PHYSIOBIOLOGIC

BASES AND
BEHAVIOR
NEUROSCIENCE:
BIOLOGY AND
BEHAVIOR

Allam, Jeremiah
Aquino, Kristiene Kyle
Balisi, Jasmin
Cagurangan, Alyssa Samantha
Lucas, Jelmar
Mateo, Ma. Melizzae
Ranjo, Rodamae

A. NEURO- ANATOMY AND NEUROPHYSIOLOGY

CENTRAL NERVOUS SYSTEM

- Is composed of the brain, the spinal cord, and associated nerves that control
voluntary acts.

 Brain
- is divided into:
 Cerebrum
 Cerebellum
 Brain Stem
 Limbic System

MEMORY, REPETITION AND LEARNING

- Sayings such as "Practice makes perfect" illustrate the well-known fact that
repetition improves learning. This was discussed by numerous ancient and medieval
thinkers and was demonstrated empirically by Hermann Ebbinghaus, the first
researcher to carry out a prolonged series of experiments on human memory. In a
classic 1885 book, Ebbinghaus showed that retention of information improves as a
function of the number of times the information has been studied. Since the time of
Ebbinghaus, countless investigators have used repetition to study learning and
memory.
- Although experimenters typically find a consistent relationship between repetition
and learning, numerous authors (Guthrie, 1935) have pointed out that this does not
necessarily mean that the learning process itself has to be either gradual or
continuous. Most learning situations contain a number of smaller facets or
subproblems that must be mastered before learning is complete. It is possible that
each of these subproblems is mastered suddenly, perhaps through insight.
However, the subproblems are learned at different times, with more and more of
them mastered as the number of trials increases. This analysis proposes that a
gradual improvement in learning as a result of repetition may reflect the
accumulation of subproblems that have been mastered in a sudden fashion.
Distinguishing between a truly continuous learning process and the accumulation of
small, sudden insights is difficult. A common assumption is that learning may be
either gradual or sudden, depending on the background of the learner and the
nature of the information to be learned.
- Although the total amount learned increases as a function of repetition, the amount
learned on each trial will not be constant. Repetition effects exhibit negative
acceleration: The most learning occurs in the first exposure to a stimulus or
situation, and the amount learned in each subsequent exposure continually declines
until further improvement is too small to be detected. The rate of learning is
negatively related to the amount already learned. Hintzman and Curran (1995) have
shown that people can register the occurrence of a repeated stimulus while failing
to learn more about its specific details. First impressions of a repeated stimulus are
particularly important, as people may show little evidence for having noticed subtle
changes that are introduced to a stimulus after its first presentation (DiGirolamo
and Hintzman, 1997).

 WHY DOES REPETITION IMPROVE LEARNING?

- Anderson and Schooler (1991) have pointed out that the sensitivity of learning to
repetition is evidence for its efficiency and adaptiveness because the frequency with
which information has been used in the past is a very good predictor of whether it
will be needed in the future. Still, although repetition has been intensively studied,
the mechanisms underlying its effects are still poorly understood. Moreover, there
is no reason to believe that a single explanation could apply to all situations where
repetition facilitates learning.
- Of particular interest to many researchers has been the effect of repeated study on
human memory, and the two dominant explanations of these repetition effects
were both discussed by Ward (1893). One class of explanations (called a functional
approach by Ward but more commonly known as strength theory in twenty-first-
century scientific circles) claims that there is a single location in memory storage
that corresponds to an event. Every time the event is repeated, that location
(known as the memory trace) increases in effectiveness or strength. It is also
assumed that stronger traces are easier to retrieve from memory than are weaker
traces.
- Repetition thus improves learning by increasing the strength of a single memory
trace. A second class of explanation for the effects of repetition on memory was
called an atomistic approach by Ward but is now known as multiple-trace theory.
This approach assumes that every occurrence of an event is a unique episode. Every
time an event occurs, a separate, independent memory trace is formed. This trace
contains information about the time and situation in which that occurrence
happened. The more times an event occurs, the more traces of that event are
placed in memory. According to this multiple-trace theory, repetition improves
learning because finding at least one trace of an event becomes easier when there
are more traces of that event in memory.
- A fundamental difference between these two accounts concerns the representation
of the individual occurrences of a repeated item. The strength theory claims that
each occurrence of an event strengthens a single memory trace. Since each
occurrence has the same effect, the specific details of individual occurrences are
lost. In contrast, the multiple-trace theory claims that every occurrence produces its
own trace. The individuality of specific occurrences is maintained.

 WHEN IS REPETITION INEFFECTIVE IN INCREASING LEARNING?

- Although the emphasis in this entry has necessarily been on the mechanisms
through which repetition improves learning, one should not assume that repetition
alone is always sufficient. For example, consider a common coin, such as the
American penny. Although people have seen such coin’s countless times, as
Nickerson and Adams (1979) showed, people can have quite poor memory for the
details of a penny. They are often unable to remember exactly where such features
as the date and the words "In God We Trust" are located. There is no need for
people to attend to these features of a penny because pennies can easily be
distinguished from other coins on the basis of their size and color. This suggests
that attention to an event may be necessary before repetition of that event leads to
noticeable improvements in memory. The generality of this claim has been
established by studies demonstrating poor memory for other currencies, for the
details of telephone dials, and for the messages of common advertisements.
- One situation in which repetition impairs memory is when people have to recall a
short series of digits or letters in order. Recall is impaired if one of the items is
repeated in the series. This phenomenon, known as the Ranschburg effect, was
introduced into the modern psychological literature by Crowder and Melton (1965).
Critical to understanding this negative effect of repetition is the fact that people
have to remember that an item was repeated and the locations of each occurrence
in the series. The Ranschburg effect occurs because recall of the first occurrence of
the repeated item inhibits accurate recall of the second occurrence (Greene, 2001).
- Thus, repetition need not lead to improved learning. Rather, repetition leads to
increased opportunities for learning to occur. Whether learning takes place will
depend on the type of information that has to be remembered and the amount and
nature of processing that a person carries out.

