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Biyani's Think Tank

Concept based notes

Mental Health & Psychiatric Nursing-I

(GNM) Subita Fageria Lecturer Deptt. of B. Sc. (Nursing Biyani Nursing College, Jaipur
(GNM)
Subita Fageria
Lecturer
Deptt. of B. Sc. (Nursing
Biyani Nursing College, Jaipur

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2

Published by :

Think Tanks Biyani Group of Colleges

Concept & Copyright :

Tanks Biyani Group of Colleges Concept & Copyright : Biyani Shikshan Samiti Sector-3, Vidhyadhar Nagar,

Biyani Shikshan Samiti

Sector-3, Vidhyadhar Nagar, Jaipur-302 023 (Rajasthan) Ph : 0141-2338371, 2338591-95

E-mail : acad@biyanicolleges.org Website :www.gurukpo.com; www.biyanicolleges.org

Website :www.gurukpo.com; www.biyanicolleges.org Fax : 0141-2338007 First Edition : 2011 While every effort

Fax : 0141-2338007

First Edition : 2011

While every effort is taken to avoid errors or omissions in this Publication, any mistake or omission that may have crept in is not intentional. It may be taken note of that neither the publisher nor the author will be responsible for any damage or loss of any kind arising to anyone in any manner on account of such errors and omissions.

Leaser Type Setted by :

Biyani College Printing Department

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Preface

I

am glad to present this book, especially designed to serve the needs of the students.
am glad to present this book, especially designed to serve the needs of
the students. The book has been written keeping in mind the general weakness
in understanding the fundamental concepts of the topics. The book is self-
explanatory and adopts the “Teach Yourself” style. It is based on question-
answer pattern. The language of book is quite easy and understandable based
on scientific approach.
This is to help the students for clearing their doubts and for guidance and to
understand the subject why easily in a settled manner. This book covers the
diagnosis and management of both medical & nursing including the
psychopharmacology & general therapies of psychiatric disorders.
Any further improvement in the contents of the book by making corrections,
omission and inclusion is keen to be achieved based on suggestions from the
readers for which the author shall be obliged.
I acknowledge special thanks to Mr. Rajeev Biyani, Chairman & Dr. Sanjay
Biyani, Director (Acad.) Biyani Group of Colleges, who are the backbones and
main concept provider and also have been constant source of motivation
throughout this Endeavour. They played an active role in coordinating the various
stages of this Endeavour and spearheaded the publishing work.
I look forward to receiving valuable suggestions from professors of various
educational institutions, other faculty members and students for improvement of
the quality of the book. The reader may feel free to send in their comments and
suggestions to the under mentioned address.
Author

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Mental Health/ Psychiatric Nursing Course Description

This course is designed to help students develop the concept of mental health and mental illness, symptoms, prevention, treatment modalities and nursing management of mentally ill. General Objectives:- Upon completion of this course, the students will be able to:

1. Describe the concept of mental health and mental illness and the emerging trends

is psychiatric nursing.

2. Explain the causes and factors of mental illness, its prevention and control.

3. Identify the symptoms and dynamics and abnormal human behavior in

comparison with normal human behavior.

4. Demonstrate a desirable attitude and skills in rendering comprehensive nursing

care to the mentally ill.

Course Content Unit I Introduction

Meaning of mental health and mental illness

Definition of terms used in psychiatry.

Review of mental mechanisms (ego mechanisms)

Review of personality and types of personality.

Unit II History of Psychiatry

Contributors to psychiatry

History of psychiatric nursing

Trends in psychiatric nursing

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Unit III Mental Health Assessment

Psychiatric history taking

Interview technique and mental status examination.

Unit IV community Mental Health  Concept, importance and scope  Attitude and misconceptions towards
Unit IV community Mental Health
 Concept, importance and scope
 Attitude and misconceptions towards mentally ill.
 Prevention of mental illness (preventive Psychiatry) during childhood,
adolescence, adulthood and old age.
 Community mental and old age.
 Community mental health services.
 Role of nurses in community mental health services.
Unit V Psychiatric Nursing Management
 Definition of psychiatric nursing
 Principles of psychiatric nursing
 Nursing process
 Role of nurses in providing psychiatric nursing care.
 Therapeutic nurse-patient relationship
 Communication skills
Unit VI Mental disorders and nursing interventions
 Etiology – various etiological theories (genetics, biochemical, psychological, etc)

Classification of mental disorders.

Organic mental disorder-Acute brain syndrome

Chronic brain syndrome

Functional mental disorder

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Prevalence, etiology, signs and symptoms, prognosis, medical nursing

management

Schizophrenic disorders.

Mood (affective ) disorders.

Manic Depressive Psychosis

Anxiety Status.

Definition, etiology, signs, symptoms, medical and nursing management of:

Phoebic disorders, obsessive compulsive disorders, depressive neurosis, conversion disorders, dissociative reaction, hypochondriasis, Psychoactive disorders, alcohol, drugs and other psychoactive substance abuse.

Unit-VII Bio-Psychosocial

Psychopharmacology

Definition, classification of drugs, antipsychotic, antidepressant, antimanic,

antianxiety agents.

Role of nurses in psychopharmacology

Psychosocial therapies

Definition of psychosocial therapies.

Types of therapies; individual and group therapy, behavior therapy, occupational

therapy.

Role of nurse in these therapies.

Somatic therapy

History, technique of electro convulsive therapy (ECT) indications,

contraindications.

Role of nurses before, during and after electroconvulsive therapy.

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Unit VIII Forensic Psychiatry/Legal Aspects

Legal responsibilities in care of mentally sick patients.

Procedure for admission and discharge from mental hospital, leave of absence.

Indian Lunatic Act 1912

 Mental Health Act 1987  Narcotic Drugs and Psychotropic Act 1985 Unit IX Psychiatric
 Mental Health Act 1987
 Narcotic Drugs and Psychotropic Act 1985
Unit IX Psychiatric Emergencies and Crisis Intervention
 Over active patient
 Destructive patient
 Suicidal patient
8 Unit I Introduction Q.1 Ans: What do you mean by mental health? According to
8
Unit I
Introduction
Q.1
Ans:
What do you mean by mental health?
According to WHO " Health is define as a state of complete physical, mental,
social and spiritual well being not merely an absence of disease or infirmity?
Mental Health means a Healthy mind in a healthy body. Mental Health is a part of
general health. It requires a balance between body, mind spirit and the
environment in which a person lines.
Mental Health
and the environment in which a person lines. Mental Health Environment Body, mind & spirit According
and the environment in which a person lines. Mental Health Environment Body, mind & spirit According

Environment

Body, mind & spirit

According to Kerl Malinger: The adjustment of human beings to the world and to each other with a maximum of effectiveness and happiness." According to WHO: "The capacity of an individual to form harmonious relationships with other and to participate in or contribute constructively to change in social environment". Thus, Mental Health is positive state in which the person is responsible, self- directive and displays self-awareness.

Q.2 Define Mental illness ; Ans.: It is an opposition of mental illness. Mental illness occurs when a state of physical, mental, social and spiritual well being is disturbed. It is explained in 3 ways:

1. Absence of Health: It defines illness is an absence of health. It emphasize

problem but does not solve it.

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2. Biology Approach : According to scadding "Mental illness is result of

biological disturbance".

3. Pathological Approach: According to szusz "Mental illness only is term of

physical pathology".

According to American Psychiatric Association defines "mental illness or mental disorder is an illness or
According to American Psychiatric Association defines "mental illness or
mental disorder is an illness or syndrome with psychological or behavioural
manifestations and/or impairment in functioning due to social, psychological,
genetic, physical/chemical or biological disturbance. The disorder is not limited
to relation between the person and society. The illness is characterized by
symptoms and/or impairment in functioning".
Q.3
How will you differentiate the mentally healthy people from mentally ill
people?
Ans.:
S.No.
Mental Health
Mental illness
1
Positive attitudes towards self
acceptance and self awareness
(Optimistic)
Negative attitude towards self
acceptance & self awareness
(pessimistic)
2
Able to solve problems by self with
creativity
Avoid problems than solve
3
Positive self concept relate well to
people and their environment
- Poor self concept
- Feels inadequate
4
Able to cope up stress and reality
perception
Not able to cope thus stressful
situations
5
Able to make decision and sound
judgment.
Poor decision making & judgments
power
6
Able to establish and maintain healthy
relationship
Relationship with friends & family
are disturbed.
7
Accepts the authority and
responsibility
Unable to assume authority &
responsibility
8
Able to work effectively and
independently
Mostly dependent work
9
Differentiate and analyze the
situations
Unable to analyze
10
Has good sense of humar
Easily get irritated

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11

Behavioural that is generally acceptable to others

Maladaptive behavior

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Able to solve conflict very easily

Always confused and unable to solve conflict

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Deeper insight

Poor insight.

