DLILNSL MLCnANISMS

8L8LSSSlCn Su8LSSlCn
CCnvL8SlCn ulSSCClA1lCn/S?M8CLlZA1lCn
luLn1lllCA1lCn ln18C!LC1lCn
Su8LlMA1lCn CCMLnSA1lCn
8A1lCnALlZA1lCn 8C!LC1lCn
ulSLACLMLn1 unuClnC
SLl11lnC 8LAC1lCn lC8MA1lCn
8LC8LSSlCn llxA1lCn
ln1LLLLC1uALlZA1lCn AC1lnCCu1
uLnlAL lAn1AS?


DLILNSL MLCnANISMS

Legend DM means Defense Mechan|sm

1 kLkLSSICN (dl sadya) lnvolunLary recall palnful or unpleasanL LhoughLs or feellngs cause Lhey are
auLomaLlcally lnvolunLarlly pushed lnLo one's unconsclousness
lC8CL1luLnLSS 8lackouL (alcohollc lnLoxlcaLlon) blocklng
(A|zhe|mer's]Dement|a) Memory gaps ConfabulaLlon maklng sLory Lo flll ln
memory gaps also used by Wern|cke's korsakoff's V|t 81th|am|ne
per|phera| neur|t|s (t|ng||ng sensat|on) 86 yrldoxlne 89 follc acld 812
anemla Lx Sexually abused as a chlld blocks Lhe experlence from her
consclousness and ls confused abouL lnablllLy Lo respond sexually
SUkLSSICN (sadya)used selecLlve lnaLLenLlon
(moderaLe anxleLy)
W||||ng|y or vo|untar||y puLLlng unaccepLable LhoughLs or feellngs ouL of one's
mlnd wlLh Lhe ablllLy Lo recall Lhe LhoughLs or feellngs aL wlll

x voloototy fotqetfoloess ot l totbet oot tolk oboot lt tlqbt oow!
2 CCNVLkSICN
#1 uM SomaLlc/somaLoform dlsease
1ransferrlng of menLal confllcL or emoLlonal anxleLy lnLo physlcal sympLom Lo
release Lenslon
x A solJlet expetleoces soJJeo blloJoess oftet wltoessloq bls best ftleoJ Jyloq
ftom o qteooJe blost ulottbeo befote exom sopptess ooqet nlN
DISSCCIA1ICN
#1 uM MulLlple personallLy desLrucLlon of ego
AcL of deLachlng of separaLlng a sLrong emoLlonally charged confllcL from one's
consclousness
x A womoo topeJ foooJ wooJetloq o bosy blqbwoy ttoomotlc omoeslo
SM8CLI2A1ICN unconsclous
#1 uM hoblas
An ob[ecL ldea or acL represents anoLher Lhrough some common aspecL and
carrles Lhe emoLlonal feellng assoclaLed wlLh Lhe oLher
x oqoqemeot tloq symbol of love pboblos
IDLN1IIICA1ICN exLernal
uM reschooler
unconsclously people use lL Lo ldenLlfy wlLh Lhe personallLy and LralLs of anoLher
1o preserve one's ego or self Mlmlcs/slmulaLes exLernal behavlor llke fashlon
fads
x lmltotot slmllot to tole ployloq
IN1kCILC1ICN ln1L8nAL
uM uepresslon counLer Lransference
ALLrlbuLlng Lo oneself Lhe good quallLles of anoLher lncorporaLe feellngs
emoLlons values bellefs LralLs and personallLy lngesLlon lnLernallzaLlon"
x Actloq Jtessloq llke Iesos cbtlst
4 SU8LIMA1ICN 8echannellng of consclously lnLolerable or Soc|a||y Unacceptab|e 8ehav|ors or
lmpulses lnLo personally or soclally accepLable Modlfy Lhe lssue problem ls sLlll
presenL and connecLed
x Ao oqqtesslve petsoo jolos Jebote teom (bebovlot moJlflcotloo)--
CCMLNSA1ICN 1he acL of maklng up for a real or lmaglned deflclency wlLh a speclflc behavlor
Consc|ous or unconsc|ous
roblem ls noL connecLed
x Ao oootttoctlve qltl become o vety qooJ teools ployet -
S kA1ICNALI2A1ICN ob[ecL
#1 uM AnLlsoclal dlsorder

