Professional Documents
Culture Documents
Mental Health of GNM
Mental Health of GNM
Subita Fageria
Lecturer
Deptt. of B. Sc. (Nursing
Biyani Nursing College, Jaipur
Published by :
Think Tanks
Biyani Group of Colleges
Concept & Copyright :
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.
Preface
the students. The book has been written keeping in mind the general weakness
in understanding the fundamental concepts of the topics. The book is selfexplanatory and adopts the Teach Yourself style. It is based on questionanswer 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
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
technique
of
electro
convulsive
therapy
(ECT)
contraindications.
Role of nurses before, during and after electroconvulsive therapy.
indications,
Unit I
Introduction
Q.1
Ans:
Environment
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, selfdirective and displays self-awareness.
2.
3.
Q.3
How will you differentiate the mentally healthy people from mentally ill
people?
Ans.:
S.No. Mental Health
1
Positive attitudes towards self
acceptance and self awareness
(Optimistic)
2
Able to solve problems by self with
creativity
3
Positive self concept relate well to
people and their environment
4
Able to cope up stress and reality
perception
5
Able to make decision and sound
judgment.
6
Able to establish and maintain healthy
relationship
7
Accepts the authority and
responsibility
8
Able to work effectively and
independently
9
Differentiate and analyze the
situations
10
Has good sense of humar
Mental illness
Negative attitude towards self
acceptance & self awareness
(pessimistic)
Avoid problems than solve
- Poor self concept
- Feels inadequate
Not able to cope thus stressful
situations
Poor decision making & judgments
power
Relationship with friends & family
are disturbed.
Unable to assume authority &
responsibility
Mostly dependent work
Unable to analyze
Easily get irritated
10
11
12
13
Deeper insight
Maladaptive behavior
Always confused and unable to solve
conflict
Poor insight.
Q.4
Defense
mechanism
and their
origin.
11
Compensation
Displacement, denial
Fixation & substitution
Conversation
Identification
Introjections
Reaction formation
Transference
Sublimation
Repression
Suppression
Regression
Rationalization
Projection
Isolation
Fantasy
Incorporation
Intellectualization
Symbolization
Undoing
12
Q.5
Ans.
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?
According to Taylor :
13
qualities of the individual as these interact & function in characteristic fashion with his
environment.
Q.7
Ans.
Heredity
Embryonic factors
Fetal factor
Antenatal factor
I.
Biological Factors
II.
Physiological factors
Nervous system
Endocrine glands
III.
Social Factor
IV.
V.
Biochemical Factor
VI.
Physique
Family
Scholastic Environment
Social-economic influences
Society
14
Q.8
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.
15
Unit II
History of Psychiatry
Q.1
2.
3.
4.
5.
16
Tortures
Burning
Jail
Asylum
Philippe pinel (father of modern psychiatry) raise his voice against asylum.
2.
3.
(National
Institute
of
Mental
Health
Neurological
5.
Past Situation :
1.
2.
3.
4.
5.
6.
17
Present situation:
1.
2.
3.
4.
5.
6.
7.
8.
About 60 seat are available for DPN & may not be filled each year.
9.
18
Unit III
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
Ans.
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. .
a) Informant ..
b) reliability of informant
III.
IV.
Precipitating factors ..
V.
VI.
Personal history
1. Developmental History
a) Infancy history
19
20
b) Childhood history
c) Adolescence
d) Adulthood
e) Late maturity
2. Educational history
3. Play history
4. Occupational history
5. Sexual & menstrual history
Q.4
Q.5.
Ans.
Personal hygiene
Posture
Facial expression
Gestures
2. Talk or speech :
a) Speech activity :i. Unusual pattern
ii. Unusual words
b) Tone and volume of speech
c) Speech pattern
d) Coherence
21
22
1. Level of consciousness
2. Attention
3. Concentration
4. Memory immediate/Recent memory/remote memory
7.
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
Ans.
2. listening
3. Validating
4. Providing information
5. Restating
6. Clarifying
7. Paraphrasing
8. Pin pointing
9. Linking
10. Questioning
11. Focusing
12. Sharing summarizing
13. Reflecting
14. Confronting
23
24
Unit-IV
Q.1
Ans.