NEUROTRANSMITTERS
- Are chemical substances manufactured in neuron that aid in the transmission of
information throughout the body.
- Approximately 100 billion of brain cells form groups of neurons, or nerve cells that
are arranged in networks.
- These neurons communicate information with one another by sending
electrochemical messages from neuron to neuron, a process called
neurotransmission.
- These electrochemical messages pass from dendrites (projection from the cell
body), through the soma or cell body, down the axon (long extended strictures),
and across the synapses (gaps between cells) to the dendrites of the next neuron.
- In the nervous system, the electrochemical messages cross the synapses between
neural cells by way of special chemical messengers called neurotransmitters.
- They either excite or stimulate an action in the cells (excitatory) or inhibit or stop
an action (inhibitory).
- These neurotransmitters fit into specific receptor cells embedded in the membrane
of the dendrite, just like a certain key shape fits into a lock.
- After neurotransmitters are released into the synapse, and relay the message to
the receptor cells, they are either transported back from the synapse to the axon to
be stored for later use (reuptake) or metabolized and inactivated by enzymes,
primarily Monoamine Oxidase (MAO).

MAJOR NEUROTRANSMITTERS ASSOCIATED WITH MENTAL

DISORDERS

 Dopamine
- is a neurotransmitter located primarily in the brain stem, and has been found to be
involved in the control of complex movements, motivation, cognition, and
regulation of emotional responses.
- Dopamine is generally excitatory and is synthesized from tyrosine, a dietary
amino acid.
- Dopamine us implicated in Schizophrenia and other psychoses as well in
movement disorders such as Parkinson’s disease.
- Antipsychotic medications work by blocking dopamine receptors and reducing
dopamine activity,

 Norepinephrine and Epinephrine

- The most prevalent neurotransmitter in the nervous system, and is located
primarily in the brain stem and play a role in changes in attention, learning, and
memory, sleep and wakefulness, and mood regulations.
- Excess norepinephrine has been implicated in several anxiety disorders.
- Deficits may contribute to memory loss, social withdrawal, and depression.
- Some antidepressants block the reuptake of Norepinephrine.
- Epinephrine has limited distribution in the brain but controls the fight or- flight
response in the peripheral nervous system.
 Seratonin
- Is a neurotransmitter found in the brain, and is derived from tryptophan, a dietary
amino acid. The function of serotonin is mostly inhibitory, and it is involved in the
control of food intake, sleep and wakefulness, temperature regulation, pain
control, sexual behavior, and regulation of emotions.
- Serotonin plays an important role in anxiety and mood disorders and
schizophrenia. it has been found to contribute to the delusions, hallucinations,
and withdrawn behavior seen in schizophrenia.
- Some antidepressants block serotonin reuptake, which results in improved mood.

 Histamine
- The role of histamine in mental illness is under investigation.
- It is involved un peripheral allergic responses, control of gastric secretions, cardiac
stimulation, and alertness.
- Some psychotropic drugs block histamine resulting in weight gain, sedation and
hypertension.

 Acetylcholine
- is a neurotransmitter found in the brain, spinal cord, and peripheral nervous
system.
- It can be excitatory or inhibitory.
- It is synthesized from dietary choline found in red meat and vegetables, and has
been found to affect the sleep- wake cycle and to signal muscles to become
active.
- Alzheimer’s disease has decreased acetylcholine- secreting neurons, and people
with myasthenia gravis (a muscular disorder, causes muscle weakness.)

 Glutamate
- Is an excitatory amino acid that at high level can have major neurotoxic effects.
- Glutamate has been implicated in the brain damage caused by stroke,
hypoglycemia, sustained hypoxia, or ischemia, and some degenerative diseases
such as Huntington’s or Alzheimer’s.
- Gamma- aminobutyric acid (GABA)

 GABBA- AMINOBUTYRIC ACID (GABA)

- An amino acid, and is the major inhibitory neurotransmitter in the brain
and has been fount to modulate other neurotransmitter systems rather than
to provide a direct stimulus.

COGNITIVE FRAMEWORK
- Focuses on distorted or negative thought pattern that leads to maladaptive or
symptomatic feelings and behaviors.

a. Distorted thinking leads to and perpetuates maladaptive behaviors.

b. certain common thought patterns can be identified as misconceptions.

 Patterns of thinking are learned, become automatic, and significantly affect

a person’s feelings and behaviors.
 The amount of perceived control over a situation affects how an individual
responds to stressors and problems.
B. CONCEPTS AND PATERNS OF HUMAN BEHAVIOR
FAMILY DYNAMICS
- Patterns of relating, or interaction, between family members.

 Types of Family Structures

a) Nuclear Family
b) Single Parents
c) Extended Family
d) Childless Family
e) Grandparent Family
f) Stepfamily

 Factors that Affect Family Dynamics

 nature of the parents' relationship
 having a particularly soft or strict parent
 number of children in the family
 personalities of family members
 an absent parent
 the 'mix' of members who are living in the same household
 level and type of influence from extended family or others
 a chronically sick or disabled child within the family
 events which have affected family members, such as an affair, divorce, trauma,
death, unemployment, homelessness
 other issues such as family violence, abuse, alcohol or other drug use, mental health
difficulties, other disability
 family values, culture and ethnicity, including beliefs about gender roles, parenting
practices, power or status of family members
 nature of attachments in family (ie secure, insecure)
 dynamics of previous generations (parents’ and grandparents’ families)
 broader systems- social, economic, political including poverty

 Various Family Dynamic Roles

1. HERO
- Achiever
- maintains the pride of the family
- a leader; is self- disciplines, and over- responsible
2. SCAPEGOAT
- “Black sheep”
- Thinks that he/she needs maximum attention.
- Further blaming him/ her for turning into a dysfunctional family.
3. RESCUER
- Thinks about other’s emotions while solving problems for ithers.
- Unable to focus in their own lives.
4. PEACEKEEPER
- Mostly played by children without any intentions.
- Plays the noble job of maintaining peace and harmony if the family.
5. MASCOT
- Includes humor, or other talents to divert attention of the family.
6. CARETAKER
- Very much likely a peacekeeper trying to pacify the chaos.
7. LOST CHILD
- Submissive member who can “fly under the radar.”
- Keeps everything to him/ herself.
8. MASTERMIND
- Usually an opportunist.
- Takes advantage of the faults committed by other members.

PATTERNS OF BEHAVIOR

 MALADAPTIVE BEHAVIOR OF INDIVIDUALS AND GROUPS: STRESS, CRISIS

AND DISASTER
- All living organisms have a tendency to maintain themselves in a state of relative
constancy called as Homeostasis.
- Adaptation occurs when there is a threat to this homeostasis. Adaptive responses
occurs when a stimulus from the internal or external environment causes a
departure from the balanced state of organism.

