EGO DEFENSE MECHANISMS COUNTERTRANSFERENCE is the

redirection of a therapist's feelings toward

Sigmund Freud: The Father of
the client.
Psychoanalysis
DEFENSE MECHANISMS are unconscious
Freud believed that repressed (driven from
strategies our minds use to protect itself
conscious awareness) sexual impulses and
from anxiety by denying and distorting
desires motivate much human behaviour.
reality in some way.
PERSONALITY COMPONENTS
While all defense mechanisms can be
Freud conceptualized personality structure unhealthy, they can also be adaptive and
as having THREE COMPONENTS: allow us to function normally.

1. ID The greatest problems arise when defense

•
reflects basic or innate mechanisms are overused.
desires such as pleasure-
Defenses may hide any of a variety of
seeking behaviour,
thoughts or feelings:
aggression, and sexual
impulses. • ANGER
2. SUPEREGO • FEAR
• reflects moral and ethical • SADNESS
concepts, values, and • DEPRESSION
parental and social • GREED
expectations, therefore it is • ENVY
in direct opposition to the id. • COMPETITIVENESS
3. EGO • PASSION
• balancing or mediating force • ADMIRATION
between the id and the • DEPENDENCY
superego.
• SELFISHNESS
FREUD’S LEVEL OF AWARENESS • GRANDIOSITY
• HELPLESSNESS
Behaviour motivated by subconscious
• LOVE
thoughts and feelings. Freud believed that
the human personality functions at THREE 3 MAIN CATEGORIES:
LEVELS OF AWARENESS:
1. PRIMITIVE
1. CONSCIOUS 2. LESS PRIMITIVE/ MORE MATURE
2. PRECONSCIOUS 3. MATURE
3. SUBCONSCIOUS
PRIMITIVE
TRANSFERENCE VS
1. DENIAL
COUNTERTRANSFERENCE
• one of the best known, most
TRANSFERENCE is the redirection of primitive defense mechanism.
feelings about a specific person onto o Examples: Drug addicts
someone else (in therapy, this refers to a or alcoholics one deny
client's projection of their feelings about that they have a problem,
someone else onto their therapist). while victims of
traumatic events may

1
 deny that the event ever other parts and behaving as if
occurred. one had separate sets of values.
2. REGRESSION 6. PROJECTION
• When confronted by stressful • Taking our own unacceptable
events, people sometimes qualities or feelings and
abandon coping strategies and blaming them on other people.
revert to patterns of behavior • It's always someone else
used earlier in development. causing the problem.
o Example: an individual o For example, if you have
fixated at an earlier a strong dislike for
developmental stage someone, you might
might cry or sulk upon instead believe that he or
hearing unpleasant she does not like you.
news. 7. REACTION FORMATION
3. ACTING OUT • Reduces anxiety by taking up
• performing an extreme the opposite feeling, impulse,
behavior to express thought or or behavior.
feelings the person feels o An example of reactions
incapable of otherwise formation would be
expressing. treating someone you
• When a person acts out, it can strongly dislike in an
act as a pressure phase, and excessively friendly
often helps the individual feel manner to hide your true
calmer and peaceful one again. feelings.
• Self-injury may also be a form of
acting-out, expressing in
physical pain what one cannot LESS PRIMITVE/ MORE MATURE:
stand to feeI emotionally.
A step up from the primitive defense
o Example: instead of
mechanism in the previous section.
saying,” I am really hurt or
angry with you!” a person 1. REPRESSION
who acts out may throw • A well-known defense
an object at the person or mechanism.
punch a wall. • It acts to keep information out of
4. DISSOCIATION conscious awareness. However,
• when a person loses track of these memories don't just
time and/or person, and instead disappear, they continue to
finds another representation of influence our behavior.
their self to continue in the o Example: A person who
moment. has repressed memories
• Have a history of any kind of of abuse suffered as a
childhood abuse often suffer child may later have
from some form of dissociation. difficulty forming
5. COMPARTMENTALIZATION relationships.
• A lesser form of dissociation, 2. DISPLACEMENT
wherein parts of oneself are • taking out our frustration,
separated from awareness of feelings and impulses on