25
26
Q.4
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:-
27
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
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 What is preventive psychiatry?
Ans.: 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 promotion
Specific protection
2. Secondary prevention :
28
29
Unit V
30
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 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)
32
Q.4
Ans.
Q.5
Ans.
S.No.
Character
Therapeutic Relationship
Technique
Planned
Interaction time
Objective
Duration
Accountability
Depends on goal
time is limited
Nurse focus on goal during
relationship
Acceptance
Termination
Q.6
Ans.
Professional
Relationship
It just happen with
mutual interest
May be planned &
unplanned & by
chance two people
meet
Satisfying needs of
each other
This varies & may
last for years
Both are
responsible in this
relationship
Based on shared
values and belief
Relationship exist
life long.
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 & affection
10. Active listeners
11. Good speaker
12. Exploration of the problem (catharsis)
13. Immediacy
14. Trustful
15. Professionalism
16. Caring
Q.7
Ans.
33
34
I. Pre-Interaction
phase
II. Introductory or
Orientation phase
IV.Termination phase
Definition
Task :
PreInteraction
phase
Begins when a
nurse assigned
a patient before
the nurse first
contact with
client.
1. Nurse
explore her
fear & anxiety.
2. Set objective
for
introductory
Introductory/
Orientation
phase
Begin when
nurse goes to
patient,
introduce herself
& get
introduction
about him.
1. Establishme
nt of contact
2. Developmen
t of an
agreement or
Working phase
Termination phase
(Resolution/End phase)
III)
Barriers
Q.9
phase.
3. Take help of
clinical
supervisory to
overcome
anxiety and
fear.
pact
3. Talking with
the patient
1. Improper
self
awareness
and self
analysis
2. Anxiety &
fear towards
the client
3. Unplanned
goals
4. Uncertainty
about her
ability
1. Client
display
manipulative
behavior
2. Social class
of patient
3. Status of
patient
4. Anxiety
level of
nurse/patient
5. Transference
6. Counter
transference
35
communicate.
4. Help the patient to
find out alternate
solution to problem,
5. Encourage the patient
to use new pattern of
behaviour.
6. Set goals for relation
ship
7. Assist the patient to
achieve his goal.
8. Encourage the pt.
towards independency
decision making
ability.
1.
1. Develop termination
2. Develop sense of
disappointment &
feeling of sadness
3. Gift giving
4. Patient may like to
telephone the nurse.
5. Develops negative self
concept.
2.
3.
4.
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
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)
C)
37
Element:
Stimulus
Need for information, comfort, advice etc.
Source / Sender
Ideas,
Encoding
Message filter
Can be : -
symbols
Through personal
Suggestion
Factors
Order
Channels
Request
Speech, written
Instruction
Message, gesture
Decoding
Receiver
Feed back
Receiver agree with
Message
Message
evaluated
through
Needs classification
personal
Provides information
Factor
38
Ans.
Communication
Formal
Informal
Communication
Communication
Verbal
Communication
Upward
communication
Downward
Communication
Nonverbal
Communication
Lateral/Horizontal
communication
Spoken/oral
Written
39
Unit IV
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
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
2. Obstetric
Complication
a. Antenatal
b. Intra natal
c. Postnatal
3. Personality
1. Physical Factor
2. Psychological
3. Social Factor
1. Isolation
1. Biological factor
2. Social withdrawal 2. psychosocial factor
3. Socio-cultural factor
4. Neuro biological factors
40
Mono
Amines
Amino
Acids
Peptides
i. Neuro biological
factors
ii. Biological
Factors
Genetic factor
Constitutional factor
Physical handicap
Physical deprivation
Emotional factors
CAUSES OF
ABNORMAL
BEHAVIOR
iii.Social
cultural factor
War & violence
group prejudice
economic and
employment problem
technological
& social changes
iv. Psycho-Social
factor
Maternal deprivation
Pathogenic family
Pattern
Pathogenic IPR
Stress
Q.2
Ans.
41
Behaviour & emotional disorders with onset usually occurring in childhood and
adolescence (F90-F98)
42
III.
