A client on a psychiatric unit states, “It’s a waste of time being here. I can’t talk to you or anyone.” Which is the correct nursing response?

Choice A reason: The Durham Rule holds that a defendant is not criminally responsible if their act was a product of mental disease. It is broad and does not specifically address the inability to control behavior despite knowing wrongfulness, making it less applicable than irresistible impulse.

Choice B reason: The M’Naghten Rule focuses on a defendant’s inability to understand the nature or wrongfulness of their actions due to mental illness. The scenario emphasizes inability to control behavior, not lack of understanding, making this choice incorrect.

Choice C reason: The Tarasoff Rule requires clinicians to warn potential victims of a patient’s threat, unrelated to insanity defenses. It addresses duty to protect, not the legal standard for criminal responsibility, making this choice irrelevant to the scenario.

Choice D reason: The irresistible impulse standard applies when a defendant understands their actions were wrong but cannot control their behavior due to mental illness. This matches the scenario, where the patient’s inability to control actions led to the insanity ruling, making this the correct choice.

Choice A reason: Repetitive, purposeless movements like hand-wringing are stereotypic behaviors often observed in anxiety disorders or obsessive-compulsive disorder. These actions stem from heightened psychological distress or neurological compulsions, not the slowed motor and emotional responses characteristic of psychomotor retardation. This condition, primarily linked to depression, involves reduced activity due to altered dopaminergic and serotonergic activity, making this choice incorrect.

Choice B reason: Sudden, jerky muscle spasms are typically extrapyramidal symptoms, such as tardive dyskinesia, caused by antipsychotic medications affecting dopamine pathways in the basal ganglia. These involuntary movements are abrupt and distinct from the generalized slowing of physical and emotional responses in psychomotor retardation, which is a hallmark of depression, rendering this choice incorrect.

Choice C reason: Rapid, involuntary movements are associated with anxiety or hyperkinetic disorders, reflecting increased autonomic arousal and motor activity. These contrast with psychomotor retardation, where patients exhibit slowed movements and emotional expression due to decreased neural activity in mood-regulating brain regions, such as the prefrontal cortex, making this choice incorrect for defining psychomotor retardation.

Choice D reason: Psychomotor retardation, common in major depressive disorder, involves slowed physical movements, speech, and emotional responses due to disruptions in dopaminergic and serotonergic neurotransmission. This leads to lethargy, delayed cognitive processing, and reduced expressiveness, accurately describing the condition and making this the correct choice for the clinical presentation described in the question.