2
 people or objects that are less person anyways, or a
threatening. student who fails a test
o Rather than express our may blame the teaching
anger in ways that could style rather than his or
lead to negative her lack of real studying.
consequences (like 5. UNDOING
arguing with our • Attempt to take back an
teacher), we instead unconscious behavior or thought
express our anger toward that is unacceptable or hurtful.
a person or object that o Example: After realizing
poses no threat (spouse, you just insulted your
parents, children, pets). significant other
3. INTELLECTUALIZATION unintentionally, you
• To reduce anxiety by thinking might see the next hour
about events in a cold, clinical praising their beauty,
way. charm, or intellect.
• Allows us to avoid thinking about
MATURE DEFENSE MECHANISM
the stressful, emotional aspect
of the situation and instead Mature defense mechanisms are often the
focus only on the intellectual most constructive and helpful to most
component. adults but may require practice and effort to
o For example, a person put into daily use.
who has just been
1. SUBLIMATION
diagnosed with a
terminal illness might • Allows us to act out unacceptable
focus on learning impulses by converting these
everything about the behaviours into a more acceptable
disease to avoid distress form.
and remain distant from o For example, a person
the reality of the experiencing extreme
situation. anger or frustration might
4. RATIONALIZATION take up kickboxing as a
means of venting
• Involves explaining an
frustration.
unacceptable behavior or
2. COMPENSATION
feeling in a rational or logical
manner, avoiding true reasons • This is a process of psychologically
for the behavior. counterbalancing perceived
weakness by emphasizing strength
• Rationalization not only prevents
in other arenas.
anxiety, but it may also protect
o For instance, when a
self-esteem and self, concept.
person says,” I may not
• Making something wrong
know how to cook, buy I
sound right.
sure can do the dishes!”
o For example, a person
they are trying to
who is turned down for a
compensate for their
date might rationalize the
lace of cooking skills by
situation by saying they
emphasizing cleaning
were not attracted to the
skills instead.

3
THERAPEUTIC AND NON- THERAPEUTIC 2. PARAVERBAL OR PARALINGUISTIC
COMMUNICATION • It adds meaning to a
message.
3. NON-VERBAL COMMUNICATION
COMMUNICATION is the process of • This involves transmission of
sharing information or the process of messages without the use of
generating and transmitting meanings. words.
• It involves facial expression,
• Act of conveying meanings from one
posture, touch, gestures,
body or group to another through the
physical appearance, eye
use of mutually understood signs,
contact, and other body
symbols, and semiotic rules.
movements.
• Foundation of our way of life
• Considered more accurate
• A requirement for a person’s well-
expressions of true feelings.
being.
• Social interactions among people are EXAMPLES OF NON-VERBAL
necessary to fulfill some of their most COMMUNICATION
elemental psychosocial needs, such
1. FACIAL EXPRESSION
as love, affection, and recognition.
• Considered as the greatest
• Originally came from the Latin word
conveyor of nonverbal
“communicare” which means “to
messages.
impart, share, or make common.”
2. POSTURE
GENERAL PURPOSES OF COMMUNICATION • May indicate anxiety,
relaxation, negative or
• To gather information positive image, confidence,
• To validate information depression, bodily
• To share information condition, acceptance or
• To develop a trusting relationship interest, rejection or
• To express feelings aversion, exhaustion, or
• To imagine boredom.
• To influence 3. GESTURE
• To meet social expectations • Movements of body parts
such as shrugging of
ELEMENTS OF COMMUNICATION
shoulders, waving the hands,
1. REFERENT OR STIMULUS tapping the feet.
2. SENDER OR ENCODER 4. TOUCH
3. MESSAGE • Can be used to soothe,
4. CHANNEL comfort, and establish
5. RECEIVER OR DECODER rapport.
6. FEEDBACK • It can reflect a sense of
caring but can also be
MODES OF COMMUNICATION
perceived as hostile.
1. VERBAL COMMUNICATION • It should be used cautiously
• This involves spoken and to patients or clients who
written words. are:
o Confused
o Aggressive