43
Mental Illness
Organic disorder
Non-organic disorders
I. Dementia
II. Delirium
A. Psychotic (Adult)
Disorder
1. Schizophrenia
B. Childhood
Disorder
1. Mental disorder
2. Developmental
. Disorder
4. Substance abuse disorder
Disorders
3. Adolescence
a. Alcohol abuse
disorder
b. Drug abuse
5. Personality disorder
6. Psychosomatic disorder
Disorders
II. Neurosis
44
Neuropsychiatric disorder
Functional disorder
Anxiety Disorder
(Hysteria)
Panic
dis.
Dissociative
disorder
Conversion disorder
Dissociative Amnesia
Somatoforms disorder
Panic disorder
Dissociative Fugue
Phobia
Somnambulism
Hypochondriasis
Depersonalization
Obsessive Compulsive
Multiple personality
Conversion Disorder
Q.3
Ans.
Neurosis
Hypochondriasis
Neurasthenia
Depersonalization
What is the different between the organic psychosis and functional psychosis?
Functional Psychosis
Caused by :
Biological factor
Psychological factor
Socio Culture factor
Very rare
Markedly affected
Auditory hallucination
Rare
It is uncommon.
Physical examination of patient
usually reveal no abnormality which
can explain mental illness
45
Psychological test
BGT Bender Gestalt test positive.
Laboratory & Radiological diagnosis
as EEG help in determining the
etiological factor responsible for
psychosis
Q.4
BGT Negative
These reveals no specific abnormality
S.No. Psychosis
1
Definition:
Very severe illness of personality
- Impairment of ego function
46
reality besting is highly impaired
Grave maladjustment to life
2
3
4
Etiology:
Biological factor
Psychosocial factor
Socio culture factor
Personality disintegrationtotal
Defense mechanism:
Denial (Run from reality)
Regression
Identification
Introjections (Self analysis)
Clinical Features :
- Impaired ego function
- Loss of reality testing
- Loss of insight
- Loss of judgment
- Presence of illusion &
hallucination
- Memory marked affected
- Impaired attention
- Intelligence absent
- Orientation absent
- Disturbance in consciousness
- Disturbance of thinking
- More behavioural change
- Social relationship affected
- Vocational, Social, Sexual,
Adjustment markedly
impaired
Treatment:
- Hospitalization present
- ECT
- Psychotherapy
- Psychotropic drugs
Prognosis:
- Bad prognosis
- Recurrence common
Neurosis
Definition :
Mild to moderate illness of
personality
Ego function & reality testing is
not affected much.
maladjustment to life is limited
Etiology :
Mainly due to psychological
factor
Personality disintegrationpartial
Defense mechanism:
Repression
Suppression
Conversion
Substitution
Reaction formation
Displacement
Undoing
Clinical Features
- Ego function affected much
- Not much affected
- Insight present
- Not lost
- Absent illusion &
hallucination
- Memory present
- Attention present
- Not affected intelligence
- Present Orientation
- Consciousness
- No disturbance in thinking
- Minor behavioural change
- Not affected
- Not markedly Impaired
Treatment :
- No need hospitalization
- No ECT
- Psychotherapy useful
- Psychotropic drug
Prognosis :
- Good prognosis
- Recurrence less
47
48
S.No. Delirium
1
Etiology
Intracranial : Tumour, Injury, Epilepsy
(ii)
(iii)
(iv)
(v)
Metabolic : Acidosis/alkalosis
Endocrinal causes
Nutritional deficiency Example Vitamin B
Drugs Alcohol use, digitalis, bromide
Dementia
Etiology
i. De-generative brain diseases :
- Alzheimers disease
- Pick's disease
- Huntington chorea
- Parkinson's disease
Cerebral Arteriosclerosis
Drugs
Brain pathology
Other
- Co-poisoning
- Vitamin deficiency
- Hypercholesterolemia
- diabetes
- Koraskoff disease
[Delirium + thiamine
deficiency]
- Wernick disease
(vi)
Orientation present
(iv)
(v)
(vi)
(vii)
(viii)
course irreversible
onset chronic
Duration Months
Clinical features:No clouded of consciousness
Recent memory impairment is
greater than remote memory
Orientation absent (First involve
time)
Very rarely
Loss of emotional control
Indecent behaviour
Present Intelligence
Other : Neglect personal hygiene,
Anxiety, depression, loss of
learning, reasoning.
49
Q.6
Define personality disorder?