Q.4

What is mental (Defense) mechanism? How many types of mental mechanism ? Sigmund freud the father of modern psychiatry coined the term, " Defense mechanism". He described defense mechanism are unconscious processes that d defined a person against anxiety. It is often used by all people to feel free or relieved from the emotional stir, internal conflict or anxiety. It gives ego satisfaction. Very commonly it is used :-

Ans.:

To solve mental conflict

To reduce fear or anxiety

Protect one's self esteem

Protect one's sense of security

Definition of mental mechanism :-

1. According to Bhatia & Craig : The individual has mental capacities or devices

for protecting himself against psychological danger & stress"

A defense mechanism is a coping mechanism used in an effort to protect the

individual from feelings of anxiety.

mechanism used in an effort to protect the individual from feelings of anxiety. Types of mental

Types of mental mechanism and their origin

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Defense

mechanism

and their

origin.

Compensation

Displacement, denial

Fixation & substitution

Origin in oral period (0-2 yrs)

Fixation & substitution Origin in oral period (0-2 yrs)  Conversation  Identification Origin in habit
 Conversation  Identification Origin in habit training (1-3 yrs)  Introjections  Reaction formation
 Conversation
 Identification
Origin in habit training
(1-3 yrs)
 Introjections
 Reaction formation
 Transference
 Sublimation
 Repression
Origin in later period of child-
hood (13-6)
 Suppression
 Regression
 Rationalization
Origin in latency period
(6-12 yrs age)
 Projection
 Isolation
 Fantasy
 Incorporation
Other commonly use defense
mechanism
 Intellectualization
 Symbolization
 Undoing
 Intellectualization  Symbolization  Undoing  Psychotic patient use defense mechanism:- Projection,

Psychotic patient use defense mechanism:- Projection, denial, fantasy, regression,

symbolization and fixation.

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Neurotic

patient

use

following

defense

mechanism:-

Repression,

isolation,

reaction formation, displacement and dissociation.

Q.5 How mental mechanism help the person to react appropriately to the

Ans.

situation? It is one of the coping mechanism used to reduce anxiety & fear.

It assist the client to identify the source of anxiety and explore the methods to reduce anxiety.

It also keeps an individual temporarily free or away from the problem.

They protect the individual against psychological threats related to ego.

Helps the people to other people's behaviour and the factors associated with their nature.

It helps the people to lead a satisfactory & productive life which prevents

mental illness, promote mental health of individual in specific family & community in general. For example:- A graduate nurse is expected to do comprehensive nursing care, if she fails to do so and the tutor identifies it and scolds, she cries like a child to overcome her failure instead of putting more efforts and succeeding in it. Here, the nurse uses regression mental mechanism.

Q.6 Define personality? Ans: According to Allport: Personality is the dynamic organization within the individual of those psychophysical systems that determine his unique adjustment to his environment.

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According to Taylor : Personality refers to "the Aggregate of the physical & mental

qualities of the individual as these interact & function in characteristic fashion with his

environment.

Personality is expressed through the behaviour of a person. The characteristic

behaviour which is a combination of physical and mental characteristics of an individual, differentiate one
behaviour which is a combination of physical and mental characteristics of an
individual, differentiate one individual from another with his/her unique ident.
Q.7
Mention the factors affecting development of personality?
Ans.
Factors affecting development of personality :-
 Heredity
 Embryonic factors
I. Biological Factors
 Fetal factor
 Antenatal factor
II. Physiological factors
 Nervous system
 Endocrine glands
III. Social Factor
 Family
 Scholastic Environment
 Social-economic influences
 Society
IV. Emotional / Psychological Factor
V. Biochemical Factor
VI. Physique

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Q.8

Explain Freud's psychodynamic theory:

Ans.:

Freud explained psychodynamic theory as :

1.

Conscious Level: It is awareness part certain thought which are pleasurable and remembered

2.

Unconscious level: Some thought are completely repressed which the person doesn't like is painful for ethical standard or self image. All ID are unconscious.

3.

Preconscious level: The memories/thought are easily available with a moment reflection.

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Unit II

History of Psychiatry

Q.1 Ans.: Brief the historical development of psychiatry nursing? History of psychiatry: History is meaningful
Q.1
Ans.:
Brief the historical development of psychiatry nursing?
History of psychiatry: History is meaningful record of human achievement. The
term, 'History' is derived from a Roman word "Historics" which means
knowledge through" enquiry. The whole series & record of past events that
occurred chronologically in relation to psychiatry were described.
The following categories of periods are identified historically :
1. The period of persecution : 1550 BC – 1400 AD
2. The period of Segregation : 1545 AD -1800 AD
3. The humanitarian period – 1745 – 1826 AD
4. Beginning of scientific attitude : 1796 AD – 1878 AD
5. The period of prevention : 1885 AD – 1960 AD
1. Past history:- In first century "CHARAK SAMHINTHA" has referred to psychiatric
as " Bhut vidhya" and personality was basically divided into 3 categories :
A.
B.
C.
Satveek (Moral level)
Rajasse (Emotional level)
Tamsie (Said as mentally retard)

Mental disorders was known as " UNMADA" & fainting was known as " Murkh"

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Psychotherapy

CHIKITSHA" About 4 th century method of treatment are :

- Tortures

- Burning

- Jail

- Asylum

- 1 st Mental asylum established in India in "DHAR" (MP)

of

process

was

present

in

form

"DAIUAIY

APARYA

- Philippe pinel (father of modern psychiatry) raise his voice against asylum. II. Present History:

1. First psychiatric nurse" Linda Richards" from America start training of nurses for care of psychiatric patient in 1873.

2. In 1953, national, legue of nursing (USA) publish a study's brought out function's and qualification of a psychiatric nurse.

3. In 1956 DPN (Diploma in psychiatric nursing) was started in NIMHANS (National Institute of Mental Health Neurological Science), Banglore, 1 year course.

4. 1960, psychiatric nursing was made a compulsory course in America.

5. 1973, standard of psychiatric nursing was established.

Past Situation :

1. In 1946, bhore committee report recommend preparation of psychiatry nurses.

2. In 1965, INC - Psychiatric Nursing or a compulsory course in BSc. (N)

3. In 1975, MSc. (Psychiatric Nursing) started in RAK New Delhi

4. In 1983, DPN in Ranchi

5. In 1986, Psychiatric Nursing In GNM

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6. In 1990, started in MG university Kottayam.

Present situation:

1. 22000 bed in 42 mental hospital

2. 2000-3000 bed in general hospital 3. I bed for 32,000 population 4. No. meaningful
2. 2000-3000 bed in general hospital
3. I bed for 32,000 population
4. No. meaningful available for rural population
5. 1000-1500 psychiatrist in India.
6. Every year 150 are being trained.
7. All the same time number of psychiatric nurses only 900-950
8. About 60 seat are available for DPN & may not be filled each year.
9. 1 Nurse for every 1,00,000 population.

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Unit III

Mental Health Assessment

18 Unit III Mental Health Assessment Q.1 What is mental health assessment? Ans.: Mental Health Assessment
18 Unit III Mental Health Assessment Q.1 What is mental health assessment? Ans.: Mental Health Assessment

Q.1 What is mental health assessment?

Ans.: Mental Health Assessment is the first step of nursing process that includes

analysis of data collected from the patient and his family and identification of

nursing needs.

The data can be collected from primary source, that is from the clients his family

members (subjective data) or from secondary source e.g. Clients care record,

nurse

notes or notes from health team members.

Q.2

How many types of basic techniques included in Mental Health Assessment?

Ans.

Three types of basic techniques included in mental health assessment:

1. History taking

2. Mental status examination

3. Psychological tests

Q.3 Describe the steps for taking psychiatric history? Ans.: History taking and mental status examination are important measure for diagnosis & treatment outline preparation of mental illness. Psychiatric history included the following steps:

I. Identification data:

Name of the patient …………………….

age………

Sex………………… Bed no. …………………….

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Hospital Reg. No. ……………………. Education ……………………… occupation ………………………… Marital status …………………… religion ………………………… Language………………………… nationality …………………………………. Income ……………………………. Address ………………………………… Data of Admission ……………………… Final diagnosis …………………………… Identification mark…………………………….