4
 o Suspicious 9. LACK OF KNOWLEDGE ON THE
o Victims of abuse TOPIC
5. PHYSICAL APPEARANCE OR 10. INFORMATION OVERLOAD
ARTIFACTS
PHASES OF A THERAPEUTIC
• Involve items in the client’s
RELATIONSHIP
environment such as
grooming or use of clothing • Pre-orientation or pre-interaction
and jewellery. phase
• May convey nonverbal • Orientation phase
messages that might o The tone and guidelines for
enhance or hinder the real the relationship are
message of the spoken established.
words. o The nurse and client are
6. PROXEMICS strangers to each other;
• Involves distance. however, each individual has
o Intimate (0-18 inches) preconceptions of what to
o Personal (18 inches- 4 expect – based on previous
feet) relationships, experiences,
o Social (4 feet- 12 feet) attitudes, and beliefs.
o Public (12 feet-limit) o The parameters of the
7. CHRONEMICS relationship are established
• The study of the use of time. (e.g., place of meeting,
• It includes punctuality, length, frequency, role, or
willingness to wait, and service offered,
interactions. confidentiality, duration of
• The use of time affects relationship).
lifestyle, daily agenda, speed • Working phase
of speech and movements. o The working phase is the
longest phase.
TYPES OF COMMUNICATION
o This is where nursing
1. SOCIAL COMMUNICATION interventions usually take
2. THERAPEUTIC COMMUNICATION place.
3. FORMAL COMMUNICATION o Problems and issues are
identified and plans to
BARRIERS TO EFFECTIVE address these are put into
COMMUNICATION action. Positive changes may
1. GIVING AN OPINION alternate with resistance
2. OFFERING FALSE REASSURANCES and/or lack of change.
3. BEING DEFENSIVE o Interaction is the essence of
4. SHOWING APPROVAL OR this phase.
DISAPPROVAL o It is vital for the nurse to
5. STEREOTYPING validate thoughts, feelings,
6. CHANGING THE SUBJECT MATTER and behaviours.
INAPPROPRIATELY • Termination
7. LANGUAGE BARRIER o The resolution or ending
8. TIME BARRIER phase is the final stage of the
nurse-client relationship.

5
 o This occurs when the you might be pursuing
conclusion of the initial specific information.
agreement is acknowledged. o Specific, open-ended
o After the client’s problems or questions, otherwise
issues are addressed, the known as leads, can be a
relationship needs to be productive way to get the
completed before it can be details you need for
terminated. offering the best possible
o The ending of the nurse- care to your patient.
client relationship is based RESTATING
on mutual understanding o Repeating the exact
and a celebration of goals words of patients to
that have been met. remind them of what they
o Both the nurse and the client said and to let them know
experience growth. they are heard.
VERBALIZING THE IMPLIED
o Involves putting clearly
THERAPEUTIC COMMUNICATION into words what the
TECHNIQUES patient has suggested.
o Verbalizing tends to
OFFERING SELF make the discussion less
o making self-available obscure.
and showing interest and o Agreeing, or giving
concern. approval, indicates the
SILENCE patient is right or wrong.
o Planned absence of CLARIFICATION
verbal remarks to allow o Asking patient to restate,
patient and nurse to elaborate, or give
think over what is being examples of ideas or
discussed and to say feelings to seek
more. clarification of what is
EMPATHY unclear.
o Planned absence of BROAD OPENINGS
verbal remarks to allow o It can be a good way to
patient and nurse to think allow patients an
over what is being opportunity to discuss
discussed and to say what’s on their mind.
more. o “What do you want to talk
EXPLORING about today? “What’s on
o Essentially a method of your mind today?” “What
asking follow-up would you like to talk
questions without giving about?”
the patient the ENCOURAGING EXPRESSIONS
impression that you’re o To encourage the
probing. expression of feelings
GENERAL LEADS and ideas.
o Sometimes when
interacting with a patient,

6
GIVING RECOGNITION differences among
o Recognition feelings, behaviours, and
acknowledges a patient’s events.
behavior and highlights it SUMMARZING
without giving an overt o reviewing the main
compliment. points of discussions
o A compliment can and making appropriate
sometimes be taken as conclusions.
condescending, FOCUSING
especially when it o “Explain more about…”
concerns a routine task ENCOURAGING EVALUATION
like making the bed. o “So, what does all this
MAKING OBSERVATION mean to you?”
o Observations about the SEEKING INFORMATION
appearance, demeanour, o “I’m not sure that I
or behavior of patients follow.”
can help draw attention SUGGESTION
to areas that might pose COLLABORATION
a problem for them. o “I can help you
PRESENTING REALITY/ understand this better.”
CONFRONTING ENCOURAGING GOAL SETTING
o Stating what is real and o “What do you think
what is not without needs to change?”
arguing with the patient. GIVING INFORMATION
ENCOURAGING DESCRIPTION o “I can tell you about your
OF PERCEPTIONS medicines.”
o Asking the patients to REFLECTION
describe feelings, o (Kliyente: “Sa tingin mo
perceptions, and views dapat ko nang sabihin sa
of their situations. doktor?) Nurse: (Nars:
o For patients experiencing “Sa tingin mo
sensory issues or kailangan?”)
hallucinations, it can be FORMULATING A PLAN OF
helpful to ask about ACTION
them in an encouraging, o “What exactly will it take
nonjudgmental way. to carry out your plan?”
VOICING DOUBT
NON-THERAPEUTIC COMMUNICATION
o Voicing uncertainty
TECHNIQUES
about the reality of
patient’s statements, ADVISING
perceptions, and o Telling the client what to
conclusions. do, giving opinions or
PLACING EVENT IN TIME OR making decisions for the
SEQUENCE client, implies client
ENCOURAGING cannot handle his or her
COMPARISONS own life decisions and
o asking to describe that the nurse is
similarities and accepting responsibility.