Ans.: 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.
Withdrawn
Dependent
Personality disorder Personality
Disorder
Inhibited
personality
disorder
Anti-Social
Personality
disorder
1. Schizotypal
2. Schizoid
3. Paranoid
1. Hypochondrial
2. Depressive
3. Obsessive
Compulsive
1. Histrionic
2. Impulsive
3. Borderline
4. Narcissitic
1. Anxious
2. Dependent
3. Aggressive
50
Q.8
Ans.
Deviation from normal behaviour
Disturbance
Of conscio-usness
Disorders
of motor
Activity
Confusion
Clouding of consciousness
Stupor
Coma
Delirium
Dream State
Somnolence
Disorder
of
Perception
Disorders
of
Through
Disorder
of
Affecter or
Mood
Illusion
Hallucination
Hyper Amnesia
Amnesia
Paramnesia
Dejavu
Dementia
Jamisvu
Dysactivity
Repetitious
Behaviour
Compulsion
Negativism
Stereotype
Activity
Automatic
behaviour
1 Echoprexia
2. Echolalia
Stereotype
Position
Stereotype
Movement
Stereotype
Speech
Waxy
flexibility
Catalepsy
Mannerism
Verbigeration
Decreased activity
Violence
Suicide
Agitation
Tics
III.
Disorder of perception
Illusion
Auditory
visual
Gustatory
51
Hallucination
Olfactory
Tactile
Kinesthetic
Hypnogogic
Hypnosomatic
At Formation level
At content level
1. Autistic thinking
2. Derestic Thinking
Structure
of Association
1. Magical
Thinking
1. Neologism
Flight of ideas
Motor aphasia
2. Poverty of
2. Word salad
Clang association
Sensory aphasia
content
of speech
4. Tangentiality
Thought retardation
Syntactical
3. Overvalued
5. Perseveration
Poverty of speech
aphasia
ideas
6. Irrelevant answer
4 Delusion
7. Lossening of association
5. Obsession
8. Derailment
6. Phobia
7. Hypochondriasis
52
V. Disorder of affect
Pleasurable affect
Unpleasurable affect
Other affect
Euphoria
Depression
Anxiety
Elation
Apathy
Exhaltation
Panic
Ecstasy
Inappropriate affect
Ambivalence
Depersonalization
Mood swing
53
54
Typical Schizophrenia
Simple
Paranoid
F 21
Hebephrenic
F 22
Catatonic
F 23
Undifferentiated
Atypical Schizophrenia
F 24
F 25
F 26
F 28
F 29
Primary/Fundamental symptoms
Secondary/Accessory symptoms
Positive symptoms
Negative symptoms
Positive Symptoms :
Aggression
Agitation
Delusion
Excitement
Grandiosity
Bizarre behaiour
Conceptual disorganization
Hallucination
Hostility
Suspiciousness
Negative symptoms :
Apathy
Blunted affect
Stereotype thinking
55
56
Social withdrawal
Lack of spontanity
Avolition
Detachment
Primary/Fundamental Symptoms (Bleuler 4 A's)
Associative
disturbance
Autism
Affective
Incongruity
or
Inappropriate
Mood
Ambivalence
Secondary/accessory symptoms
Disorder Disorder
Or
of
Perception activity
Disorder
of
thought
1 Hallucination Negativism
(Auditory
automatism
Visual or
Echolalia
Gustatory)
Echopraxia
2 Illusion
Mannerism
Mutism
Stupor
Waxy
flexibility
Catatonic
Excitement
Deterio
rated
Appearance
Manner
Delusion
Self-care
(Grandiosity
& grooming
persecution
become
reference)
minimum
Depersonalization
Incoherence
Neologism
Clang
association
Perseveration
Disturbance Disturbance
in
in
Attention
behavior
Client is
unable to
held attention
for long
time
Insight
Agitation
Severly
bizarre
affected
Suicidal
and homicidal
tendencies
Sexual over activity
criminal behaviour
violent
Assaultive & destructive
behavior
disturbances
will
Blunting of
will power
(anergia)
Aloofness
(avoiding
mixing
with
friend
& family)
Inability
to take
decisions
57
3.
Clozapine
Sulpride
Risperidone
Phenothiazines
Antiparkinsonian drugs
4.