II. a) Informant ……………………… b) reliability of informant …………………… III. Present chief
II.
a) Informant ………………………
b) reliability of informant ……………………
III.
Present chief complain
According to patient ………………………….
According to relatives :
 Onset of present complains ……………………
 Duration of present complains……………….
 Nature of present complains ………………………
 Precipitating factors …………………………
IV.
History of present illness :
a. Time of onset of present episode of illness
b. Chronological arrangement of the symptoms
V.
Past history of illness:
a. Medical illness
b. Psychiatric illness

VI. Personal history

1. Developmental History

a) Infancy history

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b) Childhood history

c) Adolescence

d) Adulthood

e) Late maturity

2. Educational history

3. Play history

4. Occupational history

5. Sexual & menstrual history

VII. Family history :

Family structure

Family history of mental illness

Current social condition of family

VIII Premorbid personality

Q.4 Define MSE (Mental Status Examination). Ans.: According to K. Lalitha: MSE is defined as systematic evaluation of

cognitive functions of an individual.

MSE in a standardized format is which the clinician records the mental sign &

Behaviour, emotion,

symptoms present at the time of interview

Q.5.

What are the aspects of MSE?

Ans.

The aspects included in this examination are:-

1. General appearance & behavior:-

Consciousness

Physique

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Personal hygiene

Posture

Facial expression

 2. Gestures Talk or speech : a) Speech activity :- i. Unusual pattern ii.
2.
Gestures
Talk or speech :
a) Speech activity :-
i. Unusual pattern
ii. Unusual words
b) Tone and volume of speech
c) Speech pattern
d) Coherence
3.
Mood or affect :-
A. objective mood
a) Appearance
b) Intensity of happiness
c) Consistency of word
d) Emotional Expression
B. Subjective mood
4.
Thought process :
1. Thought at formation level
2. Stream of Thought
3. Thought at content level.

5. Perception :

a) Illusion

b) Hallucination

6. Cognitive function:

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1. Level of consciousness

2. Attention

3. Concentration

4. Memory immediate/Recent memory/remote memory

7.

Orientation: time, place, person

8.

Intelligence: average/confused

9.

Insight: Present/Partial/Present/Absent

10.

Judgment: Personal/social

11.

Abstract ability:

12

General Information

13

Psychosocial factor

Stressor

Coping skills

Relationship

Socio-cultural aspects

Adaptability

Spiritual areas

Q.6 Define interview technique? Ans. Interview is an oral questionnaire where the interviewee gives the needed information verbally in a face-to-face relationship. InterviewerThe person who conduct interview Interviewer the person that interviewed According to oxford English dictionary: - interview is a private meeting between people where questions are asked & answered According to Webster: Interview is a meeting at which information is obtaining from a person.

Q.7

Mention the types of interview techniques :

Ans.:

Interview Techniques:-

1.

Observing

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2. listening

3. Validating

4. Providing information

5. Restating

6. Clarifying 7. Paraphrasing 8. Pin pointing 9. Linking 10. Questioning 11. Focusing 12. Sharing
6. Clarifying
7. Paraphrasing
8. Pin pointing
9. Linking
10. Questioning
11. Focusing
12. Sharing summarizing
13. Reflecting
14. Confronting

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Unit-IV

Community Mental Health

Q.1

Ans.

What are common misconceptions regarding mental illness? Some of the misconceptions of community towards mental illness are:

1. Abnormal behavioural is bizarre.

2. Normal person will never be abnormal.

3. Mental illness is heredity.

4. Mental illnesses are not related to physical health.

5. Mental disorders are incurable.

6. Mental illness is caused by supernatural power.

7. Mental illness is life long

8. Mental illness is contagious

9. Marriage can cure mental illness

10. Mentally ill person should only be treated in asylums.

11. Mentally ill patients are dangerous.

12. Mental illness sometimes to be ashamed.

13. Prevalence of mental illness is low in India

14. Professionals who works with psychiatric patients are likely to become disturb

themselves.

15. Mental hospitals are place where only dangerous mental ill individual are

treated with restraint as a major approach.

Q.2

Define community mental health nursing

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Ans.:

Community mental health nursing is the application of knowledge of psychiatric nursing in preventing, promoting and maintaining mental health of people to help in early diagnosis and to rehabilitate the client after mental illness. It is also defined as to promote, maintain and conserve the health of population aggregates in the community with emphasis on mental health.

Q.3 What are the facilities (Services) available in the community to strengthen their mental Health
Q.3
What are the facilities (Services) available in the community to strengthen
their
mental Health ?
Ans.:
varied community facilities are available to provide mental health care for total
population and self involvement for their future life.
1. Day hospital centre: Patient receives a full range of treatment, services during
day time and return home at the end of day. Patients develop routine &
discipline in life.
2. Half way house: These are for those who no longer need full services of a
hospital but are not yet ready for a completely independent living, still he may
require supervision for medication & carrying domestic activities
3. Quarter way house:-
 Chronically ill patients are kept in quarter way homes.
 These patients are enough improved to live in family but their family
members reject them
 This home try to make these patients self dependent. It reduces gap
between hospital life & community life.
Ex. 13 & 14 ward at NIMHANS, Banglore.
4. Group homes:-
 15-20 recovered mentally ill patients (client) will be placed in this
home.

They stay together & provides moral, emotional, & social support to

each other.

5. Foster homes

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It is a social agency sponsored programme in which recovering patients are placed for family care.

This voluntary family is paid by social agency

This placement may be for short time or permanent.

6. Sheltered workshop

It is a work oriented rehabilitation facilities with a controlled working

environment to fulfill the individual vocational goals.

Appropriate for those patient who find difficult to complete for employment.

7. Mental Health Emergency Care :-

Hotline : Telephone link

Walk-in-clinic psychiatric emergency room (24 hrs.)

Home visits

Crisis intervention centre

8. Self help Groups

Group of patients having same mental illness

Eg. Alcohol anonymous Group of MR patient

9. Evening/Night Hospital:

Evening hospital provide mental health facilities on 5 evening of a week

Night hospital for those patients who are unable to attend clinic due

to job in day time.

Q.4 What are the role of nurse in community mental health services? Ans. Nurse can play an important role in linking the community services to the hospital. The following roles of nurse in community mental health services:-

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1. Consultative role

2. Clinician role/Practitioner role

3. Therapeutic role

4. Researcher role

5. Educator role 6. Liason role 7. Coordinator role 8. Domiciliary role 9. Manpower facilitator
5.
Educator role
6.
Liason role
7.
Coordinator role
8.
Domiciliary role
9.
Manpower facilitator
10.
Social skill training
11.
Manger/administration role
12.
Preventive role
13.
Other role :
 Assertiveness training to improve self confidence
 Conducts groups meeting.
 Carryout community outreach services.
 Provide crisis intervention services.
Q.5
Ans.:
What is preventive psychiatry?
Preventive psychiatry includes preventive measures at three levels.
1.
Primary Prevention:
 Means reducing incidence of mental illness by controlling the factors
which cause mental illness.
 It includes two component:

Health promotionthe factors which cause mental illness.  It includes two component: Specific protection 2. Secondary prevention

Specific protectionthe factors which cause mental illness.  It includes two component: Health promotion 2. Secondary prevention

2. Secondary prevention :

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Aims at early diagnosis and treatment of mental illness

It Includes following components :

Screening of populationof mental illness  It Includes following components : Crisis intervention services Mental health education 3.

Crisis intervention servicesIt Includes following components : Screening of population Mental health education 3. Tertiary prevention : Aims

Mental health education: Screening of population Crisis intervention services 3. Tertiary prevention : Aims at reduce the recurrence

3. Tertiary prevention:

Aims at reduce the recurrence of mental illness & prevalence of residual defects

or disability due to mental illness.

It includes following components:

Intensive patient care

Rehabilitation services.

Follow up care of patient.

Interactional skill training

Recreational therapy

Individual & behaviour therapy

Preventive psychiatry includes different preventive measures according to age of mental ill patient:-

1. Prevention during child hood

2. Prevention during adolescence

3. Prevention during Adulthood

4. Prevention during Old age

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Unit V

Psychiatric Nursing Management

Q.1 Define psychiatric nursing. Write the branches of Psychiatric Nursing. Ans. Psychiatric nursing : Mental
Q.1
Define psychiatric nursing. Write the branches of Psychiatric Nursing.
Ans.
Psychiatric nursing :
Mental health nursing or psychiatric nursing can be defined as a part of nursing
where nurse uses herself, her knowledge of social and behaviour sciences and
communication skills for the purpose of :
 Promotion of mental health
 Prevention of mental illness
 Helping individual family and community to cope with mental disorders.
It is a branch of medicine deal with diagnosis and treatment of mental illness.
BRANCHES OF PSYCHIATRIC NURSING:
1. Community psychiatry
2. Forensic psychiatry
3. Cultural psychiatry
4. Geriatric psychiatry
5. Child psychiatry
6. Industrial psychiatry

Q.2

What are the principles of psychiatric nursing?

Ans.:

Basic principles of MHN (Mental Health Nursing) are:

1.

To Provide a sense of individuality, safety & comfort to the patient.

2.