7
 ▪ Nontherapeutic down into the
response: "I think dumps." "I've felt
you should..." "If I that way
were you, I'd... “ sometimes."
AGREEING ▪ Therapeutic
o -indicating agreement response: "Tell
with client me about being
▪ Nontherapeutic down in the
responses: dumps." "You
"That's right." "I have the right to
agree." your own
▪ Therapeutic feelings." Client:
responses: “I have nothing to
"What did you live for . . .I wish I
think of Frank is was dead.”
yelling at you?" or Nurse:
"What part of this “Everybody gets
argument did you down in the
think was right?" dumps.” “I’ve felt
APPROVAL that way myself.”
o Sanctioning the client’s CHALLENGING
behavior or ideas o Demanding proof from
▪ Nontherapeutic the client
response: "You ▪ Nontherapeutic
were good to response:
have done "Everybody gets
that...” "I’m glad down into the
that you..." dumps." "I've felt
▪ Therapeutic that way
response: "Tell sometimes."
me how you think ▪ Therapeutic
you performed response: "Tell
when you told me about being
Lucy you were down in the
sorry for hurting dumps." "You
her feelings." have the right to
"What do you see your own
as the best part feelings." Client:
of giving a “I have nothing to
present to live for . . .I wish I
Denise? was dead.”
BELITTLING FEELINGS Nurse:
EXPRESSED “Everybody gets
o Misjudging the degree of down in the
the client’s discomfort dumps.” “I’ve felt
▪ Nontherapeutic that way myself.”
response:
"Everybody gets

8
DEFENDING happen to you if
o Attempting to protect you jumped off
someone or something the roof?"
from verbal attack. DISAPPROVING
▪ Nontherapeutic o Denouncing the client’s
response: "No behavior or ideas
one here would ▪ Nontherapeutic
lie to you." "Miss responses: "How
is a very capable can you consider
nurse." divorce when you
▪ Therapeutic have four
response: "Who children?" "How
is one person you can having a
think lied to baby fix your
you?" "I can't relationship
speak for Miss, when you're not
but I see you are even married?"
upset. Tell me "That's not living
your concerns." by the Golden
DESTRUCTIVE HUMOR Rule." "Get a life."
o Any humour that "Shape up." "You
belittles, implies guilt or need to start a
incompetence, new
continually refocuses relationship."
client on topic selected ▪ Therapeutic
by nurse, or is met with responses:
client displeasure. "What is one
▪ “This hospital reason you are
has a fine considering
reputation.” divorce?" "What
▪ “I’m sure your is one way you
doctor has your believe having a
best interests in baby would save
mind.” your
DISAGREEING relationship?"
o opposing the client’s "How do you see
ideas yourself handling
▪ Nontherapeutic this problem?”
responses: EGOCENTRIC FOCUS
"That's wrong." "I o Nurse enjoys being
don’t believe centre of attention and
that. “ “I answering questions
definitely about self and winds up
disagree with . . .” being interviewed by the
▪ Therapeutic client.
responses: o Nurse is focused on
"What do you thinking what to ask next
think would instead of actively

9
 processing client’s think this is
message. about?"
▪ Nontherapeutic INTRODUCING AN UNRELATED
response by TOPIC
nurse: "My o Changing the subject
girlfriend and I ▪ Client: "I wish I
love to go were dead."
camping. We Nontherapeutic
have been to 36 response: "Did
states so far. We you have
dance and make visitors?"
stained glass, ▪ Therapeutic
too. “ responses: "Tell
▪ Therapeutic me about
response: "What wishing you were
is one of your dead." "What is
hobbies?” going on that you
GIVING LITERAL RESPONSES wish to be
o Responding to figurative dead?" "Are you
comments as though it planning to
were a statement of fact. commit
▪ Client: “They’re suicide?"
looking in my JUDGING
head with a o Rejecting the client’s
television action, thoughts, or
camera.” feelings because they do
▪ Nurse: “Try not to not agree with your moral
watch code or life choices.
television.” ▪ Nontherapeutic
“What responses: "You
channels?” don't need to call
INTERPRETING your mother at
o telling the client the midnight." 'Don't
meaning of his or her ever let me hear
experience you are thinking
▪ Nontherapeutic about running
response: "What away again."
you really mean ▪ Therapeutic
is..." responses:
"Unconsciously "What's going on
you're saying...," that you feel like
▪ Therapeutic running away?"
responses: "Your "Your mom says
conversation she gets
evolves around frightened when
Sam's getting the you call her at
scholarship. night. Tell me
What do you what you are