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
58
Elation
Exaltation
Ecstasy
More talkative
Delusion of grandeur
3.
Over activeness
Restlessness
Unusually alert
Social withdrawal
Persistent sadness
Hypochondrial ideas
C. Depressive stupor :
Clouding of consciousness
2. Poverty of ideas :
Retarded thinking
Difficulty in thinking
Death of thought
Delusion of nihilism
Suicidal of ideas
Feeling of hopelessness
Negativism
Delusion of guilt
59
60
Ans.: I. Classification
Mood disorder
Manic type
II.
depressive type
circular type
Unipolar disorder
Bipolor disorder
Bipolar I
Bipolar II
Episode of severe
Mania and
& Hypomania
depression
Bipolar III
depression
Manic episode
F 31
F 32
Depressive episode
F 33
F 34
F 38
F 39
3. Drugs :
a) Sedatives if patient agitated
b) Hypnotics - if insomnia present
61
62
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 :
amitryptiline Hydrochloride
Trimipramine
Mianserin
MAO (Mono amino oxide) inhibitors like phenelezine. It is more powerful anti
depressant drug
Aminiptine
Fluoxetine
Amoxopine
Tradozone
Psychotherapy :
Analytical psychotherapy
Occupational psychotherapy
Work therapy
Art therapy
Music therapy
Interpersonal therapy
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Family therapy
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:Hysteria
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
Excessive consumption
Alcohol related disability
Problem drinking
Alcohol dependence
Mild tremors
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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Narcotics
Opium &
its
derivatives
Eg. Opium,
heroin,
morphine,
Codeine
Synthetic
Narcotics
Such as
methadone
Sedative
Stimulants
& Depressant
Ethyl
alohol
sedative/
hypnotics
Eg.
Barbiturates
Nindral
Dalmane
Doriden
Hallucinogens
Amphetamines
Cocaine
Minor Tranquilizers
Cannabis eg ganja,
charas, bhang,
hashish
other
LSD: Lysergic
Acid
Diethylemide
Maprobamate
Diazepain
Chlordiazepoxide
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Developme
ntal
Disorders
Disruptive
Behavioural
Disorder
1. Mental retardation
2. Pervasive disordersa. autistic disorder
b. childhood autism
c. childhood psychosis
d. pseudo defective psychosis
3. Specific development
disordersa. Specific reading disorder
b. Specific arithmetic
disorder
c. specific development
disorder of speech &
language
d. Specific developmental
disorder of motor function.
Anxiety
Disorder
of
Childhood
1. Attention
deficit
hyperactive
disorder
(ADHD)
2. conduct
disorder
Eating
disorders
1. Separation
anxiety
disorder
2. avoidant
Disorder
3. Overanxious
disorder
General
Identity
disorder of
childhood
1.Anorexia
nervosa
2.bulimia
nervosa
3. pica
4. rumination
disorder of
infancy
To disorder
Elimination
disorder
1.Trans
Sexuliasn
2. Gender
identity
disorder of
childhood
1.Eneuresi
s
2.Encopre
sis
Autistic
disorder
Speech
disorder
Other disorder
Stuttering
Childhood
Schizophrenia
Temper tantrum
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Primary
Sleep
Disorders
Secondary
Sleep disorder
(Clinical problem
accompanied by
specific or nonspecific
disturbance)
Cateplexy
Insomnia
Hypersomnia
Narcolepsy
Nightmares
Night terrors
Alcoholism
Anorexia
nervosa
Depression
Hyperthyroidism
Hypothyroidism
Schizophrenia
Parasomnias
(Walking up
during sleep)
Bruxisam
Nocturnal
Eneuresis
Sleep talking
Sleep Walking
Insomnia
quantitative and
qualitative
insufficient
Sleep based
On the
individual
Need.
Sleep onset
Insomnia
Frequent
Nocturnal
awakening
Early morning
awakening
Sexual dysfunction
Not caused by organic
Disorder
Sexual inadequacies
Gender
identify
disorder or
Trans
sexualism
In male
In female
Erectile
Impotence
Premature
Ejaculation
Frigidity
Vaginismus :Involuntary
Contraction of
vaginal introits
at penetration
Disorder
of
sexual
preference
Fetishism
Transvestism
Exhibitionism
Voyuerism
Paedophillia
Sadism
Masochism
Sexual
orientation
disorder
Homosexuality
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Unit VII
Bio Psychosocial Therapies
Q.1 What is psychotropic drugs/psychopharmacology?
