The nurse is preparing to perform a psychosocial assessment on a patient. Which of the following should be included in the environment to promote an effective assessment? (Select all that apply)

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.

Choice A reason: The irresistible impulse test focuses on a defendant’s inability to control their actions due to mental illness, even if they understand the act’s wrongfulness. The scenario emphasizes the patient’s lack of understanding of wrongfulness, not impulse control, making this choice incorrect for the legal standard described.

Choice B reason: The substantial capacity test, part of the Model Penal Code, assesses whether a defendant lacks the capacity to appreciate the criminality of their conduct or conform to the law. The scenario specifically highlights not understanding wrongfulness, aligning more directly with M’Naghten, making this less precise.

Choice C reason: The Durham Rule states that a defendant is not criminally responsible if their act was a product of mental disease. It is broader and less specific than M’Naghten, which focuses on understanding wrongfulness, making it less applicable to the scenario described.

Choice D reason: The M’Naghten Rule holds that a defendant is not guilty by reason of insanity if, due to mental illness, they did not understand the nature or wrongfulness of their actions. This directly matches the scenario’s emphasis on the patient’s inability to understand wrongfulness, making it the correct choice.