 Group adaptation is a process by which the group maintains a balance so that it can
promote growth of individual and group members.

For group to adapt successfully there must be:

1) Good communication skills.

2) Mutual respect for each other

3) Adequate resources available for adaptation

4) Previous experience with stressors

 The word “Stress” was derived from Latin word “Stringere” which means “to draw tight”.
 Change in the internal/ external environment causes stress and an organism has to adapt to
it to survive. The stimulus preceding or precipitating the changes are called stressors.
 crisis is a disturbance caused by a stressful event or a perceived threat. The person usual
way of coping becomes ineffective in dealing with the threat, causing anxiety.
 Disaster is defined by the WHO as “A severe disruption, ecological and psychological,
which greatly exceeds the coping capacity of the affected community. It can be natural and
man- made, psychological reaction may be either adaptive or maladaptive.

 ETIOLOGY: BIO- PSYCHO-SOCIAL FACTORS

- Previously, cause of mental illness was explained through humoral, demonic and
physical theories. However, over the last few decades, a number of theories have been
elaborated to explain psychiatric disorders on a scientific basis:

Some of these are:

1. Genetic theories
2. Biochemical theories
3. Psychological theories
4. Behavioral and cognitive theories
5. Social Theories
 Cause of mental illness can be chronologically divided into 3 groups:

I. Pre- disposing Factors: These occurs before the onset of the disease or before
psychopathology have appeared.
1) Genetic Factors

2) Biological Factors

3) Psychological Factors

II. Precipitating Factors: These are events that occur shortly before the onset of
disorders and appear to have induced it.

1) Physical Factors

2) Physiological Factors

3) Psychological Factors

4) Social factors

III. Perpetuating Factors: These are factors that prolong the course of a disorder after it
has been provoked. It is extremely vital to consider these factors while planning
treatment.

 PSYCHOPATHOLOGY OF MENTAL DISORDERS

- Meaning of Psychopathology: Psychopathology is the systematic study of abnormal
experience, cognition and behavior. It involves the observation and categorization of
abnormal psychic events, internal experiences of the patient and his consequent
behavior.
- Disorder may be due to disorder of personality, activity, perception, thinking, affect,
attention, consciousness, memory and structural disturbances in the brain

1. DISORDERS OF PERSONALITY

a) Cyclothymic Personality (Alternating Mood)

b) Hypomanic Personality (Cheerful, enjoyer of life, energetic, confident, aggressive,
pleasure loving)
c) Melancholic Personality (kindly, sympathetic, quiet, good tempered, easily
depressed, helplessness)
d) Paranoid Personality (suspicious, stubborn, lonely, insecured, unhappy, sarcastic,
argumentative)
e) Schizoid Personality (loneliness, isolation,
f) Obsessive Compulsive Personality (rigid, punctual, cannot work under pressure, do
not relax, cannot make decisions)
g) Hysterical Personality (self- centered dramatization, labile affect, emotional out
burst, attention seeking)
h) Passive- Aggressive Personality (Manifest by 3 ways: (Passive- dependent, Passive-
aggressive, Aggressive type)
i) Explosive Personality (friendly, happy, likeable, outgoing suddenly displayed guilt

2. DISORDERS OF MOTOR BEHAVIOR

a) Over Activity (seen in mania, can be goal directed but goal keeps changing)
b) Decreased Activity (takes long time to start activity, once started it is done very
slowly)
c) Stereotypy (persistent, constant repetition of activities, that involve position,
movement or speech) (e.g: catalepsy, waxy- flexibility, mannerisms, verbigeration)
d) Repetitious Activities (activity is initiated, there is tendency to repeat)
e) Automatic Behavior (echolalia, echopraxia)
f) Negativism (manifested by opposition and resistance to what is suggested)
g) Compulsion (morbid and irresistible urges to perform purposeless acts repetitiously)
h) Violence (expression of aggressiveness in the form of murders, assaults, rape,
damaging self)
i) Suicide (means self- destruction, feel rejected and unloved, commonly seen
recovery depression, acute schizophrenia and delirium)

3. DISORDERS OF PERCEPTION

a) Illusion (misinterpretation of sense impression)

b) Hallucination (perception occurs in the absence of the object, not related to
external stimuli) Types: (auditory, visual, olfactory, gustatory, tactile and
kinesthetic hallucination)

4. DISORDERS OF THINKING

a) Disorders of Form of Thought (thinking is the response to a stimulus. This stimulus

can be from unconscious or external environment, autistic thinking)
a) Disorders in Progression of Thought (flight of ideas, retardation, perseveration,
circumstantiality, incoherence, tangentiality, blocking)
b) Disorders of Content of Thought (overvalued ideas, delusion)
c) Hypochondriacal Delusion (exaggerated concern over physical health)
d) Obsession (persistent, irresistible thoughts)
e) Phobias (irrational fear)

5. DISTURBANCES OF AFFECT

a) Pleasurable Affects (euphoria, elation, exhilaration, ecstasy)

a) Depression (feeling of sadness)
b) Anxiety (free- floating anxiety, agitation, tension, panic)
c) Inadequate affect (emotionally dull o detached, indifferent and apathetic)
d) Inappropriate Affect (disharmony of affect and situation)
e) Ambivalence (contradictory feeling and attitude)
f) Depersonalization (feeling of unreality and loss of self-identity)

6. DISTURBANCES OF ATTENTION

a) Disordered attention (conation, affect and associations, fatigue, toxic states and
organic lesion interfere and lowered attention)
b) Distractibility (inability to hold attention for sufficient length of time)

7. DISORDERS OF CONSCIOUSNESS

1. Confusion (bewilderment, disorientation, disturbances of associative function and

poverty of ideas)
2. Clouding of Consciousness (due to physical or chemical disturbances producing
functional impairment of the cerebrum)
3. Delirium (acute brain syndrome)
4. Dream State (twilight state, person is unaware of his surroundings, may last for
several minutes to few days)
5. Stupor (motionless, mute, movement of eyes and respiration occur)

8. DISORDERS OF MEMORY

- Memory is a function when information is acquired, presented to the consciousness,

store and later recalled.
- There are three processes:
a) Registration
b) Retention
c) Recall
- There are several disorders of memory: Hyperamnesia (exaggerated degree of
retention and recall) ii. Amnesia (intergraded amnesia, retrograde amnesia) iii.
Paramnesia (confabulation, retrospective falsification)

9. DÉJÀ VU

- Is a French term meaning, “Already seen”. It is an experience of seeing with the

feeling that one has seen it before but does not know when and where.