MosL common ego uM unconsclously used Lo [usLlfy ldeas acLlons and/or
feellngs wlLh good accepLable reasons or explanaLlon lrraLlonal/llloglcal excuses
Lo escape responslblllLy kat|ona||zat|on |s [ust|fy|ng one's act|ons wh|ch are
based on other mot|ves It |s usua||y seen among a|coho||cs
x lt wosot wottb lt ooywoy lt ls oll fot tbe best 5toJeot folls oo exom blomes lt
oo tbe poot lectotes
1emporarlly allevlaLes anxleLy
kCILC1ICN person
#1 uM aranold
erson re[ecLs unwanLed characLerlsLlcs of self and asslgns Lhem Lo
oLhersro[ect|on |s attr|but|ng to others one's unconsc|ous w|shes]fear Usua||y
|t |s observed |n parano|d pat|ents
x 8lomloq otbets fot owo foolts scopeqoot
6 DISLACLMLN1 hlgher Lo lower

Mechanlsm LhaL serves Lo Lransfer feellngs such as frusLraLlon hosLlllLy or anxleLy
from one ldea person or ob[ecL Lo anoLher
x ellloq ot o sobotJloote oftet beloq yelleJ ot by tbe boss
UNDCING Ck kLS1I1U1ICN lower Lo hlgher
uM Cbsesslve Compulslve
negaLlon of prevlous consclously lnLolerable acLlon or experlence Lo reduce or
allevlaLe feellngs of gullL
x 5eoJloq flowets oftet embottossloq bet lo pobllc
7 SLI11ING (good]bad) vlewlng people as all good and oLhers as all bad
lmpolslve poot selfcoottol
x nx of Jtoq oJJlcts olcobollcs
uM 8orderllne (female)

kLAC1ICN ICkMA1ICN (backstab)
#1 uM asslveaggresslve personallLy dlsorder
erson exaggeraLes or overdevelops cerLaln acLlons by dlsplaylng exacLly Lhe
opposlLe behavlor aLLlLude or feellng from whaL he or she normally would show
ln a glven slLuaLlon CvL8CCMLnSA1lCn Consclous lnLenL ofLen alLrulsLlc
rocrasLlnaLe
x 5toJeot botloq bet cl moy oct vety cootteoosly towotJs bet
8 kLGkLSSICN A temporary retreat Lo pasL levels of behavlor LhaL reduce anxleLy allow one Lo
feel more comforLable Lx A 27 year old acLs llke a 17 yo on her flrsL daLe wlLh a
fellow employee smoklng aL parLles chronlc regresslon
IIkA1ICN ermanent or perslsLence lnLo laLer llfe of lnLeresLs and behavlor paLLerns
approprlaLe Lo an early age WlLhouL sLressors
x cbolo smokets olcobollcs otol flxotloo
9 IN1LLLLC1UALI2A1ICN 1he acL of Lransferrlng emoLlonal concerns lnLo Lhe lnLellecLual sphere
LxaggeraLlon of lnLellecL erson uses reasonlng as a means Lo avold
confronLaLlon x ueot Iobo lettet tbe qtoom ls ttyloq to flqote oot wltb bls
toom mote wby bls flooce cbooqeJ bet mloJ to ovolJ cooftootloq bet
AC1ING CU1 unconsclous wlsh Lurned lnLo reallLy
x MolesteJ cbllJ woots to be comfotteJ becomes psycboloqlst Optob
10 DLNIAL
#1uM
Alcohollcs 1Su lncurable lllness
1he unconsclous refusal /avoldance Lo face LhoughLs feellngs wlshes needs
and/or reallLy facLors LhaL are lnLolerable 8locklng Lhe awareness of reallLy x
tbloqs wlll qet bettet sooo
14 y]o g|r| who |s undergo|ng d|a|ys|s says "What's good about th|s |s that after
|t I w||| |ook good th|n" 1h|s shows that the teen |s deny|ng her chron|c
|||ness
Cancer pat|ent say|ng "ou m|ght have m|xed my resu|t w|th other pat|ents" |s
show|ng den|a|