10
 experiencing so not to worry or be
we can work anxious.
together on ASKING FOR EXPLANATIONS
helping you to o A nurse may be tempted
wait till the to ask the other person to
morning to call explain why the person
Mom.” believes, feels or is
USING DENIAL acting in a certain way.
o Refusing to admit that a Clients frequently
problem exists. Closes interpret why questions
off avenue for discussion as accusations.
▪ Client: "I'm ▪ “Why” questions
dead." can cause
Nontherapeutic resentment,
response: "You insecurity, and
can't mean that." mistrust. It’s best
▪ Therapeutic to phrase a
responses: question to avoid
"What is one using the word
aspect of “why”.
yourself that has ▪ You seem upset.
withered and What’s on your
died?" "What is mind?” “Why are
going on that you you so upset?”
say you are
dead?"
PROBING THE NERVOUS SYSTEM
o Persistent questioning of
the client or asking about What causes a sensory neuron to fire?
unrelated topics Incoming signals can be either excitatory-
▪ Client: "And so which means they tend to make the neuron
my wife and I fire (generate an electrical impulse) or
split up." inhibitory- which means that they tend to
Nontherapeutic keep the neuron from firing.
response: "Now
tell me about Most neurons receive many input signals
your mother.” throughout their dendritic trees.
▪ Therapeutic NEUROTRANSIMITTERS
response: "Tell
me about you • Chemicals found and produced in
and your wife the brain to allow the transmission of
splitting up." impulses from one nerve cell to the
Reassuring— next across synapses.
trying to make • They aid in the conduction of
the client feel information throughout the body.
better
ACETYLCHOLINE (ACH)
superficially and

11
 • Deals with motor movement and • The brain
memory • Spinal cord
• Lack of ACH has been linked
Peripheral Nervous System
Alzheimer's disease.
• All nerves that are not encased in
DOPAMINE
bone.
• Deals with motor movement and • Everything but not the brain and
alertness. spinal cord.
• Lock of dopamine has been linked to • Is divided into †wo categories:
Parkinson ‘s disease. o somatic and
• Too much has been linked †o o autonomic
schizophrenia.
Somatic Nervous System
SEROTONIN
• is a subdivision of your peripheral
• BLOOD CLOTTING: helps the body nervous system, which is all your
to heal faster. nervous system except your brain
• SLEEP: stimulates the areas of the and spinal cord.
brain that are in control of sleep-
Autonomic Nervous System
wake behavior.
• SEXUAL FUNCTION: can cause a • Controls †he automatic functions of
decreased libido when levels are too the body.
high. • Divided into †wo categories:
• BONE FUNCTION: can cause o the sympathetic and
osteoporosis when levels are too o the parasympathetic
high.
• MOOD REGULATION: reduces
feelings of depression and anxiety. Sympathetic Nervous System
• NAUSEA: helps the body expel food
quicker than normal • Best known for its role in responding
to dangerous or stressful situations.
ENDORPHINS
Parasympathetic Nervous System
• Involved in pain control.
• Relax or reduce your body’s
• Many of our most addictive drugs
activities.
deal with endorphins.

Drugs can be...

• Agonists- make neuron fire.

• Antagonists- stop neural firing.
• Reuptake Inhibitors- block reuptake

TYPES OF NEURONS

• Efferent (Motor) Neurons

• Interneurons Reflexes
• Afferent (Sensory) Neurons
• Normally, sensory (afferent) neurons
Central Nervous System take info up through spine to the
brain.