10. DEMENTIA

- Is a permanent, irreversible loss of intellectual efficiency, it occurs due to structural

disturbances or degeneration of the higher cortical neurons of the brain due to
prolonged toxication or malnutrition.

CONCEPTS OF HUMAN BEHAVIOR

 Maslow’s Hierarchy of Needs

- Human motivation can be defined as the fulfillment of various needs. These needs
can encompass a range of human desires, from basic, tangible needs of survival to
complex, emotional needs surrounding an individual’s psychological well-being.
- Abraham Maslow was a social psychologist who was interested in a broad spectrum
of human psychological needs rather than on individual psychological problems. He
is best known for his hierarchy-of-needs theory. The theory organizes the different
levels of human psychological and physical needs in order of importance.
- The needs in Maslow’s hierarchy include physiological needs (food and clothing),
safety needs (job security), social needs (friendship), self-esteem, and self-
actualization. This hierarchy can be used by managers to better understand
employees’ needs and motivation and address them in ways that lead to high
productivity and job satisfaction.
- At the bottom of the pyramid are the physiological (or basic) human needs that are
required for survival: food, shelter, water, sleep, etc. If these requirements are not
met, the body cannot continue to function. Faced with a lack of food, love, and
safety, most people would probably consider food to be their most urgent need.
- Once physical needs are satisfied, security (sometimes referred to as individual
safety) takes precedence. Security and safety needs include personal security,
financial security, and health and well-being. These first two levels are important to
the physical survival of the person. Once individuals have basic nutrition, shelter,
and safety, they seek to fulfill higher-level needs.
- The third level of need is social, which includes love and belonging; when individuals
have taken care of themselves physically, they can address their need to share and
connect with others. Deficiencies at this level, on account of neglect, shunning,
ostracism, etc., can impact an individual’s ability to form and maintain emotionally
significant relationships. Humans need to feel a sense of belonging and acceptance,
whether it comes from a large social group or a small network of family and friends.
Other sources of social connection may be professional organizations, clubs,
religious groups, social media sites, and so forth. Humans need to love and be loved
(sexually and non-sexually) by others. Without these attachments, people can be
vulnerable to psychological difficulties such as loneliness, social anxiety, and
depression. These conditions, when severe, can impair a person’s ability to address
basic physiological needs such as eating and sleeping.
- The fourth level is esteem, which represents the normal human desire to be valued
and validated by others, through, for example, the recognition of success or status.
This level also includes self-esteem, which refers to the regard and acceptance one
has for oneself. Imbalances at this level can result in low self-esteem or an inferiority
complex. People suffering from low self-esteem may find that external validation by
others—through fame, glory, accolades, etc.—only partially or temporarily fulfills
their needs at this level.
- At the top of the pyramid is self-actualization. At this stage, people feel that they
have reached their full potential and are doing everything they’re capable of. Self-
actualization is rarely a permanent feeling or state. Rather, it refers to the ongoing
need for personal growth and discovery that people have throughout their lives.
Self-actualization may occur after reaching an important goal or overcoming a
particular challenge, and it may be marked by a new sense of self-confidence or
contentment.

 Patterns of Adaptation
 Adaptation is the ability to adjust to new information and experiences. Learning is
essentially adapting to our constantly changing environment. Through adaptation,
we are able to adopt new behaviors that allow us to cope with change.
 Twentieth century Swiss psychologist and genetic epistemologist Jean Piaget's
theory of cognitive development outlined four stages of learning. These stages
include sensorimotor (0 to 2 years old), preoperational (2 to 7 years old), concrete
operational (7 to 12 years old), and formal operational (12 years old and up)—
however, the age each stage starts can vary.2
 According to Piaget's theory, adaptation is one of the important processes guiding
cognitive development. The adaptation process itself can take place in two ways:
assimilation and accommodation.

 Piaget's Schemas and Learning

 Schemas are cognitive or mental structures that are formed based on past
experiences. The concept was first described in 1932 by Frederic Bartlett, and Piaget
incorporated the term into his theory of cognitive development.
 People use these mental categories to help understand the world around them.
Schemas are influential in shaping how someone takes in new information and
organizes it. Thus, schemas can play an important role in learning. Adaptation is
one schema that describes how people learn and understand new information.

 Adaptation Through Assimilation

 In assimilation, people take in information from the outside world and convert it to
fit in with their existing ideas and concepts. New information can sometimes be
readily assimilated into an existing schema.
 However, this process doesn't always work perfectly, especially during early
childhood. Here's one classic example: Imagine a very small child is seeing a dog for
the first time. If the child already knows what a cat is, they might assume the dog is
a cat: It fits into their existing schema for cats, since both are small, furry, and have
four legs. Correcting mistakes like these takes place through the next adaptation
process, accommodation.

 Adaptation Through Accommodation

 In accommodation, people process new information by changing their mental
representations to fit that new information. When people encounter information
that is completely new or that challenges their existing ideas, they often have to
form a new schema to accommodate the information or alter their existing mental
categories.
 This is much like trying to add information to a computer database only to find that
there is not a pre-existing category that will fit the data. In order to incorporate it
into the database, you will have to create a brand-new field or change an existing
one.
 The child in the previous example that initially thought that a dog was a cat might
begin to notice key differences between the two animals. One barks while the other
meows. One likes to play while the other wants to sleep all day. After a while, the
child will accommodate the new information by creating a new schema for dogs
while at the same time altering their existing schema for cats.

 Adaptation in Cognitive Development

 The adaptation process is a critical part of cognitive development. According to
Piaget's theory, this process is what facilitates growth through each of the four
developmental stages.
 Schemas continue to change over time as people experience new things.8 Through
the adaptive processes of assimilation and accommodation, children and adults are
able to take in new information, form new ideas or change existing ones, and adopt
new behaviors that make them better prepared to deal with the world around them.

 Frustration and Conflict

- All individuals at one or other time in our day to day life have conflicts and
frustration. Continuous feeling of chronic conflict and frustration will have a
negative impact on our well-being. Frustration and unresolved needs and desires
cause great emotional unhappiness.