IAN1AS
uM Schlzold
lmaglned evenLs or menLal lmages Wlshful Lhlnklng 1emporary fllghL from reallLy
Lo anxleLy x uoyJteomloq (petmooeot fllqbt ftom teollty ootlsm)

SCnC1IC DISCkDLk SCnI2CnkLNIA

Def|n|t|on Severe lmpalrmenL of menLal soclal funcLlonlng wlLh grossly lmpalred reallLy LesLlng sensory percepLlon and wlLh
deLerloraLlon regresslon of psychosoclal funcLlonlng

A ASSLSSMLN1 IINDINGS (GLNLkAL SIGNS)


1nL ICUk A's of SCnI2CnkLNIA ACCCkDING 1C 8LLULLk

ASSCCIA1ICNS LCCSL Iump|ng to d|fferent top|cs WI1nCU1 assoc|at|on or re|evance
AM8IVALLNCL (1wo opposlng feellngs Loward oLhers aL Lhe same Llme)
AU1ISM (wlLhdrawal from envlronmenL and oLhers) maglcal Lhlnklng neologlsm aloofness)
AIILC1 ILA1 (lnapproprlaLe or no dlsplay of feellngs)
#1 nALLUCINA1ICN of Sch|zophren|a |s Aud|tory

1nLCkILS

1 Increased dopam|ne comlng from Lhe subsLancla nlgra
2 1rauma 1Su
uoubleblnd Lheory 2 klnds of lnformaLlon/communlcaLlon
4 CeneLlcs 63 chances lf Lwo parenLs are dlagnose wlLh schlzophrenla
23 chances lf 1 parenL ls dlagnosed wlLh schlzophrenla
3 Drug add|cts and a|coho||cs Plgh probablllLy for schlzophrenla due Lo lncrease
ueluslons halluclnaLlon

DSM V Cr|ter|a for Sch|zophren|a

Character|zed by both () (+) symptoms soc|a| ] occupat|ona| dysfunct|on for at |east SIk (6) months
at|ent w|th S adm|ss|ons |n 2 yrs |s cons|dered a chron|c sch|zo


(+) CSI1IVL SIGNS CI SCnI2CnkLNIA Due to LkCLSS DCAMINL


Do you know nILDDA I?

nalluclnaLlon Illuslon Looseness of AssoclaLlon Deluslon DlsorlenLaLlon AglLaLlon
aranola Insomnla

Sch|zophren|c pat|ent says "retty red dress tomatoes are red" |s show|ng |ooseness of
assoc|at|on


() NLGA1IVL SIGNS CI SCnI2CnkLNIA Due to LACk CI DCAMINL

kemember your CCk A's?
oor [udgmenL oor lnslghL oor self care
Alogla Anergla Anhedonla

NUkSING DIAGNCSIS ICk NLGA1IVL SM1CMS CI SCnI2CnkLNIA
1 A|terat|on |n 1hought rocess 2 A|terat|on |n Content of 1hought



C1nLk NLGA1IVL SM1CMS

All Lhls slgns sympLoms can also be seen ln SAM (Schlzophrenla Alzhelmer's Manlc)

