true even with evidence to the contrary. 3 common delusions: Persecution thought that one is singled out for harm by others; Grandeur that one is very powerful and important; Jealousy that ones mate is going out with other person. person might interpret everyday occurrences as proof The

Obsessions An idea, impulse or emotion that a person cannot put out of his/ her consciousness; can be mild or severe. Rituals Repetitive actions that people must do over and over until either they are exhausted or anxiety is decreased. Often done to lessen the anxiety triggered by an obsession. Phobias An intense irrational fear of an object, situation, or place. The fear persists even though the object of the fear is perfectly harmless, and the person is aware of the irrationality

Varcarolis, Elizabeth (2007) Reprinted Ed. Manual of Psychiatric Nursing Care Plans. Elsevier, Singapore

Keltner AFFECT Labile Blunted Flat Incongruent Inappropriate THOUGHT PROCESS Ambivalence opposing impulses or feelings directed toward the same person or object at the same time Circumstantiality Digression of inappropriate thoughts into ideas, eventually reaching the desired goal Tangentiality Thought blocking Loose association pattern of speech in which a persons ideas slip off track onto another that is completely unrelated or only slightly related Flight of ideas Speech patterns demonstrated by a rapid transition from topic to topic, frequently without completing any of the preceding ideas; prominent in manic states Perseveration Neologism Word salad THOUGHT CONTENT

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General Appearance and Motor Behavior


Automatisms: repeated, purposeless behaviors often indicative of anxiety such as drumming fingers, twisting locks of hair, or tapping the foot Psychomotor retardation: overall slowed movements Waxy flexibility: maintenance of posture or position over time even when it is awkward or uncomfortable Speech: quantity, quality, and any abnormalities. Talking nonstop? Perseveration -seem to be stuck on one topic and be unable to move to another idea

Are responses a minimal yes or no without elaboration? Is the content of the clients speech relevant to the question being asked? Is the rate of speech fast or slow? Is the tone audible or loud? Does the client speak in a rhyming manner? Does the client use neologisms (invented words that have meaning only for the client)? The nurse notes any speech difficulties such as stuttering or lisping.

Mood and Affect


Mood refers to the clients pervasive and enduring emotional state. Clients mood may be described as happy, sad, depressed, euphoric, anxious, or angry Affect is the outward expression of the clients emotional state. Common terms used in assessing affect include the following: Blunted affect: showing little or a slow-to respond facial expression Broad affect: displaying a full range of emotional expressions Flat affect: showing no facial expression Inappropriate affect: displaying a facial expression that is incongruent with mood or situation; often silly or giddy regardless of circumstances Restricted affect: displaying one type of expression, usually serious or somber . Labile: rapidly changing, unpredictable and rapid mood swings from depressed and crying to euphoria with no apparent stimuli,

Thought Process and Content


Thought process refers to how the client thinks which is inferred from clients speech and speech patterns. from

Thought content: helplessness, hopelessness, is what the client actually says. Circumstantial thinking: term used when a client eventually answers a question but only after giving excessive unnecessary detail Delusion: a fixed, false belief not based in reality Flight of ideas: excessive amount and rate of speech composed of fragmented or unrelated ideas Ideas of reference: clients inaccurate interpretation that general events are personally directed to him or her such as hearing a speech on the news and believing the message had personal meaning

Loose associations: disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts Tangential thinking: wandering off the topic and never providing the information requested Thought blocking: stopping abruptly in the middle of a sentence or train of thought; sometimes unable to continue the idea Thought broadcasting: a delusional belief that others can hear or know what the client is thinking Thought insertion: a delusional belief that others are putting ideas or thoughts into the clients headthat is, the ideas are not those of the client Thought withdrawal: a delusional belief that others are taking the clients thoughts away and the client is powerless to stop it Word salad: flow of unconnected words that convey no meaning to the listener

Sensorium and Intellectual Processes


Orientation refers to the clients recognition of person, place, and time; that is, knowing who and where he or she is and the correct day, date, and year. This is often documented as oriented X 3. Occasionally a fourth sphere, situation, is added (whether or not the client accurately perceives his or her current circumstances). Disorientation is the absence of correct information about person, place, and time. The order of person, place, and time is significant. When a person is disoriented, he or she first loses track of time, then place, and lastly person. Orientation returns in the reverse order: first, the person knows who he or she is, then realizes place, and finally time. Disorientation is not synonymous with confusion. A confused person cannot make sense of his or her surroundings or figure things out even though he or she may be fully oriented.

Sensory-Perceptual Alterations
Hallucinations: false sensory perceptions, or perceptual experiences that do not really exist. Hallucinations can involve the five senses and bodily sensations. Auditory hallucinations (hearing voices) are the most common; visual hallucinations (seeing things

that dont really exist) are the second most common. Initially clients perceive hallucinations as real experiences, but later in the illness they may recognize them as hallucinations.

Judgment and Insight


Judgment refers to the ability to interpret ones environment and situation correctly and to adapt ones behavior and decisions accordingly (Chow & Cummings, 2000). Problems with judgment may be evidenced as the client describes recent behavior and activities that reflect a lack of reasonable care for self or others. For example, the client may spend large sums of money on frivolous items when he or she cannot afford basic necessities such as food or clothing. Risky behaviors such as picking up strangers in bars or unprotected sexual activity also may indicate poor judgment. Insight is the ability to understand the true nature of ones situation and accept some personal responsibility for that situation.

Self-Concept
Self-concept is the way one views oneself in terms of personal worth and dignity.