Economise her time & energy judiciously while nursing the patient.

3.

Maximum therapeutic intervention

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30

General principles are:

1. Accept the client exactly as he is :

a) Being non-judgmental & Non punitive

b) Sincerity & positive interest

c) Recognizes & reflects on clients feelings, which he expresses.

d) Be an active listener

e) Purposeful conversation.

2. Self understanding will be used as a therapeutic tool

3. Be consistent while working with patient with behavioural problem

4. Give reassurance to the client in an acceptable and realistic manner

5. Modify client's behaviour through emotional experience.

6. Avoid unnecessary increase in patient's anxiety.

7. Maintain therapeutic nurse patient relationship (T-NPR).

8. Be maintained objectivity in understanding client's behavioural.

9. Avoid physical & verbal restrains

10. Continuous close observation.

11. Explained ward routines & procedures at the level of pt's understanding.

12. Use appropriate language.

13. Treat and respect the client as an individual & specificity in nature.

Q.3

Ans.

Describe the role of Mental Health nurse in various setting? Mental Health nursing practice encompasses various roles in different settings like community hospital, varied agencies, therapies, etc.

A. Role of nurse in mental hospital:-

1. Direct patient care

2. Education

3. Communication of interpersonal relationship

Mental Health & Psychiatric Nursing

31

4. Ward management

5. Role of nurse in psychotropic drugs

6. Role of nurse in psychotherapy :-

a. Nurse as a Psychotherapist

b. Nurse as a parent substitute c. Nurse as a role model d. Nurse as
b. Nurse as a parent substitute
c. Nurse as a role model
d. Nurse as a resource person
e. Nurse as a supporter
f. Nurse as a socializing agent
g. Nurse as a communication
h. Nurse as a counselor
i. Nurse as a catalyst
j. Nurse as a Occupational Therapist
k. Nurse as a administrator
l. Nurse as a interpreter
m. Nurse as a teacher or technician
n. Role of nurse before during and after electro convulsive therapy (ECT)
B. Role of nurse in community setting :
Main function of nurse in community setting are :-
1. Case finding
2. Assessment of individual needs
3. Consultation with other professionals

4.

5. Co ordination of health services for individual and family

6. Establishment of therapeutic milieu

7. Function as client advocate

Involvement in individual, family and group therapy'

32

32

8. Prevention of mental illness

9. Nurses' role in primary prevention, secondary prevention, tertiary

prevention.

Q.4

Define Therapeutic - Nurse Patient Relationship (T-NPR)? T-NPR :- Interaction occurs between two persons, the nurse who possesses the skills, abilities and resources to relieve the clients discomfort and assisting him to alleviate his existing problems. According to Webster new collegiate dictionary defines "Relationship as character of being related or interrelated".

Ans.

Q.5

What is the difference between therapeutic relationship and professional (social) relationship?

Ans.

 

S.No.

Character

Therapeutic Relationship

Professional

Relationship

 

1

Technique

Planned

It just happen with mutual interest

 

2

Interaction time

Planned for specific time & place

May be planned & unplanned & by chance two people meet

 

3

Objective

Helping the patient

Satisfying needs of each other

 

4

Duration

Depends on goal

This varies & may

 

time is limited

last for years

 

5

Accountability

Nurse focus on goal during relationship

Both are responsible in this relationship

 

6

Acceptance

Nurse accept the patient as "Here and Now" without attaching judgment & interest

Based on shared values and belief

 

7

Termination

Planned and discuss with patient

Relationship exist life long.

Q.6

What are essential qualities of T-NPR? Essential qualities of T-NPR:-

 

Ans.

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33

1. Genuineness

2. Respecting the client

3. Empathy

4. Self-discipline

5. Sincerity 6. Role model 7. Good communication skills 8. Good observer 9. Show love
5. Sincerity
6. Role model
7. Good communication skills
8. Good observer
9. Show love & affection
10. Active listeners
11. Good speaker
12. Exploration of the problem (catharsis)
13. Immediacy
14. Trustful
15. Professionalism
16. Caring
Q.7
Ans.
Why T-NPR is essential?
T-NPR is essential:
I.
1.
Self realization, self acceptance and self respect.
2.
Sense of personal identity and personal integration
3.
An intimate interdependent and interpersonal relationship
4.
Satisfying needs

5.

Development goals.

II.

Nurse helps the patient to

Cope with problems

Understand the problem

34

34

Face problem realistically

Find out alternate solution to problem

Tryout new pattern of behaviour

Communication freely

Socialize effectively

Find meaning in his/her illness.

Q.8 Ans. What are phase involved in establishing and maintaining the therapeutic relationship? T-NPR involves
Q.8
Ans.
What are phase involved in establishing and maintaining the therapeutic
relationship?
T-NPR involves series of phases:-
T-NPR Phases

I. Pre-Interaction phase

Phases of T-NPR :-

II. Introductory or Orientation phase

III. Working phase

IV.Termination phase

Quality

Pre-

Introductory/

Working phase

Termination phase (Resolution/End phase)

Interaction

Orientation

phase

phase

 

Definition

Begins when a nurse assigned a patient before the nurse first contact with client.

Begin when nurse goes to patient, introduce herself & get introduction about him.

It starts when nurse and patient are able to overcome barrier of orientation phase. Nurse & patient actively works on meeting the goals.

Begins during orientation phase. In this nurse develop pact with patient

Task :

1. Nurse explore her fear & anxiety. 2. Set objective for introductory

1. Nurse collect data and identifying nursing

1. Bring a therapeutic end of T-NPR.

1. Establishme nt of contact

needs of patient.

2. Assist the patient to

2. Establish reality of separation by attaining

2. Developmen t of an agreement or

identify his problem.

3. Help the patient to socialize &

specific goals.

3. Feeling of rejection,

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35

phase. pact communicate. loss of sadness & anger 3. Take help of 3. Talking with
phase.
pact
communicate.
loss of sadness & anger
3.
Take help of
3.
Talking with
clinical
the patient
4. Help the patient to
find out alternate
solution to problem,
are expressed &
explore.
supervisory to
4.
Decrease patient
overcome
anxiety and
fear.
5. Encourage the patient
to use new pattern of
behaviour.
dependency and
increases with
independency in his
6.
Set goals for relation
ship
environment
7.
Assist the patient to
achieve his goal.
8.
Encourage the pt.
towards independency
decision making
ability.
III)
1. Improper
1.
Client
Barriers
self
display
1.
awareness
manipulative
Patient test the nurse
in various situations.
1.
Develop termination
2.
Develop sense of
and self
behavior
2.
Nurse think that
analysis
2.
Social class
disappointment &
feeling of sadness
2. Anxiety &
of patient
patient's progress is
slow.
3.
Gift giving
fear towards
3.
Status of
3.
the client
patient
Resistance to explore
& to develop
4.
Patient may like to
telephone the nurse.
3. Unplanned
4.
Anxiety
independency
5.
Develops negative self
goals
level of
4.
concept.
4. Uncertainty
nurse/patient
Fear of closeness
with patient.
about her
5.
Transference
ability
6.
Counter
transference
Q.9 Define communication, therapeutic communication and communication
skills?

Ans. Communication: Communication refers to the reciprocal exchange of information, ideas, belief, feeling and attitudes between persons or among a group of persons. It is goal directed process in which people use a system of symbols & signs to convey a message. Therapeutic Communication: The therapeutic interaction between the nurse and the client will be helpful to develop mutual understanding between two individuals. It occurs when the nurse exhibits empathy, utilize effective communication skills and responds to the client's thought, needs and concerns. Communication Skills:- It is the ability or efficiency of the nurse to utilize their knowledge systematically and effectively

36

36

a) General ability: Ability to listen, interpret speak & express through writing.

b) Special ability:

Ability to observe or interpret observation

Ability to ascertain

Ability to recognize when to speak, silent smile, interact

Ability to wait, proceed, speed

Ability to maintain T-NPR

Q.10 What is communication process? Ans.: Communication Process: Communication is two way process (sender & receiver), multidisciplinary process, multistage process & goal directed process. Communication between two or more persons involves a series of steps & element this is known as communication process.

In communication process, we will discuss:

1. Stages of communication process

2. Steps of communication process

3. Elements of communication process

a) Stages of communication process (Multistage process)

1. Attention

2. Comprehension

3. Acceptance of the information

4. Retention & Action

B) Steps of communication process:

1. Clear perception of the ideas, information or problems

2. Participation of other in the decision

3. Transmission of ideas or message

4. Ensuring that the receiver of the message acts & behave as derived by the sender.

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C)

Element:

Stimulus

Need for information, comfort, advice etc. Source / Sender Ideas, Encoding Message filter Through personal
Need for information, comfort, advice etc.
Source
/
Sender
Ideas,
Encoding
Message filter
Through personal
Factors
Can be : -
– Suggestion
– Order
symbols
Channels
– Request
Speech, written
– Instruction
Message, gesture
Feed back
Decoding
Receiver
Receiver agree with
Message
Disagree with message
Needs classification
Provides information
Message
evaluated
through
personal
Factor

38

38

Q. 11 Classify the communication?

Ans.