12
 • Some reactions occur when sensory Hypothalamus
neurons reach just the spinal cord.
• Pea sized in brain but plays a not-so
• Survival adaptation.
pea sized role.
THE BRAIN • Body temperature
• Hunger
BRAIN STRUCTURES
• Thirst
THREE PARTS: • Sexual arousal (libido endocrine
system)
• Hindbrain
• Lateral- Sympathetic NS: + heart
• Midbrain
rate, +BP
• Forebrain
Hippocampus and Amygdala
Medulla Oblongata
• It is involved in memory processing.
• Heart rate
• Amygdala is vital for our basic
• Breathing
emotions.
• Blood Pressure
Cerebral cortex
Pons
• Top layer of our brain.
• Connects hindbrain, midbrain, and
• Contains wrinkles called fissures.
forebrain together.
The fissures increase surface area of
• Involved in facial expressions. our brain.
Cerebellum • Laid out it would be about the size of
a large pizza.
• Located in the back of our head-
means li††le brain. Hemispheres
• Coordinates muscle movements. • Divided into a left and right
• Like tracking a target. hemisphere.
Midbrain • Contralateral controlled
o left controls right side of
• Coordinates simple movements with body and vice versa.
sensory information. • Brain lateralization.
• Contains the reticular formation: • Lefties are better at spatial old
o arousal and creative tasks.
o ability to focus attention. • Righties are better at logic.
Thalamus Split- Brain Patients
• In Forebrain Receives sensory • Corpus Collosum attaches the two
information and sends them to hemispheres of cerebral cortex.
appropriate areas of forebrain. Like • When removed you have a split-brain
switchboard. patient.
Limbic System Areas of the Cerebral Cortex
• Emotional control centre of the • Divided into 8 lobes, four in each
brain. hemisphere:
• Made up of Hypothalamus, o frontal,
Amygdala, and Hippocampus. o parietal,

13
 o occipital and o pathological coining of new
o temporal words
• Any area not dealing with our senses • Circumstantiality
or muscle movements are called o excessive inclusion of details
association areas. • Word salad
o incoherent mixture of words
Frontal Lobe
and phrases
• Deals with planning, maintaining • Flight of ideas
emotional control and abstract o shifting of one topic from one
thought. subject to another in a
• Contains Broca's Area. somewhat related way
• Broca's Aphasia. • Looseness of Association
• Contains Motor Cortex. o shifting of a topic from one
subject to another in a
Parietal lobes completely unrelated way
• Located at the top of our head. • Verbigeration
• Contains the somatosensory cortex. o meaningless repetition of
• Rest are association areas. word or phrases
• Perseveration
Temporal Lobe o persistence of a response to
a previous question
• Process sound sensed by ears.
• Echolalia
• Not lateralized.
o pathological repetition of
• Contains Wernicke's area.
words of others
• Wernicke's Aphasia. (impaired
• Stilted language
language comprehension)
o use of flowery words
Occipital Lobe • Clang association.
o the sound of the word gives
• In the back of our head.
direction to the flow of
• Handles visual input from eyes. thought.
• Right half of each retina goes to left • Delusion
occipital lobe and vice versa. o fixed, false belief which
cannot be corrected by
appeal or logical reasoning.
SIGNS AND SYMPTOMS OF PSYCHIATRIC
ILLNESS • Grandeur
DISTURBANCE IN PERCEPTION o an exaggerated belief of
identity
• Illusion • Nihilistic
o misperception of an actual o the client denies the
external stimuli existence of self or part of
• Hallucination self.
o false sensory perception in • Persecution
the absence of external o belief that he or she is the
stimuli object of environmental
• Neologism attention and being singled
out for harassment.