Ans. Psychotropic drug/psychoactive drugs is one which has mainly effect on the
behaviour experience and other psychological functions and will be used to treat
psychiatric condition.
The psychoactive drugs will have specific purpose and action, work on client symptoms
rather than diagnosis.
Psychoactive durgs are classified into five groups :
1. Antipsychotic Drugs
2. Anti parkinsonian agents
3. Antimanic Drugs
4. Anti depressant drugs
5. Anti anxiety drugs, Sedative and Hypnotics
Q.2 What are common antipsychotic drugs used?
Ans.: It is also known as neuroleptic drugs or major tranquilizers and used in the
treatment of psychosis.
Classification of antipsychotic drugs:-
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Antipsychotic Drugs
Conventional
Antipsychotic
drugs
Phenothiazines
Atypical
antipsychotics Es.
Clozapin
Risperidone
Thioxanthene
Chlorpromazine
Perphenazine
Fluphenazine
Trifluperazine
Prochorperazine
Thioridazine
Mesoridazine
Thio-thexene
Fluphenthixol
New generation
Antipsychotic
Drugs
Eg. Aripiprazole
Butyrophenones
Dibenzazepines
Dihydroindolane
Haloperidol
(Haldol)
Loxapine
Olanzapine
Molindone
(Morban)
Delirium
Dementia
3. Drug hypersensitivity
4. Severe depression
5. Other contraindications :
History of epilepsy
Pregnancy
Parkinson disease
Peptic ulcer
1. Parkinsonism :
It occurs in 40 percent of patient with EPS
It occurs one week after treatment
It is of two types :
(A) Akinetic form :
a. Impairment in masticating movement
b. Weakness
c. Muscle pain
d. Fatigue
(B) Agitating form:
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72
a) Muscle rigidity
b) Motor retardation
c) Mask like face
d) Shuffling gait
e) Slurred speech
f) Salivation
g) Tremors
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AntiCholinergic drugs
Agents :Benztropine
Biperiden, HCL
Procyclidine HCL
Promethazine
Dopamine
Agonists
Carbidopa
Livo dopa
Bromocriptine
Antihistamine
blockers
Muscle relaxant
Anti
dopaminargic
Dantrolene
Reserpine
Diphenhydramine
Q.6
Ans.
Indications :
1. Mania
2. Manic Depressive Psychosis (MDP-Bipolar disorder)
3. Hypomania
4. Recurrent depression
5. Alcoholism
6. Schizo affective disorder
Contraindication :1. Side effect of renal, CVS, liver and respiratory system
2. Thyroid disorder (Hypothyroidism)
3. Diuretic potent
4. Dehydration
5. Child below 12 yrs. Age
6. Parkinsonism
7. Obesity
8. High grade fever
Mode of action:
It reduces the level of nor-epinephrine and serotonin or catecholamine.
Q.7
75
76
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Contraindications:
1. Increase manic and psychotic episode of MDP.
2. CVS problem (arrhythmias)
3. Liver problem
Mode of action:
It acts by accelerate (increase level of) receptors of nor epinephrine and serotonin in the
central nervous system and reduce anxiety.
Q.10 How will you classify the antidepressant drugs?
Ans.:
Anti depressant drugs
Tricylic
Antidepressant
Tetra cyclic
antidepressant
MAO
Inhibitors
Sympatho
Mimetic
Stimulant
Imipramine
Tri-imipramine
Clonipramine
Amitriptyline
Doxepine
Nortriptyline
Mianserin
maprotiline
Phenezine
Isocarbaxazid
Tranylcypromine
Dextroam
Phetamine
Q.11
Ans.
Indications :
1. Anxiety disorder/Panic disorder
2. Insomnia
3. Obsessive compulsive disorder
4. Depression
5. Alcohol withdrawal symptoms.
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6. Convulsions
7. Induce sleep pre-operatively.
Contraindications:
Patent with renal, liver, respiratory impairment and hepatic failure.