Communication

38 Q. 11 Classify the communication? Ans. Communication On the basis of relationship On the basis
38 Q. 11 Classify the communication? Ans. Communication On the basis of relationship On the basis
38 Q. 11 Classify the communication? Ans. Communication On the basis of relationship On the basis

On the basis of relationship

On the basis of flow

On the basis of expression

Formal Informal Communication Communication Verbal Nonverbal Communication Communication Upward Downward
Formal
Informal
Communication
Communication
Verbal
Nonverbal
Communication
Communication
Upward
Downward
Lateral/Horizontal
communication
Communication
communication
Written
Spoken/oral

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Unit IV

Mental Disorders and nursing interventions

Q.1 What are common causes of mental illness or mental disorder? disorder, Suicide, depression etc.)
Q.1 What are common causes of mental illness or mental disorder?
disorder, Suicide, depression etc.)
Many causes are responsible for mental disorders which are classified as:
Causes of mental Disorder
Predisposing
Precipitating
Perpetuating
Abnormal
Factor
Factor
Factor
Behaviour
1. Genetic factor
1. Physical Factor
1. Isolation
1. Biological factor
2. Obstetric

Complication

2. Psychological 3. Social Factor

a. Antenatal

b. Intra natal

c. Postnatal

Ans: As there are many causes for single effect (Mental Retardation caused by gentio, birth

injury etc) and single cause for several effects (Parental neglect leads to behaviour

2. Social withdrawal 2. psychosocial factor 3. Socio-cultural factor 4. Neuro biological factors

3. Personality

40

40 Diagrammatic presentation of causes of abnormal behaviour :- Mono Amines i. Neuro - biological factors

Diagrammatic presentation of causes of abnormal behaviour :-

Mono Amines i. Neuro - biological factors Amino Acids Peptides
Mono
Amines
i. Neuro -
biological
factors
Amino
Acids
Peptides
ii. Biological Factors Genetic factor Constitutional factor Physical handicap Physical deprivation Emotional factors
ii. Biological
Factors
Genetic factor
Constitutional factor
Physical handicap
Physical deprivation
Emotional factors

CAUSES OF

ABNORMAL

BEHAVIOR

Emotional factors CAUSES OF ABNORMAL BEHAVIOR iii.Social cultural factor iv. Psycho-Social factor
iii.Social cultural factor
iii.Social cultural factor

iii.Social

cultural factor

OF ABNORMAL BEHAVIOR iii.Social cultural factor iv. Psycho-Social factor War & violence group

iv. Psycho-Social

factor

War & violence group prejudice economic and employment problemtechnological & social changes

technological & social changesWar & violence group prejudice economic and employment problem

Maternal deprivation Pathogenic family Pattern Pathogenic IPR Stress

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41

Q.2

Write the Classification of mental disorder?

Ans.

Major classification of mental disorder are :

1. International classification of diseases by WHO (ICD-10)

2. Diagnostic and statistical manual of mental classification (DSM-IV-TR)

3. Research diagnostic criteria (RDC) 4. ICMI – Indian classification of mental illness. 1. International
3. Research diagnostic criteria (RDC)
4. ICMI – Indian classification of mental illness.
1. International classification of diseases:
Organic, including sympathetic, mental disorders. (F 00 -F 09 )
Mental & behavioural disorder due to psychoactive substance use (f 10 -f 19 )
Schizophrenia, schizotypal & delusional disorders (F 20 -F 29 )
Mood (affective) disorder (F 30 -F 39 )
Neurotic, stress related & somatoform disorders (F 40 -F 49 )
Behavioural syndromes associated with psychological disturbances and physical
factors (F 50 - 59 )
Disorder of adult personality & behaviour (F 60 -F 69 )
Mental retardation (F 70 -F 79 )
Disorder of psychological development (F 80 –F 89 )
Behaviour & emotional disorders with onset usually occurring in childhood and
adolescence (F 90 -F 98 )
Unspecified mental disorder (F 99 )
2. Diagnostic & Statistical manual of mental classification: (DSM-IV)
Clinical psychiatric diagnosis

Personality disorders and mental retardation

General medical condition

Psychosocial & environment problems.

Global Assessment of functioning

42

42

3. Research diagnostic criteria: (R&C) According to this, at least two of following symptoms for schizophrenic are essential :-

I.

 

a. Withdrawal

b. Delusions of being controlled

c. Delusion other than persecution lasting at least one month

d. Delusion accompanying hallucination of any type for at least one week.

e. Current auditory hallucination

II.

Period of illness lasing for at least 2 weeks.

III.

No manic or depressive symptoms

4. Indian classification of mental illness :

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Mental Illness

Organic disorder Non-organic disorders I. Dementia II. Delirium (Chronic brain syndrome) (Acute brain syndrome) I.
Organic disorder
Non-organic disorders
I. Dementia
II. Delirium
(Chronic brain syndrome)
(Acute brain syndrome) I. Psychosis
A. Psychotic (Adult)
B. Childhood
Disorder
Disorder
1. Schizophrenia
1. Mental disorder
2. Mood or Affective disorder ,
.
Mania
.
Depression
3. Psychosexual
2. Developmental
. Disorder
Disorders
4. Substance abuse disorder
3. Adolescence

a. Alcohol abuse

b. Drug abuse

5. Personality disorder

6. Psychosomatic disorder

disorder

Disorders

II. Neurosis

44

44
44 Neuropsychiatric disorder Functional disorder Anxiety Disorder (Hysteria) Panic Dissociative dis. disorder

Neuropsychiatric disorder

Functional disorder

Anxiety Disorder

(Hysteria)

disorder Functional disorder Anxiety Disorder (Hysteria) Panic Dissociative dis. disorder Conversion disorder
Panic Dissociative dis. disorder Conversion disorder Dissociative Amnesia Somatoforms disorder Dissociative Fugue
Panic Dissociative dis. disorder Conversion disorder Dissociative Amnesia Somatoforms disorder Dissociative Fugue

Panic Dissociative dis. disorder

Conversion disorder

Dissociative AmnesiaSomatoforms disorder

Somatoforms disorder

Somatoforms disorder

Dissociative FugueBody dimorphic disorder

Body dimorphic disorder

Body dimorphic disorder

SomnambulismHypochondriasis

HypochondriasisSomnambulism

DepersonalizationSomatoform pain disorder

Somatoform pain disorderDepersonalization

Multiple personalityConversion Disorder

Conversion Disorder

Conversion Disorder

Panic disorder

Phobia

Post Traumatic Disorder

Obsessive Compulsive

Neurosis

Hypochondriasis

Neurasthenia

Depersonalization

Q.3

What is the different between the organic psychosis and functional psychosis?

Ans.

S.No.

Organic Psychosis

Functional Psychosis

1

Impairment of brain tissue function due to head injury, toxic condition, encephalitis, brain tumour. Systemic infection etc.

Caused by :

Biological factor Psychological factor Socio Culture factor

2

Disturbance Of consciousness

Very rare

3

Disturbance Of Memory, Orientation & Intelligence Present

Markedly affected

4

Visual hallucination

Auditory hallucination

5

Emotional incontinence

Rare

6

Deterioration of personal & social

It is uncommon.

7

Physical examination reveals clinical features of systemic disease.

Physical examination of patient usually reveal no abnormality which can explain mental illness

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45

8

Psychological test BGT Bender Gestalt test positive.