 Meaning of conflict
 Douglas and Holland define conflict as a painful emotional state which
results from a tension between opposed and contradictory wishes
 Barney and Lehner defines conflict is a state of tension brought by the
presence in the individual of two or more opposing desires.

 Types of conflict
o Approach-Approach conflict: This arises when an individual is faced with the
problem of making a choice between two or more positive goals almost equally
motivating and important. For example, a child may have to choose between
watching a movie in TV or going out to play games.
o Avoidance-Avoidance conflict: In this, an individual is forced to choose between two
negative courses of action. For example, a child who does not want to study and at
the same time does not want to displease the parents by failing in the examination
may experience such conflict.
o Approach-Avoidance conflict: In this, an individual is faced with a problem of choice
between approaching and avoiding tendencies at the same time.

 Sources of Conflict
o The conflict arises from the home, school, occupational social and cultural
environment. The faulty upbringing at home, unhealthy relationships, over
protection is the sources of conflict from home environment. Unpleasant school or
college environment, role of teachers, faulty method of teaching, denial of
opportunities for self expression and classmates are some of the sources of conflict
in youngsters. Improper working environment, dissatisfaction with the working
conditions, unsatisfactory relationships and poor salary or wages is the sources of
conflict in occupational environment. The taboos, inhibitions and the negative
attitude towards sex are the causes of many sex conflicts in the minds of youth and
adults.

 Conflict resolution
o Negotiation is an important part of conflict resolution
o First of all, accept each desire as it arrives without judgment or resistance
o Remove any barrier or resistance in choosing among conflicting desires
o Think the goals of life and which one of the desires will be helpful to achieve the
life’s goal
o Choose one desire and follow it with full enthusiasm

 Meaning of Frustration
o Frustration means emotional tension resulting from the blocking of a desire or need
(Good, 1959)
o According to Barney and Lehner (1953), frustration refers to failure to satisfy a basic
need because of either condition in the individual or external obstacles.

 Causes of Frustration
o External factors
 Physical factors: Natural calamities, floods, droughts, earthquakes, fire and
accidents cause frustration in an individual.
 Social and societal factors: Societal norms and values impose certain
obstacle in meeting the individual needs which leads to frustration
 Economic and financial factors: Unemployment and lack of money causes
frustration in an individual.
o Internal factors
 Physical abnormality or defects: Too small or too big a stature, very heavy or
thin body, an ugly face or dark complexion etc causes frustration.
 Conflicting desires or aims: When a person has conflicting desires, he develops
frustration. For example, a nurse wants to work in abroad and does not want to
leave her family in home country causes frustration.
 Individual’s morality and high ideals: An individual’s moral standards, code of
ethics and high ideals may become a source of frustration to him.
 Level of aspirations: One may aspire very high in spite of one’s incapabilities or
human limitations which may lead to frustration
 Lack of persistence and sincerity in efforts: Frustration may result in one’s own
weakness in putting continuous and persistent efforts with courage, enthusiasm
and will power.

 Human Response to Frustration

a) Anger:
 Anger is expressed toward the object perceived as the cause of the frustration
 Anger can be a healthy response if it motivates us to positive action.
b) Giving Up:
 Giving up (quitting or being apathetic) is another form of giving in to frustration.
c) Loss of Confidence:
 Loss of confidence is a frequent side effect of giving up and not fulfilling
personal goal.
d) Stress:
 Stress is the (wear and tear) that our body and mind experience as we response
to frustrations.
e) Depression:
 Depression is a response to repeated frustration and can affect the way we eat,
sleep, and the way we feel about ourselves.
f) Drug abuse and alcohol addiction:
 Substance abuse is self-destructive and usually unsuccessful attempt to deal
with frustration.

ANXIETY RESPONSES AND ANXIETY DISORDERS

 Anxiety is a part of everyday life. It has always existed and belongs to no particular era or
culture. Anxiety involves one’s body, perceptions of self, and relationships with others,
making it a basic concept in the study of psychiatric nursing and human behavior.
Anxiety disorders are the most common psychiatric disorders in the United States,
affecting between 15% and 25% of the population. Those with an anxiety disorder have
significant impairment in quality of life and functioning.

 Defining Characteristics
 Anxiety is an emotion and a subjective individual experience. It is energy and
cannot be observed directly. A nurse infers that a patient is anxious based on
certain behaviors. The nurse needs to validate this inference with the patient
 Anxiety is an emotion without a specific object. It is provoked by the
unknown and accompanies all new experiences, such as entering school,
starting a new job, or giving birth to a child. This characteristic of anxiety
differentiates it from fear
 Fear has a specific source or object that the person can identify and describe.
Fear involves the cognitive appraisal of a threatening stimulus; anxiety is the
emotional response to that appraisal. Fear is caused by physical or
psychological exposure to a threatening situation. Fear produces anxiety.
Fear and anxiety are different, and this is reflected in our speech: We speak
of having a fear but of being anxious.
 Anxiety is communicated interpersonally. If a nurse is talking with a patient
who is anxious, within a short time the nurse also will experience feelings of
anxiety. Similarly, if a nurse is anxious in a particular situation, this anxiety
will be communicated to the patient. The “contagious” nature of anxiety can
have positive and negative effects on the therapeutic relationship. The nurse
must carefully monitor these effects.
 Anxiety is about self-preservation. It occurs as a result of a threat to a
person’s selfhood, self-esteem, or identity. It results from a threat to
something that is central to one’s personality and essential to one’s
existence and security. It may be connected with fear of punishment,
disapproval, withdrawal of love, disruption of a relationship, isolation, or loss
of body functioning. Culture is related to anxiety, because culture can
influence the values one considers most important (Gwynn et al, 2008;
Westermeyer et al, 2010).