1 Neo|og|sm (creaLlng nLW WC8uS) vs Word Sa|ad (lncoherenL mlxLure of words)
2 I||ght of Ideas ([umplng from one 8LLA1Lu Loplc Lo anoLher) Commonly seen ln MANIC paLlenLs also ln Schlzophrenla
Verb|gerat|on (meanlngless repeLlLlon of act|on words (Verb)) vs erseverat|on
eg 1
sL
sLlmulus correcL response
2
nd followlng
sLlmulus sLlll respondlng Lo Lhe 1
sL
sLlmull
4 C|rcumstant|a||ty (beaLlng around Lhe bush answers buL delayed) vs 1angent|a||ty (dld noL answer Lhe sLlmulus/ quesLlon)
3 C|ang assoc|at|on (use of rhymes ln senLences) vs Lcho|a||a]arrot|ng Lchoprax|a
(Commonly seen ln AU1ISM)

8 kICkI1I2LD NUkSING DIAGNCSLS ICk ALL 1LS CI SCnI2CnkLNIA
1 k|sk for v|o|ence D|rected toward se|f or other (pr|or|ty!!!)
2 Selfcare deflclL
1houghL process alLered
4 Sensory/percepLual alLeraLlons ( relaLed Lo llluslon deluslon halluclnaLlon)
S Soclal lsolaLlon



C S (IIVL) 1LS CI SCnI2CnkLNIA

1 AkANCID resenLlng slgn ls
SuSlClCuSnLSS ldeas of persecuLlon and deluslons sees envlronmenL as hosLlle and LhreaLenlng 8LMLM8L8 Lhe 4 's
ro[ecLlon (#1 defense mechanlsm) roxemlcs( 7 feeL away from Lhe paLlenL) asslve lrlendllness (#1 aLLlLude Lherapy no
Louchlng no whlsperlng laughlng) deluslon of ersecuLlon (#1 deluslon of aranold Schlzophrenla)
A pat|ent who says" 1he other staff members are |augh|ng at my back" shows a parano|d
de|us|on of sch|zophren|a
Sch|zophren|c says "Someone has p|aced a trans|stor |n my bra|n" correct |nterpretat|on shows parano|d de|us|on
Statement ||ke "I don't ||ke to eat meat because an|ma| produced foods are
o|sonous" shows susp|c|ous parano|d type sch|zophren|a

Deve|opmenta| Stage IIkA1ICN CkAL nASL (1kUS1 vs MIS1kUS1)

NUkSING CCNSIDLkA1ICN
1 Cons|stency to bu||d trust
2 Iood ACkLD Ck SLALLD foods except canned goods No meta|
Soclal lsolaLlon no group sesslon when schlzophrenlc
arano|d who |s susp|c|ous say|ng "1h|s p|ace |s meant for bugs pr|son" In order to
encourage trust the pat|ent shou|d be |nvo|ved |n the p|an of care

2 CA1A1CNIC WlLh sLereoLyped poslLlon (caLaLonla) wlLh waxy flexlblllLy muLlsm blzarre mannerlsm
#1 Defense mechan|sm Aut|sm mut|sm
#1 Card|na| S|gn of Cataton|a waxy f|ex|b|||ty (cerea f|ex|b|||tas)

S|m||ar |n chlldren wlLh auLlsm
Most dangerous]ser|ous type of sch|zophren|a may d|e from dehydrat|on

CA1A1CNIC CnAkAC1LkIS1ICS
CaLaLonlc sLupor markedly slowed movemenL
CaLaLonlc posLurlng blzarre or welrd poslLlons
CaLaLonlc rlgldlLy cemenLaLlon/sLonellke poslLlon
CaLaLonlc negaLlvlsm reslsLance Lowards flexlon exLenslon
CaLaLonlc hyperacLlvlLy or exclLablllLy

kICkI1I2LD NUkSING DIAGNCSIS
1 lluld LlecLrolyLe lmbalance
2 AlLered nuLrlLlon less Lhan body requlremenL
Self Care ueflclL

DISCkGANI2LD AnoLher word ls nebephren|c CharacLerlzed wlLh lnapproprlaLe behavlor Sllly crylng laughlng regresslon
LranslenL halluclnaLlons (AudlLory)
All behavlors are slmllar wlLh Loddlers slnce Lhey are anal flxaLed
Deve|opmenta| Stage IIkA1ICN Ana| I|xat|on
#1 Defense Mechan|sm kegress|on I|xat|on