BGT Negative

9

Laboratory & Radiological diagnosis as EEG help in determining the etiological factor responsible for psychosis

These reveals no specific abnormality

Q.4 What is the difference between the psychosis and neurosis?
Q.4
What is the difference between the psychosis and neurosis?
S.No. Psychosis Neurosis 1 Definition: Definition : Very severe illness of personality - Impairment of
S.No.
Psychosis
Neurosis
1
Definition:
Definition :
Very severe illness of personality
- Impairment of ego function
– Mild to moderate illness of
personality
46
- reality besting is highly impaired
- Grave maladjustment to life
– Ego function & reality testing is
not affected much.
– maladjustment to life is limited
2
Etiology:
Etiology :
– Biological factor
Mainly
due
to
psychological
– Psychosocial factor
factor
– Socio culture factor
3
Personality disintegration–total
Personality disintegration–partial
4
Defense mechanism:
Defense mechanism:
– Denial (Run from reality)
– Repression
– Regression
– Suppression
– Identification
– Conversion
– Introjections (Self analysis)
– Substitution
– Reaction formation
– Displacement
– Undoing
5
Clinical Features :
Clinical Features
- Impaired ego function
- Ego function affected much
- Loss of reality testing
- Not much affected
- Loss of insight
- Insight present
- Loss of judgment
- Not lost
- Presence of illusion &
hallucination
- Absent illusion &
hallucination
- Memory marked affected
- Memory present
- Impaired attention
- Attention present
- Intelligence absent
- Not affected intelligence
- Orientation absent
- Present Orientation
- Disturbance in consciousness
- Consciousness
- Disturbance of thinking
- No disturbance in thinking
- More behavioural change
- Minor behavioural change
- Social relationship affected
- Not affected
- Vocational, Social, Sexual,
Adjustment markedly
impaired
- Not markedly Impaired
6
Treatment:
Treatment :
- Hospitalization present
- No need hospitalization
- ECT
- No ECT
- Psychotherapy
- Psychotherapy useful
- Psychotropic drugs
- Psychotropic drug
7
Prognosis:
Prognosis :
- Bad prognosis
- Good prognosis
- Recurrence common
- Recurrence less

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Q.5

What is the difference between the delirium and dementia?

Ans.:

Mental Health & Psychiatric Nursing 47 Q.5 What is the difference between the delirium and dementia?

48

48

S.No.

Delirium

Dementia

1

Etiology

Etiology

 

Intracranial : Tumour, Injury, Epilepsy

i.

De-generative brain diseases :

- Alzheimer’s disease

- Pick's disease

- Huntington chorea

- Parkinson's disease

(ii)

Metabolic : Acidosis/alkalosis

Cerebral Arteriosclerosis

(iii)

Endocrinal causes

Drugs

(iv)

Nutritional deficiency Example Vitamin B

Brain pathology

(v)

Drugs Alcohol use, digitalis, bromide

Other

- Co-poisoning

- Vitamin deficiency

- Hypercholesterolemia

- diabetes

- Koraskoff disease

 

[Delirium + thiamine

deficiency]

-

Wernick disease

(vi)

Systemic deficiency example TB, Septicemia

 

(vii)

Others

post operative care circulatory disturbance

 

2

Course reversible

course irreversible

3

Onset Acute

onset chronic

4

Duration few days

Duration Months

5

Clinical features:-

Clinical features:-

(i)

Clouded of consciousness

No clouded of consciousness

(ii)

Impaired memory

Recent memory impairment is greater than remote memory

(iii)

Orientation present

Orientation absent (First involve time)

(iv)

Illusion, hallucination & delusion present

Very rarely

(v)

Emotions labile mood

Loss of emotional control

(vi)

Inappropriate or violent behaviour

Indecent behaviour

(vii)

Intelligence deterioration

Present Intelligence

(viii)

Other reasoning ability & judgment impaired

Other : Neglect personal hygiene, Anxiety, depression, loss of learning, reasoning.

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Q.6

Ans.:

Define personality disorder? Personality disorders is defined as any deviation in personality traits from the normal that they interfere with his well being or adjustment to society and require psychiatric attention. Personality disorders is different from mental illness. The symptoms of mental illness are mostly episodic & not continuous and starts from adolescence or even before. It is commonly found in 18-40 years age.

Q.7 Ans. Mention the different types of personality disorders? Personality disorders can be classified into
Q.7
Ans.
Mention the different types of personality disorders?
Personality disorders can be classified into four groups.
Personality disorder
Withdrawn
Personality disorder
Dependent
Inhibited
Anti-Social
Personality
personality
Personality
Disorder
disorder
disorder
1. Schizotypal
1. Anxious
2. Schizoid
2. Dependent
3. Paranoid
3. Aggressive
1. Hypochondrial
2. Depressive
3. Obsessive
Compulsive
1. Histrionic
2. Impulsive
3. Borderline
4. Narcissitic
Other types of personality disorder :
1. Cyclothymic Personality disorder
2. Hypomanic
3. Melancholic
4. Expolsive

5. Inadequate Personality

50

50
Q.8 What is the sign and symptoms of psychiatric illness? OR What are types of
Q.8
What is the sign and symptoms of psychiatric illness?
OR
What are types of deviation from normal behaviour?
Ans.
Deviation from normal behaviour
Disturbance
Disorders
Disorder
Disorders
Disorder
Disorder of
Of conscio-
of motor
of
of
of
Disorder of memory
or intelligence
orientation
-usness
Activity
Perception
Through
Affecter or
Mood

Confusion

Illusion

Hyper Amnesia

Clouding of consciousness

Hallucination

Amnesia

Stupor

Paramnesia

Coma

Dejavu

Delirium

Dementia

Dream State Somnolence

Jamisvu

II. Disorder of motor activity

State Somnolence Jamisvu II. Disorder of motor activity Increased activity (Over Activity) Dysactivity Decreased
State Somnolence Jamisvu II. Disorder of motor activity Increased activity (Over Activity) Dysactivity Decreased
State Somnolence Jamisvu II. Disorder of motor activity Increased activity (Over Activity) Dysactivity Decreased

Increased activity (Over Activity)

Dysactivity

Decreased activity

activity (Over Activity) Dysactivity Decreased activity Repetitious Negativism Automatic Compulsion

Repetitious

Negativism

Automatic

Compulsion

Violence

Suicide

Agitation

Tics

Behaviour

behaviour

Violence Suicide Agitation Tics Behaviour behaviour Stereotype Activity 1 Echoprexia 2. Echolalia

Stereotype

Activity

Stereotype Activity
Stereotype Activity 1 Echoprexia 2. Echolalia

1 Echoprexia

2. Echolalia

1 Echoprexia 2. Echolalia
Stereotype Stereotype Stereotype Position Movement Speech Waxy Mannerism Verbigeration flexibility Catalepsy
Stereotype
Stereotype
Stereotype
Position
Movement
Speech
Waxy
Mannerism
Verbigeration
flexibility
Catalepsy

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51

III. Disorder of perception
III.
Disorder of perception

Illusion

Hallucination

Auditory visual Gustatory Olfactory Tactile Kinesthetic Hypnogogic Hypnosomatic IV. Disorder of Thought At
Auditory
visual
Gustatory
Olfactory
Tactile
Kinesthetic
Hypnogogic
Hypnosomatic
IV. Disorder of Thought
At Formation level
At progression (Association) level
At content level
1. Autistic thinking
2. Derestic Thinking
Structure
Speed of association
Type of Association
of Association
1.
Magical
1. Neologism
Flight of ideas
2. Word salad
Clang association
3. Circumstantiality Blocking of through
4. Tangentiality
Thought retardation
5. Perseveration
Poverty of speech
Motor aphasia
Sensory aphasia
Nominal aphasia
Syntactical
aphasia
6. Irrelevant answer
7. Lossening of association
Thinking
2. Poverty of
content
of speech
3. Overvalued
ideas
4 Delusion
5. Obsession
8. Derailment
6. Phobia

7. Hypochondriasis

52

52

V. Disorder of affect

52 V. Disorder of affect Pleasurable affect Unpleasurable affect Other affect Euphoria Depression –
52 V. Disorder of affect Pleasurable affect Unpleasurable affect Other affect Euphoria Depression –

Pleasurable affect

Pleasurable affect

Unpleasurable affect

Unpleasurable affect

Other affect

Other affect

EuphoriaDepression – Anxiety

Depression

Anxiety

ElationGrief and Mourning – Apathy

Grief and Mourning

Apathy

Exhaltation– Panic

Panic

Ecstasyand Mourning – Apathy Exhaltation – Panic – Inappropriate affect – Ambivalence –

Inappropriate affect

Ambivalence

Depersonalization

Mood swing

Q.9

Define delusion. Mention the types of delusion?

Ans.

Delusion is defined as false, fixed unshakable belief, not in accordance with one's

intelligence socio cultural and educational back ground. For example : Sitting in a classroom as a student, thinking that he is the prime minister of the county or he is supreme or god.