 Levels of Anxiety
 Peplau (1963) identified four levels of anxiety and described their effects:

1. Mild anxiety occurs with the tension of day-to-day living. During this stage the
person is alert and the perceptual field is increased. The person sees, hears, and
grasps more than before. This kind of anxiety can motivate learning and produce
growth and creativity.
2. Moderate anxiety, in which the person focuses only on immediate concerns,
involves narrowing of the perceptual field. The person sees, hears, and grasps less.
The person blocks selected areas but can attend to more if directed to do so.
3. Severe anxiety is marked by a significant reduction in the perceptual field. The
person tends to focus on a specific detail and not think about anything else. All
behavior is aimed at relieving anxiety, and much direction is needed to focus on
another area.
4. Panic is associated with dread and terror, as the person experiencing panic is unable
to do things even with direction. Increased motor activity, decreased ability to
relate to others, distorted perceptions, and loss of rational thought are all
symptoms of panic. The panicked person is unable to communicate or function
effectively. This level of anxiety cannot persist indefinitely, because it is
incompatible with life. A prolonged period of panic would result in exhaustion and
death. But panic can be treated safely and effectively.

 PHYSIOLOGICAL, BEHAVIORAL, COGNITIVE, AND AFFECTIVE RESPONSES

TO ANXIETY

A. Physiological
o Cardiovascular
 Palpitations
 Racing heart
 Increasedblood pressure
 Faintness∗
 Actual fainting∗
 Decreased blood pressure∗
 Decreased pulse rate∗
o Respiratory
 Rapid breathing
 Shortness of breath
 Pressure on chest
 Shallow breathing
 Lump in throat
 Choking sensation
 Gasping
o Gastrointestinal
 Loss of appetite
 Revulsion toward food
 Abdominal discomfort
 Abdominal pain
 Nausea
 Heartburn
 Diarrhea
o Neuromuscular
 Increased reflexes
 Startle reaction
 Eyelid twitching
 Insomnia
 Tremors
 Rigidity
 Fidgeting
 Pacing
 Strained face
 Generalized weakness
 Wobbly legs
 Clumsy movement
o Urinary Tract
 Pressure to urinate∗
 Frequent urination∗
o Skin
 Flushed face
 Localized sweating (e.g., palms)
 Itching
 Hot and cold spells
 Pale face
 Generalized sweating
o Behavioral
 Restlessness
 Physical tension
 Tremors
 Startle reaction
 Hypervigilance
 Rapid speech
 Lack of coordination
 Accident proneness
 Interpersonal withdrawal
 Inhibition
 Flight
 Avoidance
 Hyperventilation
o Cognitive
 Impaired attention
 Poor concentration
 Forgetfulness
 Errors in judgment
 Preoccupation
 Blocking of thoughts
 Decreased perceptual field
 Reduced creativity
 Diminished productivity
 Confusion
 Self-consciousness
 Loss of objectivity
 Fear of losing control
 Frightening visual images
 Fear of injury or death
 Flashbacks
 Nightmares
o Affective
 Edginess
 Impatience
 Uneasiness
 Tension
 Nervousness
 Fear
 Fright
 Frustration
 Helplessness
 Alarm
 Terror
 Jitteriness
 Jumpiness
 Numbing
 Guilt
 Shame
 Frustration
 Helplessness

 PREDISPOSING FACTORS
A. Biological
 The majority of studies point to a dysfunction in multiple systems rather than
implicating one particular neurotransmitter in the development of an anxiety
disorder. These systems include the following:
 GABA system. The regulation of anxiety is related to the activity of the
neurotransmitter gamma-aminobutyric acid (GABA), which controls the activity, or
firing rates, of neurons in the parts of the brain responsible for producing anxiety.
GABA is the most common inhibitory neurotransmitter in the brain.
 Norepinephrine system. The norepinephrine (NE) system is thought to mediate the
fight-or-flight response. The part of the brain that manufactures NE is the locus
ceruleus. It is connected by neurotransmitter pathways to other structures of the
brain associated with anxiety, such as the amygdala, the hippocampus, and the
cerebral cortex.
 Medications that decrease the activity of the locus ceruleus (antidepressants such
as the tricyclics) effectively treat some anxiety disorders. This suggests that anxiety
may be caused in part by an inappropriate activation of the NE system in the locus
ceruleus and an imbalance between NE and other neurotransmitter systems.
 Serotonin system. A dysregulation of serotonin (5-HT) neurotransmission may play
a role in the etiology of anxiety, because patients experiencing these disorders may
have hypersensitive 5-HT receptors.
 Drugs that regulate serotonin, such as the selective serotonin reuptake inhibitors
(SSRIs), have been shown to be particularly effective in treating several of the
anxiety disorders, suggesting a major role for 5-HT and its balance with other
neurotransmitter systems in the etiology of anxiety disorders.
B. Familial
 Anxiety disorders run in families. The heritability of panic disorder is estimated to be
about 40%. Individuals with a family history of psychiatric illness are three times
more likely to develop PTSD after a traumatic event.
 Despite strong evidence for genetic vulnerability, no single or specific gene has
been clearly identified for anxiety disorders. This is due, in part, to the critical role
that the environment plays in interacting with genetic vulnerability in mental
disorders.
 It is also important to understand that anxiety disorders can overlap, as can anxiety
disorders and depression. People with one anxiety disorder are more likely to
develop another or to experience a major depression within their lifetime.
C. Psychological
 Learning theorists believe that people who have been exposed in early life to
intense fears are more likely to be anxious in later life, so parental influences are
important. Children who see their parents respond with anxiety to every minor
stress soon develop a similar pattern. In contrast, if parents are completely
unmoved by potentially stressful situations, children feel alone and lack emotional
support from their families. The appropriate emotional response of parents gives
children security and helps them learn constructive coping methods.
D. Behavioral
 Anxiety can be a product of frustration caused by anything that interferes with
attaining a desired goal. An example of an external frustration might be the loss of a
job. Many goals may thus be blocked, such as financial security, pride in work, and
perception of self as family provider. An internal frustration is seen when young
college graduates set unrealistically high career goals and are frustrated by entry-
level job offers. Their view of self is threatened by their unrealistic goals and they
are likely to experience feelings of failure, insignificance, and mounting anxiety.

 Coping Mechanisms
 As anxiety increases to the severe and panic levels, the behaviors displayed by a
person become more intense and potentially injurious, and quality of life decreases.
People seek to avoid anxiety and the circumstances that produce it
 The nurse needs to be familiar with the coping mechanisms people use when
experiencing the various levels of anxiety. For mild anxiety, caused by the tensions
of day-to-day living, several coping mechanisms commonly used include crying,
sleeping, eating, yawning, laughing, cursing, physical exercise, and daydreaming.
Oral behavior, such as smoking and drinking, is another way of coping with mild
anxiety
 When dealing with other people, the individual copes with low levels of anxiety
through superficiality, lack of eye contact, use of clichés, and limited self-disclosure.
People also can protect themselves from anxiety by assuming comfortable roles
and limiting close relationships to those with values similar to their own
 Moderate, severe, and panic levels of anxiety pose greater threats to the ego. They
require more energy to cope with the threat. These coping mechanisms can be
categorized as problem or task focused and as emotion or ego focused.