14
 • Self-depreciation DISTURBANCES OF CONSCIOUSNESS
o worthlessness or
• Disorientation
hopelessness
o Disturbance of orientation in
• Somatic
time, place, or person.
o false belief to body function
• Clouding of consciousness
DISTURBANCE IN MEMORY o Incomplete clear
mindedness w/ disturbances
• Confabulation
in perception & attitudes
o filling in of memory gaps.
• Stupor
• Amnesia
o Lack of reaction to &
o inability to recall past events.
unawareness of
o Anterograde
surroundings.
▪ immediate past
• Delirium
o Retrograde –
o Bewildered, restless,
▪ distant past
confused, disoriented
• Déjà vu
reaction associated with fear
o a subjective feeling that an
& hallucinations.
experience which is
• Coma
occurring for the first time
o Profound degree of
has been experienced
unconsciousness.
before.
• Coma Vigil
• Jamais vu
o Coma in w/c a px appears to
o a feeling that the familiar
be asleep but ready to be
does not seem familiar.
aroused (akinetic mutism)
• Dementia
• Twilight state
o gradual deterioration of
o Disturbed consciousness w/
intellectual functioning
hallucinations
results in decreased
• Dreamlike state
capacity to perform ADL.
o Often used as a synonym for
OTHER BEHAVIORAL SIGNS & SYMPTOMS complex partial seizure or
psychomotor epilepsy.
• Insomnia
• Somnolence
o inability to attain enough
o Abnormal drowsiness
sleep.
• Confusion
o Disturbance of
• Hypersomnia
consciousness in w/c
o excessive sleep
reactions to environmental
• Parasomnia stimuli are inappropriate:
o abnormal sleep behavior o manifested by a disordered
• Narcolepsy orientation in relation to TPP.
o sleep disorder characterized • Drowsiness
by frequent irresistible urge o A state of impaired
to sleep with episodes of awareness associated with a
desire or inclination to sleep.
• Sundowning
o Syndrome in older people
that usually occurs at night &
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 is characterized by • Inappropriate affect
drowsiness, confusion, o disharmony between the
ataxia & falling as the result stimuli and the emotional
of being overly sedated w/ reaction
medications (Sundowner’s • Blunted affect
Syndrome) o severe reduction in
emotional reaction
DISTURBANCES OF ATTENTION
• Flat affect
• Distractibility o absence or near absence of
o Inability to concentrate emotional reaction
attention; state in w/c • Apathy
attention is drawn to o dulled emotional tone.
unimportant or irrelevant • Lability of affect
external stimuli. o rapid “mood swings”
• Selective inattention
DISTURBANCES OF MOOD
o Blocking out only those
things that generate anxiety. • Dysphoric mood
• Hypervigilance o an unpleasant mood
o Excessive attention & focus • Euthymic mood
on all internal & external o normal range of mood,
stimuli, usually secondary to implying absence of
delusional or paranoid states depressed or elevated
• Trance mood.
o Focused attention & altered • Expansive mood
consciousness, usually seen o a person's expression of
in hypnosis, dissociative feelings without restraint,
d/o’s, & ecstatic religious frequently with an
experiences overestimation of their
DISTURBANCES OF SUGGESTIBILITY significance or importance.
• Mood swings (labile mood)
• Folie a deux (folie a trois) o oscillations between
o Communicated emotional euphoria & depression or
illness bet 2 (3) persons. anxiety
• Hypnosis • Elevated mood
o Artificially induced o Air of confidence &
modification of enjoyment; a mood more
consciousness cheerful than usual
characterized by a
heightened suggestibility. • Euphoria
o intense elation with feelings
DISTURBANCES OF AFFECT
of grandeur
• Appropriate affect • Ecstasy
o Condition in which the o Feeling of intense rapture.
emotional tone is in harmony • Depression
with the accompanying idea, o psychopathological feeling
thought, or speech. of sadness

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 • Irritable
• Panic
o A state in w/c a person is
o acute, episodic, intense
easily annoyed & provoked to
attack of anxiety associated
anger.
with overwhelming feelings
• Anhedonia
of dread and autonomic
o loss of interest in and
discharge.
withdrawal from all regular
• Apathy
and pleasurable activities,
o dulled emotional tone
often associated with
associated with detachment
depression.
or indifference.
• Grief or mourning
• Ambivalence
o sadness appropriate to a real
o coexistence of two opposing
loss
impulses toward the same
• Alexithymia
thing in the same thing in the
o a person's inability to or
same person at the same
difficulty in describing being
time.
aware of emotions or mood.
• Abreaction
• Suicidal ideation
o emotional release or
o thoughts or act of taking
discharge after recalling a
one's own life.
painful experience.
• Elation
• Shame
o Feelings of joy, euphoria,
o failure to live up to self-
triumph, intense self-
expectations.
satisfaction, or optimism.
• Guilt
OTHER EMOTIONS o emotion secondary to doing
what is perceived as wrong.
• Anxiety • Impulse control
o Feeling of apprehension o ability to resist an impulse,
caused by anticipation of drive, or temptation to
danger, which may be perform an action.
internal or external.
• Melancholia
• Free-floating anxiety o severe depressive state;
o Pervasive, unfocused fear used in the term involutional
not attached lo any idea. melancholia both
• Fear descriptively and also in
o Anxiety caused by reference to a distinct
consciously recognized and diagnostic entity.
realistic danger.