Types of Delusion :

1. Bizarre delusion

2. Delusion of grandeur

3. Delusion of self accusation

4. Delusion of control

5. Delusion of persecution

6. Delusion of reference

7. Delusion of jealousy/infidelity

8. Encapsulated delusion

9. Nihilistic delusion

10. Delusion of worthlessness and property

Mental Health & Psychiatric Nursing

53

11. Delusion of thought possession

12. Hypochondrial delusion

13. Sexual delusion

14. Religious delusion

15. Delusion of loving 16. Delusion of influence 17. Delusion of dysmorphophobia 18. Erotic delusion
15.
Delusion of loving
16.
Delusion of influence
17.
Delusion of dysmorphophobia
18.
Erotic delusion
19.
Somatic delusion
Q.10
Ans.
Types of phobia :
1. Acrophobia –– Fear of heights
2. Agoraphobia –– Fear of Open spaces
3. Astraphobia –– Fear of Electrical Storms
4. Claustrophobia –– Fear of Closed Spaces
5. Haematophobia –– Fear of blood
6. Hydrophobia –– Fear of water
7. Monophobia –– Fear of being alone
8. Mysophobia –– Fear of dirt/germ
9. Nyctophobia –– Fear of darkness

What do you mean by phobia? Phobia is an exaggerated pathological fear of a specific type of stimulus or situation The fear that a person feels in the presence of particular object or experience. An irritational fear of an object/situation that persist, although the person may recognize it as unreasonable

10. Pyrophobia –– Fear of fires

11. Social phobia –– Fear of situation in which one might be criticized; fear of making a fool of

one self;

12. Xenophobia Fear of Strangers

54

54 13. Zoophobia – Fear of animals Q.11 Define Schizophrenia? Ans.: In 1911, Eugene Bleuler, a

13. Zoophobia Fear of animals

Q.11

Define Schizophrenia?

Ans.:

In 1911, Eugene Bleuler, a Swiss psychiatrist explain the schizophrenia, which is combination of two Greek words schizo means split and phrenic means mind. In other words schizophrenia means splitting of mind. Split occurred between the cognitive and emotional aspect of the personality.

According to ICD 10 & DSM-IV Schizophrenia is a group of disorders manifested by fundamental disturbances in thinking, mood (affect), behavior (BAT) last for at least a month of active phase symptoms.

Disturbance in thinking is marked by alteration of concept formation which may lead to misinterpretation of reality hallucinations and delusions.

Mood changes includes ambivalent constricted and inappropriate responsiveness or blunted affect and lack of empathy with other.

Behaviour may be withdrawn regressive and bizarre.

Q.12

Ans.

How schizophrenia is classified? No accurate classification is possible because symptoms of one type of

schizophrenia may be observed in another type.

Schizophrenia

schizophrenia may be observed in another type. Schizophrenia Typical Schizophrenia Simple Hebephrenic Catatonic
schizophrenia may be observed in another type. Schizophrenia Typical Schizophrenia Simple Hebephrenic Catatonic
schizophrenia may be observed in another type. Schizophrenia Typical Schizophrenia Simple Hebephrenic Catatonic

Typical Schizophrenia

Simple Hebephrenic Catatonic Paranoid Undifferentiated or mixed Simple
Simple
Hebephrenic Catatonic
Paranoid
Undifferentiated
or mixed
Simple

Classification according to ICD-10 (F 20-29 )

F

F

F

F

20

21

22

23

Paranoid

Hebephrenic

Catatonic

Undifferentiated

Atypical Schizophrenia

Juvenile Late Schizoaffective Latent Residual Psychosis
Juvenile
Late
Schizoaffective
Latent Residual
Psychosis

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F

F

F

F

F

24

25

26

28

29

Post Schizophrenic depression

Residual Schizophrenia

Simple Schizophrenia

Other Schizophrenia

Unspecified Schizophrenia

Q.13 State the clinical features of schizophrenia? Ans. Bleuler has explained : – Primary/Fundamental symptoms
Q.13
State the clinical features of schizophrenia?
Ans.
Bleuler has explained :
– Primary/Fundamental symptoms
– Secondary/Accessory symptoms
According to recent concept :
– Positive symptoms
– Negative symptoms
Positive Symptoms :
 Aggression
 Agitation
 Delusion
 Excitement
 Grandiosity
 Bizarre behaiour
 Conceptual disorganization
 Hallucination
 Hostility
 Suspiciousness

Negative symptoms :

Apathy

Blunted affect

Diminished Emotional Responsiveness

Stereotype thinking

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56
 

Social withdrawal

Lack of spontanity

Avolition

Detachment

Primary/Fundamental Symptoms (Bleuler 4 A's) Associative Autism Affective Ambivalence disturbance Incongruity
Primary/Fundamental Symptoms (Bleuler 4 A's)
Associative
Autism
Affective
Ambivalence
disturbance
Incongruity

or

Inappropriate

Mood

 

Secondary/accessory symptoms

Secondary/accessory symptoms
 
  Secondary/accessory symptoms     Disorder Disorder Disorder Deterio Disturbance
  Secondary/accessory symptoms     Disorder Disorder Disorder Deterio Disturbance
  Secondary/accessory symptoms     Disorder Disorder Disorder Deterio Disturbance
  Secondary/accessory symptoms     Disorder Disorder Disorder Deterio Disturbance
  Secondary/accessory symptoms     Disorder Disorder Disorder Deterio Disturbance
  Secondary/accessory symptoms     Disorder Disorder Disorder Deterio Disturbance
  Secondary/accessory symptoms     Disorder Disorder Disorder Deterio Disturbance
 

Disorder

Disorder

Disorder

Deterio

Disturbance Disturbance

Insight

disturbances

Or

of

of

rated

in

in

will

Perception activity

thought

Appearance

Attention

behavior

1

Hallucination Negativism
Hallucination Negativism

Hallucination Negativism

Delusion Manner Self-care

Delusion

Manner

Delusion Manner Self-care

Self-care

Client is

Client is

1 Hallucination Negativism Delusion Manner Self-care Client is Agitation Severly Blunting of
Agitation

Agitation

Severly

Severly

Blunting of

Blunting of

(Auditory

automatism

(Grandiosity

& grooming

unable to

bizarre

affected

will power

Visual or

Echolalia

persecution

become

held attention

Suicidal

(anergia)

Gustatory)

Echopraxia

reference)

minimum

for long

and homicidal

Aloofness

2

Illusion

Mannerism

Depersonalization

time

tendencies

(avoiding

 

Mutism

Incoherence

Sexual over activity

mixing

Stupor

Neologism

criminal behaviour

with

Waxy

Clang

violent

friend

flexibility

association

Assaultive & destructive

& family)

Catatonic

Perseveration

behavior

Inability

Excitement

to take

 

decisions

 

Q.14

Ans.

How schizophrenic patients are managed?

Treatment of schizophrenia depends upon the type of schizophrenia:-

1. Prevention of schizophrenia : by reducing etiological factors

2. Chemotherapy drugs

Sedative is indicated when patient is excited and restless

Hypnotics when patient is sleepless

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Neuroleptics antipsychotics such as :

Clozapine

Sulpride

Risperidone

– Phenothiazines – Antiparkinsonian drugs 3. Electro – conclusive therapy : (ECT)  Indicated when
– Phenothiazines
– Antiparkinsonian drugs
3. Electro – conclusive therapy : (ECT)
 Indicated when patient with severe schizophrenia
 About 10-12 ECT in 4-6 weels
4.
Intense Psychotherapy : Indicated in
 Early schizophrenia
 Maintenance & rehabilitation of recovered patient
 Psychotherapy are given follows:-
i.
Individual psychotherapy
ii.
Supportive psychotherapy
iii.
Group psychotherapy
iv.
Behavioural psychotherapy
v.
Occupational psychotherapy
vi.
Recreational psychotherapy
vii.
Social psychotherapy
viii.
Milieu therapy
ix.
Family therapy
5. Psycho education

6. Rehabilitation

Q.15

Define Manic-Depressive Psychosis (MDP)

Ans.:

MDP is characterized by recurrent episodes of mania and depression in the same patient at different times.

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58

MDP is a mood disorder that is characterized by a severe disturbance of mood manifested as elation and depression.

Q.16

What are the criteria to define mania and depression?

Ans.:

Criteria to define mania (Triad Symptoms) :-

1. Elevation of mood

Euphoria

Elation

Exaltation

Ecstasy

2. Increase pressure of speech :

Flight of ideas

Increase tone of speech

More talkative

Delusion of grandeur

Increase self esteem

3. Increase psychomotor activity

Over activeness

Restlessness

Person wants to keep himself busy

Unusually alert

Try to do many things at a time

Criteria to define depression (Triad symptoms):-

1.

Sadness of mood (Depressive mood)

A. Mild depression

sensitivity to criticism,

Lack of confidence

B. Acute/severe depression

Head fixed face immobile

Look fixedly downwards

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Social withdrawal

Persistent sadness

Hypochondrial ideas

C. Depressive stupor :

 Intense form of depression  Clouding of consciousness  Marked ideas of death 2.
 Intense form of depression
 Clouding of consciousness
 Marked ideas of death
2. Poverty of ideas :
 Retarded thinking
 Difficulty in thinking
 Death of thought
 Delusion of nihilism
 Suicidal of ideas
 Feeling of hopelessness
3. Decrease Psychomotor activity :
 Reduce energy level
 Negativism
 Delusion of guilt
 Frustration in day to day activity

Q.17

How will you classify the mood disorder ?