 Problem- or Task-Focused Coping

 Problem- or task-focused coping mechanisms are thoughtful, deliberate
attempts to solve problems, resolve conflicts, and gratify needs. These reactions
can include attack, withdrawal, and compromise. They are aimed at realistically
meeting the demands of a stress situation that has been objectively appraised.
They are consciously directed and action oriented
 In attack behavior a person attempts to remove or overcome obstacles to satisfy
a need. There are many possible ways of attacking problems, and this type of
reaction can be destructive or constructive. Destructive patterns are usually
accompanied by great feelings of anger and hostility. These feelings may be
expressed by negative or aggressive behavior that violates the rights, property,
and well-being of others. Constructive patterns reflect a problem-solving
approach. They are evident in self-assertive behaviors that respect the rights of
others
 Withdrawal behavior may be expressed physically or psychologically. Physically,
withdrawal involves removing oneself from the source of the threat. This
reaction can apply to biological stressors, such as smoke-filled rooms, exposure
to radiation, or contact with contagious diseases
 A person also can withdraw in various psychological ways, such as by admitting
defeat, becoming apathetic, or lowering aspirations. As with attack, this type of
reaction can be constructive or destructive. When it isolates the person from
others and interferes with the ability to work, the reaction creates additional
problems
 Compromise involves changing one’s usual way of thinking about things,
substituting goals, or sacrificing aspects of personal needs. It is necessary in
situations that cannot be resolved through attack or withdrawal. Compromise
reactions are usually constructive and are often used in approach-approach and
avoidance-avoidance situations. Occasionally, however, the person realizes over
time that the compromise is not acceptable; a solution must then be
renegotiated or a different coping mechanism adopted
 The likelihood of effective problem solving is influenced by the person’s
expectation of at least partial success. This depends on remembering past
successes in similar situations, which allows the person to go forward and deal
with the current stressful situation.

 Emotion- or Ego-Focused Coping

 Emotion- or ego-focused coping mechanisms, known as defense mechanisms,
protect the person from feelings of inadequacy and worthlessness and prevent
awareness of anxiety. Everyone uses them, and they often help people cope
successfully with mild and moderate levels of anxiety. However, they can be
used to such an extreme degree that they distort reality, interfere with
interpersonal relationships, and limit the ability to work productively.

CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS CRISIS

 What is Mental Health?

- World Health Organization: "Mental health is a state of well-being where a person
can realize his or her abilites to cope with normal stresses of life and work
productively.”

 Mental Health/Illness Continuum

Stress – Mental Health – Adaptive – Healthy – *Reality-oriented, *Positive self-
concept, *Emotionally stable
Neurosis
Stress – Mental Illness – Maladaptive – Psychosis – *Denies Reality

FUNDAMENTAL CONCEPTS

 MENTAL HEALTH
- Is a state of emotional, psychological, and social wellness evidenced by:
 Satisfying interpersonal relationships
 Effective behavior and coping
 Positive self-concept
 Emotional stability
 Self-awareness

 Who has mental health?

 We all fall short to some extent.

 Therefore, advocates of mental health believe that a broad range of mental health
services should be available to general population, not just seriously mentally ill.
 They believe that prevention and education, as well as treatment, are important.

 Mental Illness
- A mental disorder or condition manifested by disorganization and impairment of
functions that arises from various causes such as psychological, neurobiological and
genetic factors.

 What is mental illness? Is it a disease, like diabetes or smallpox?

- It is a form of deviant behavior—like being disobedient, choosing to dress
differently.
- It is manifested by disorganization and impairment of functions that arises from
various causes such as psychological, neurobiological and genetic factors

 What causes mental illness?

- Psychological such as: early development, cognitive styles, personal identity
- Biological as Genetics, Neurochemisty, Viral causation
- Sociological “environmental/social |causation”: as Poor living conditions and
dangerous neighborhoods

 Factors Affecting Mental Health

- Mastering the Environment
- Reality orientation
- Stress Management
- Maximizing One’s Potential
- Autonomy and Independence
- Tolerating One’s Uncertainties
- Self-esteem

 The Classification of Mental Illness:

 The Neuroses – Usually the patient retains insight and orientation; they experience
deep distress and may commit suicide as depression

 The Psychoses – (the patient is disorientated, deluded, and lacking in insight) e.g.,
Schizophrenia, puerperal psychosis

 The Dementias – Progressive deterioration with loss of recent memory and

deterioration of a normal personality, they may be primary or more commonly
secondary to another condition e.g. alcohol, stroke.

 Etiology mental illness

 Drug Abuse - Alcohol,Heroin etc

 Inheritance - Genetics/Intra-uterine environment
 Upbringing - Mothering,education,parenting
 Neurological diseases - MS,Brain tumour
 There are several well-known factors which determine mental illness:
Schizophrenia,Huntington’s
 Infections - Syphilis, HIV
 Trauma-post head injury
 Neoplasms - Brain tumours may present with personality change and mental distress
 Genetics - Huntington’s chorea and dementia
 Vascular - post stroke or intermittent arterial embolism
 Drug abuse - Korsakoff’s psychosis in chronic alcoholics but often there is no obvious
cause
 Trauma/head injury
 Biochemistry/metabolic - Porphyria,Diabetes
 Infections - HIV,Syphilis,CJD
 Vascular - CVA, Nutrition/PCM
 Classification of Mental Illnesses

- The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text
Revision (DSM-IV-TR).
- Diagnostic criteria are listed for each of the psychiatric disorders.
- A multiaxial system- people are evaluated from multiple aspects or points of
function.