4 UNDIIILkLN1IA1LD or MIkLD SympLoms of more Lhan one Lype of schlzophrenla
has deluslons dlsorganlzed behavlor buL uCLS nC1 meeL Lhe crlLerla for Lhe above
sub Lypes alone 1he #1 drug of cholce ls I|uphenaz|ne (ro||x|n decanoate)

3 kLSIDUAL no longer exhlblLs overL sympLoms no more deluslons buL sLlll has negaLlve sympLoms or odd bellefs or unusual
percepLlons
Und|fferent|ated type chron|c sch|zophren|a must be referred to a program promot|ng
soc|a| sk|||s due to funct|ona| |oss def|c|t

ICUk nASLS CI NUkSL CLILN1 kLLA1ICNSnI (NCk)

A re|nteract|on]reor|entat|on (Ior the Nurse)
SLage of SelfAwareness 1o prevenL CounLer 1ransference
#1 CCkL VALUL CI sych|atr|c Nurs|ng


8 CkILN1A1ICN (INI1IA1ICN)

AssessmenL of problems needs expecLaLlons of cllenLs
ldenLlfy anxleLy level of self and cllenL
Set goa|s of re|at|onsh|p
ueflne responslblllLles of nurse and cllenL SLage of LesLlng
Lstab||sh boundar|es of re|at|onsh|p SLress confldenLlallLy

Contract 2 famous psych|atr|c contracts

1 No su|c|de contract Ma[or depresslon emergency

1WC def|n|t|ons of no su|c|de contract
A 24 hrs monlLorlng
8 verballzaLlon Lo Lhe nurse of all sulclde ldeas

2 uleL conLracL LaLlng dlsorder

1he start of term|nat|on phase Cood mornlng full name 8n shlfL sesslon daLe sLarL end"

C WCkkING nASL

romoLe accepLance of each oLher
AccepL cllenL as havlng value and worLh as a unlque lndlvldual
SLage of reslsLance
CounLer Lransference phase
Most d|ff|cu|t phase
nC ls on golng
Ident|f|cat|on of the prob|em]exp|orat|on
1he #1 sych|atr|c Core Va|ue |s Cons|stency Ior man|pu|at|ve pat|ents
8e conslsLenL Lo paLlenL wlLh 8AAAM CCS
8 orderllne C onducL d/o
A nLlsoclal C ra|]eaLlng dlsorder
A lzhelmer's aranold
A uLlsLlc S ulcldal
M anlc
use LherapeuLlc and problem solvlng Lechnlques
MalnLaln 8ClLSSlCnAL LherapeuLlc relaLlonshlp
eep lnLeracLlon reallLy orlenLed here and now
rovlde AC1lvL LlS1LnlnC and 8LlLLC1lCn of feellngs
use non verbal communlcaLlon Lo supporL cllenL
8ecognlze blocks Lo communlcaLlon and work Lo remove Lhem
lCCuS on cllenL's
ConfronLlng and worklng Lhrough ldenLlfled problems
roblems solvlng skllls
lncreaslng lndependence
5 Pelp cllenL develop alLernaLlve adapLlve coplng mechanlsms

ersona| b|ases (man|festat|on by countertransference v|ce versa) are seen
dur|ng work|ng phase

D 1LkMINA1ICN
lan for LermlnaLlon of relaLlonshlp early Lhe relaLlonshlp
Stage of Separat|on Anx|ety
S|gns symptoms kegress|on 1emper tantrums thumb suck|ng apathy feta| pos|t|on when cry|ng
hase of prognos|s Lva|uat|on
MalnLaln boundarles
AnLlclpaLe problems of LermlnaLlon
5 lncreased dependency on Lhe nurse
5 8ecall of prevlous negaLlve experlence re[ecLlon depresslon abandonmenL eLc
5 8egresslve behavlors
ulscuss cllenL's feellngs and ob[ecLlves achleved