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60

Ans.: I. Classification

Mood disorder

Manic-depressive psychosis

(MDP)

Involution psychotic reaction

Manic type depressive type circular type
Manic type
depressive type
circular type

II. Classification of Mood disorder

type circular type II. Classification of Mood disorder Unipolar disorder Only attack of depression Bipolor disorder

Unipolar disorder

Only attack of depression

Bipolor disorder

Bipolar I Bipolar II Bipolar III
Bipolar I
Bipolar II
Bipolar III

Episode of severe Mania and depression

Episode of depression & Hypomania

Episode of major depression

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III. According to ICD 10 classification of mood disorder (F 30 -F 39 )

F Manic episode 30 – F Bipolar affective disorder 31 – F Depressive episode 32
F
Manic episode
30
F
Bipolar affective disorder
31
F
Depressive episode
32
F
Recurrent depressive disorder
33
F
Persistent mood disorder
34
F
Other mood disorder
38
F
Unspecified mood disorder
39
Q.18
What are the treatment modalities available for depression?
Ans.: 1. Hospitalization : indicated in
Severe attack of depression
Suicidal & homicidal tendencies
Stupor condition of patient
Psychotic & delusional depression
2.
Electro convulsive therapy :
Total 6-8 Ect
3
in I st Week
2
in II nd Week
1
in III rd Week

3. Drugs :

a) Sedatives –– if patient agitated

b) Hypnotics - if insomnia present

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c) Tranquillizers:

Meprobamate 200-400 mg

Chlordizepoxide 10-20 mg

Diazepam 5-10 mg T.D.S. If patient is anxious

d) Neuroleptics - if patient agitated and anxious

Chlorpromazine hydrochloride

e) Antidepressant drugs :

Tricycle & Tetracyclic compounds Such as immipremine, hydrochloride

amitryptiline Hydrochloride

Trimipramine

Mianserin

MAO (Mono amino oxide) inhibitors like phenelezine. It is more powerful anti depressant drug

Recently more specific drugs are :

Aminiptine

Fluoxetine

Amoxopine

Tradozone

Psychotherapy :

Cognitive & behaviour therapy

Analytical psychotherapy

Occupational psychotherapy

Work therapy

Art therapy

Music therapy

Interpersonal therapy

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Family therapy

Q.19

Define anxiety disorders ?

Ans. Anxiety disorder are psychological disturbance where anxiety is the essential

symptoms anxiety is a normal phenomena. Every normal person experience anxiety. But when it cause
symptoms anxiety is a normal phenomena. Every normal person experience
anxiety.
But when it cause excessive tension out of proportion & interfere with physical &
mental activities is known as pathological anxiety.
Anxiety reaction is a neurotic state of chronic apprehension with recurrence of
acute anxiety symptoms.

Q.20 Define obsessive compulsive neurosis (OCN) ? Ans.: It is a psychiatric neurotic disorder in which obsession & compulsion are a significant source of distress and interfere with an individual ability to function. Obsession:- Recurrent & persistent unwelcome ideas & impulses or images. They interfere with individual mind again and again in a stereotype from. Patient does not enjoy getting those ideas. Thoughts, images or impulses are not simply excessive worries about real life problems. They appear senseless to the individual. He actually feel miserable and guilty. Compulsion:- Repetitive stereotype behavioural or mental acts that person feels driven to perform in response to an obsession to relive tention even though they are recognized senseless by the individual. Eg. Hand washing, checking, counting.

Q.21

What do you mean by Hysteria?

Ans.

It is a neurotic disorder characterized by :

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64

Hysterionic behaviour

Suggestibility (susceptible against any suggestion)

Transformation of an unconscious conflict into physical symptoms

Emotional outbursts

Repressed anxiety

It is of two types:-

outbursts  Repressed anxiety It is of two types:- Hysteria Somatoform disorder 1. Body dysmorphic disorder

Hysteria

 Repressed anxiety It is of two types:- Hysteria Somatoform disorder 1. Body dysmorphic disorder 2.
 Repressed anxiety It is of two types:- Hysteria Somatoform disorder 1. Body dysmorphic disorder 2.

Somatoform disorder

1. Body dysmorphic disorder

2. Hypochondriasis

3. Somatoform pair disorder

4. Conversion disorder

Dissociative disorder

1. Dissociative amnesia a. Circumscribed amnesia b. Selective amnesia c. Continuous Amnesia d. Generalized

2. Dissociative fugue

3. Somnambulism

4. Depersonalization

5. Multiple personality

Q.22.

What is psychosomatic disorder ?

Ans:

It is also called psycho physiological disorder :

It is characterized by physical symptoms resulting from psychological factor (emotional stress) usually involving one system of body under voluntary control:

Types 1. GIT Peptic ulcer, Anorexia nervosa

2. CVS : Hypertension, Ischemic heart disease

3. Endocrine system Diabetes, thyrotoxicosis

4. Genito urinary system Impotence, menstrual disorder

5. Respiratory system Asthma

6. Integumentary -

7. Musculoskeletan System Arthritis, backache

8. Others headache, migraine

Psoriasis

Q.23

Define alcoholism?

Ans.:

Alcohol has been used for countries to obtain relief from discomfort & tention.

Alcoholisms or alcohol abuse disorder is defined as chronic dependence of alcohol characterized by excessive and compulsive drinking that produces disturbances in mental or cognitive level of functioning which interferes with social and economic functioning :

Alcoholism results due to

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Excessive consumption

Alcohol related disability

Problem drinking

Alcohol dependence

Q.24 Mention the certain special alcohol withdrawal syndrome? Ans.: 1. Simple withdrawal syndrome : 
Q.24
Mention the certain special alcohol withdrawal syndrome?
Ans.:
1.
Simple withdrawal syndrome :
Mild tremors
Nausea & vomiting
Weakness
Irritability
Insomnia
Anxiety
Tachycardia
Hypertension
Impaired attention
2.
Delirium tremens
3.
Pathological darkness (Acute Alcoholic Psychosis)
4.
Delirium
5.
Alcoholic seizures
6.
Alcoholic Hallucination
7.
Dipsomania
8.
Alcoholic paranoia

9. Dementia

10. Wernick's syndrome

11. korsakow's syndrome

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66
Q.25 How the psychoactive substances are classified? Ans.: Psychoactive substances
Q.25
How the psychoactive substances are classified?
Ans.:
Psychoactive substances

Narcotics

are classified? Ans.: Psychoactive substances Narcotics – Opium & its derivatives Eg. Opium, heroin,

Opium & its derivatives Eg. Opium, heroin, morphine, Codeine Synthetic Narcotics Such as methadone

Sedative

Stimulants

Hallucinogens

Minor Tranquilizers

& Depressant

   
Minor Tranquilizers & Depressant     – Ethyl alohol     – Amphetamines –

Ethyl

alohol

 
 

Amphetamines

Cannabis eg ganja,

Maprobamate

sedative/

Cocaine

charas, bhang, hashish other LSD: - Lysergic Acid Diethylemide

Diazepain

hypnotics

   

Chlordiazepoxide

Eg.

 

Barbiturates

Nindral

Dalmane

Doriden

Q.26

Ans.

It is a term applied to pathological use of persistent or sporadic drugs with impairment social & occupational functioning and a minimum duration of disturbance of at least one month.

The substance abuse leads to many psychological dependence :-

Define substance abuse/drug dependent? Drug abuse/psychoactive substance abuse:

1. Psychological dependence results in drug seeking behaviour

2. An inability to stop using the drug to physical dependence on the drug & tolerance

to its effect.

3. Continuous substance use results in physical & mental deterioration.

Drug Dependence: a maladaptive pattern of substance use leading to significant impairment or distress as manifested by :- Tolerance withdrawal symptoms

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Frequent pre-occupation with seeking or taking the substance Often takes the substance in larger amount or over a longer period Often takes the substances to relieve or avoid withdrawal symptoms. Define childhood disorder? Childhood Disorder:- Nursing personnel find various childhood & adolescent problems while working in a hospital as well as in a community setting. Disorders of psychological development & behaviour & emotional disorders with onset usually occurring in childhood & adolescence. The development phase from infancy to childhood is a significant period to prevent a number of behavioural and other problems.

Q.27

Ans.:

a number of behavioural and other problems. Q.27 Ans.: Childhood Disorders Developme Disruptive Anxiety Eating
Childhood Disorders Developme Disruptive Anxiety Eating General To disorder Elimination Speech Other disorder
Childhood Disorders
Developme
Disruptive
Anxiety
Eating
General
To disorder
Elimination
Speech
Other disorder
ntal
Behavioural
Disorder
disorders
Identity
disorder
disorder
Disorders
Disorder
of
disorder of