 DSM-IV-TR Multiaxial Evaluation System

 Axis I - Clinical disorders and other conditions that may be a focus of clinical attention
 Axis II - Personality disorders and mental retardation
 Axis III - General medical conditions
 Axis IV - Psychosocial and environmental problems
 Axis V - The measurement of an individual’s psychological, social, and occupational
functioning on the GAF Scale

 Population at Risk for Mental Illness

 Familiar or genetic predisposition to mental illness
 2. Poor access to health care
 3. Misusing substance
 Undergoing lifestyle changes
 Victims of violence
 Elderly poor

Community Mental Health Services

 Treatment and Care Hospital Care Community Care

 It is increasingly recognised that mental illness is a chronic and relapsing condition and
that treatment may, in consequence be for months, years or even for life. Previously
many patients spent weary years in long-stay care-the mental asylums. They became
institutionalised. There was no effective therapy and they were simply looked after in a
simple routine, the worst of their symptoms often “burned out’ but by that time they
had lost all contact with family, friends,work etc. Now many more patients can be cared
for in the community after discharge from hospital. They may never need hospital
admission or attend day hospital as part of therapy. Community care is expensive in the
professional time and effort to look after patients in a social setting rather than an
institution. There are more demands upon friends, family and social services but the
results are much better. Long term medication, supervised therapy and intense
rehabilitation all play their part.

 Medication: Anti-depressants, anti-psychotics, anxiolytics, mood stabilisers

 Electro-convulsive therapy (ECT)
 Psychotherapy-individual and group,
 Psychoanalysis
 Psychosurgery-Prefrontal leucotomy, temporal lobe surgery
 Community Care

 Preventive Networks Church, Family, Home, Friends, Work

- Mental illness is preventable, mental illness can be effectively treated.

- The social networks are important in:
 Primary prevention: Having a home, being married, having work, friends, beliefs-a
positive self- image.
 Secondary prevention: Early diagnosis, effective treatment, community support
 Tertiary prevention: long term management and care in the community

 Psychiatric Nursing
- Psychiatric nursing or mental health nursing is the specialty of nursing that cares for
people of all ages with mental illness or mental distress.
- An interpersonal process that promotes and maintains behavior that contributes to
integrated functioning

 What do psychiatric nurses do?

 Ensure safety and security

 Care for biophysical needs: ADL’s, Nutrition, exercise, Medication management
 Assist in creating a healthy social world
 Increase self-awareness by: Discussion, Experience, and Role play

 Nursing Approach/Model
Components:
1. Nurse-Client Interactive Relationship
- mutuality, collaboration, and problem-solving; tools: communication and nurse-
client relationship
2. Environmental Management
- provide therapeutic environment by serving as advocates and role models, by
offering social support and by engaging clients in collaborative problem-solving of
here-and-now problems of daily living
3. Nursing Process

COMMON TERMINOLOGY USED IN PSYCHIATRIC AND MENTAL THERAPY

 Dynamics of Human Behavior

 Behavior – the way an individual reacts to a certain stimulus
 Conflict – situation arising from the presence of two opposing drives
 Need - organismic condition that requires a certain activity
 Stress – life events in which a demanding situation taxes a person’s resources as
coping mechanisms
 Adaptation – process of interacting with the environment to maintain homeostatic
equilibrium
 Maladaptation – ineffective coping
Personality – integration of systems and habits representing an individual’s
characteristic and adjustment to his environment expressed through behavior

 Personality
 Each human being is unique
We all have different personalities
 My personality reflects genetic inheritance and environment
 Personality will be reflected in behaviour and predilection to a particular mental
state.
 E.g., Introvert/Extrovert Practical men and Visionaries Idle and industrious Thinkers
and Doers
 It is possible to do a Personality inventory and classify human beings quite
accurately into their predominant personality type and to predict their preferred
mode of behaviour in a particular set of circumstances

 3 Divisions of the Mind

1. Conscious – focused on awareness
2. Subconscious – recalled at will
Unconscious – never recalled / largest part
3. Learning – change in behavior through – insight, relearning and remotivation

 Common Behavioral Signs and Symptoms

1. Disturbances in perception
Illusion: Misinterpretation of an actual external stimuli
Hallucinations: False sensory perception in the absence of external stimuli

2. Disturbances in thinking and speech

Word salad – incoherent mixture of words and phrases with no logical sequence.
Verbigeration – meaningless repetition of words and phrases.
Perseveration – persistence of a response to a previous question.
Echolalia – pathological repetition of words of others
Aphasia – speech difficulty and disturbanceExpressive , receptive or global
Flight of ideas – shifting of one topic from one subject to another in a somewhat
related way.
Looseness of association – incoherent, illogical flow of thoughts (unrelated way)
Clang association – sound of word gives direction to the flow of thought.
Delusion – persistent false belief,rigidly held
o Delusions of grandeur- special /important in a way
o Persecutory-threatened

Magical thinking – primitive thought process thoughts alone can change events.
Autistic thinking – regressive thought process-subjective interpretations not validated
with objective reality

3. Disturbances of affect (imotion)

Inappropriate – disharmony between the stimuli and the emotional reaction.
Blunted affect – severe reduction in emotional reaction.
Flat affect – absence or near absence of emotional reaction.
Apathy – dulled emotional tone.
Depersonalization – feeling of strangeness from one’s self common.
Derealization – feeling of strangeness towards environment.
Agnosia – lack of sensory stimuli integration
examples of affect are sadness, fear, joy, and anger.

4. Disturbances in motor activity

Echopraxia – imitation of posture of others
Waxy flexibility – maintaining position for a long period of time
Ataxia – loss of balance
Akathesia – extreme restlessness
Dystonia- uncoordinated spastic movements of the body
Tardive dyskenisia – involuntary twitching or muscle movements
Apraxia – involuntary un-purposeful movements

5. Disturbances in memory
Confabulation – filling of memory gaps
Amnesia – memory loss (inability to recall past events)
o Retrograde-distant past
o Anterograde – immediate past
o Anomia – lack of memory of items

SUMMARY

 MENTAL HEALTH is balance in a person’s internal life and adaptation to reality.

 MENTAL ILLNESS is a state of imbalance characterized by a disturbance in a person’s
thoughts, feelings and behavior
 Familiar, genetic predisposition, poverty, and abuses are major risk factors
 Psychiatric nursing – interpersonal process whereby the professional nurse practitioner
assists clients to achieve psychosocial well- being through the therapeutic use of self
(art) and nursing theories (science).
 Core of psych nursing – interpersonal process – human to human relationship (both
formentally healthy and ill

 Community Mental Health Services

o curative services as hospital and community care.

o preventive services as Church, Family, Home, Friends, Work.