• Agitation DISTURBANCES OF SPEECH

o severe anxiety associated
• Pressure of speech
with motor restlessness.
o Rapid speech that is
• Tension increased in amount &
o increased and unpleasant difficult to interrupt.
motor and psychological
activity.
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• Volubility (logorrhoea) DISTURBANCES OF LANGUANGE OUTPUT
o Copious, coherent, logical
• Motor aphasia
speech
o Disturbance of speech
caused by a cognitive
• Poverty of speech
disorder in which
o Restriction in the amount of
understanding remains but
speech used; replies may be
ability to speak is grossly
monosyllabic.
impaired; halting, laborious,
• Nonspontaneous speech
and inaccurate speech (also
o Verbal responses given only
known as Broca's, nonfluent,
when asked or spoken to
and expressive aphasia).
directly, no self-initiation of
• Sensory aphasia
speech.
o Organic loss of ability to
• Poverty of content of speech
comprehend the meaning of
o speech that is adequate in
words; fluid and
amount that conveys little
spontaneous but incoherent
information because of
and nonsensical speech
vagueness, emptiness, or
(also known as Wernicke's,
stereotyped phrases.
fluent, and receptive
• Dysprosody
aphasia).
o Loss of normal speech
• Nominal aphasia
melody (called prosody).
o Difficulty in finding correct
• Dysarthria
name for an object (also
o Difficulty in articulation, not
termed anomia and
in word finding or in
amnestic aphasia).
grammar.
• Syntactical aphasia
• Excessive loud or soft speech
o Inability to arrange words in
o loss of modulation of normal
proper sequence.
speech volume; may reflect
• Jargon aphasia.
a variety of pathological
o Words produced are totally
conditions ranging from
neologistic; nonsense words
psychosis to depression to
repeated with various
deafness.
intonations and inflections.
• Stuttering
• Global aphasia
o frequent repetition or
o Combination of a grossly
prolongation of a sound or
non-fluent aphasia and a
syllable, leading to markedly
severe fluent aphasia.
impaired speech fluency.
• Alogia
• Cluttering
o Inability to speak because of
o Erratic & dysrhythmic
a mental deficiency or an
speech, consisting of rapid &
episode of dementia.
jerky spurts.
• Copropregia
o Involuntary use of vulgar or
obscene language; seen in
Tourette’s disorder and some
cases schizophrenia

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DISTURBANCES ASSOCIATED COGNITIVE DISTURBANCES IN MOTOR ACTIVITY
DISORDER
• Echopraxia
• Anosognosia (ignorance of illness) o the pathological imitation of
o A person's inability to posture/action of others
recognize a neurological • Waxy flexibility
deficit as occurring to o maintaining the desired
himself or herself. position for long periods of
• Asomatognosia (ignorance of the time without discomfort.
body) • Akinesia
o A person’s inability to o loss of movement
recognize a body part as his • Bradykinesia
or her own (autotopagnosia) o slowness of all voluntary
• Visual agnosia movement including speech.
o Inability to recognize objects • Ataxia
or persons. o loss of coordinated
• Astereognosis movement
o inability to recognize objects • Automatism
by touch. o repeated purposeless
• Prosopagnosia behavior.
o inability to recognize faces. • Akathisia
• Apraxia o a feeling of muscular
o Inability to carry out specific quivering, an urge to move
tasks. about constantly and an
• Simultagnosia inability to sit still.
o inability to comprehend • Astasia abasia
more than one element of a o inability to stand or walk in
visual scene at a time or to the absence of other
integrate the parts into a neurologic abnormalities.
whole. • Catalepsy
• Adiadochokinesia o a medical condition
o inability to perform rapid characterized by a trance or
alternating movements. seizure with a loss of
• Aura sensation and
o warning sensations such as consciousness
automatisms, fullness in the accompanied by rigidity of
stomach, blushing, and the body.
changes in respiration; • Cataplexy
cognitive sensations, and o transient episodes of
affective states usually voluntary muscle weakness
experienced before a precipitated by intense
seizure; a sensory prodrome emotion.
that precedes a classic • Catatonia
migraine headache. o abnormal movements,
behaviours, and withdrawal,
is a condition that is most
often seen in mood disorders
but can also be seen in

19
 psychotic, medical,
neurologic, and other
disorders.
• Chorea
o is a symptom that causes
involuntary, irregular, or
unpredictable muscle
movements. It affects your
arms, legs, and facial
muscles.
• Dyskinesia
o involuntary, erratic, writhing
movements of the face,
arms, legs, or trunk.
• Dystonia
o is a movement disorder that
causes the muscles to
contract involuntarily.

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