Mode of action: It acts by increasing GABA activity that can cause decrease activity of
neurotransmitter in brain results in decrease neural activity.
1. Tolerance/physical or psychological dependence
2. Inhibited behaviour
3. Memory disturbances: Anterograde & retrograde
4. CNS depression :
Drowsiness
Poor co ordination
Clouded sensorium
Confusion
Ataxia due to cerebellar action
5. Sexual dysfunction :
Erectile and ejaculatory disturbance
6. Miscellanceous :
Lethargy
Impaired psychomotor disturbance
Blurring vision
Gastric Upset
Urinary incontinence
Nightmares
Depression
Aggression
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Headache
Hypotension
Bodyache
Impotence
Drowsiness
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Confusion
Tremors
Convulsion
Ataxia
ANS :
Dry mouth
Tinnitus
Tachycardia
Orthostatic Hypotension
Arrhythmia
Note :
Bradycardia : In Antimanic drugs
Palpitation : In anti anxiety drugs
3.
Hematopoietic System :
Agranulocytosis
Leukopenia
Leukocytosis
4.
Endocrine System :
Amenorrhea
Breast enlargement
Impotency
Change in Libido
Galactcorrhoea
Gynaecomostia
Hyperglycemia
Constipation
Diarrhea
Anorexia
Nausea
Vomiting
Weight gain
Jaundice
7.
Ocular effect :
Blurring of Vision
Dilated Pupils
Retinopathy
7. Allergic effect :
Dermatitis
Rash
Itching
Alopecia
8. Urinary system:
Urinary Retention
Oliguria
Polyuria
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Q.13 Write in detail about nursing care of patient receiving psychotropic drugs?
Ans.: Psychotropic drugs are used to treat the signs and symptoms of mental illness. But
all behavioural problem are not treated by the drugs. The treatment is based on the
thorough psychiatric evaluation of the patient.
Before administering any drug, the nurse should know about the drugs that is half
life period and after dose, the side effect of drug, age of the patient, to know the liver
metabolites and kidney excretion etc
Nurse's Role:
I.
General Role :
1. No drug should be administered without prescription
2. Do not leave the patient alone until the drug is swallowed
3. Do not allow patient to carry medicine to another patient.
4. Keep safety measures.
5. Give a glass of water after medicine.
6. Do not leave the drug tray within reach of patient.
7. All medicine given must be recovered on patient chart.
8. Do not force the patient orally.
9. Check drug daily for any change for colour order.
10. Drug bottle should be properly labeled .
11. Drug cupboard are always to be kept locked when not in use.
12. Nurse should know side effect indication and contraindication of drug.
13. Nurse must know the legal aspect.
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3. While administrating drug, if any doubt arises without hesitation nurse should
consult with doctor.
4. Observe drowsiness, sore throat, fever
5. Record blood pressure.
6. Provider good oral hygiene to reduce dry month.
7. Weight recording and low salt in case of anti-psychotic/anti manic drugs.
8. Discourage the patient to take antacids as they cause decrease absorption.
9. Maintain intake/output chart
10. Advice to protect the skin.
11. Record in client's chart about which drug administered; if any side effects
observed.
12. Nurse need to have an effective drug attitude.
13. Nurse has to be familiar with regular usage of drugs, their actions, side effects and
they hold responsibility while administering to avoid errors.
14. Uses a variety of techniques with different clients in different situations.
15. While administering the drug, confirm the client by calling their name.
16. While administering lithium, complete investigation as urine analysis, BUN
creatinine electrolytes, 24 hrs creatinine clearance, thyroid test etc should be
checked.
17. Every 3 month, lithium level to be checked.
18. Blood level of lithium is tested 12 hrs after last dose. The therapeutic level should
always be maintained 0.6-1.4 m Eq/lt.
19. While administering MAOI, caution should be taken food substances, as cheese,
pickle, beer, red, wine chicken, liver, overripe fruit, banana peel, yoghurt and
some medications as cold medication, nasal and sinus decongestants, narcotics,
local anesthetics, epinephrine, cocaine, amphetamine should be avoided
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3. Schizophrenia
4. Mania, depression
5. Alcoholism
6. Drug addiction
7. Sexual deviation
8. Personality & character disorder
9. Childhood disorder
10. Marital disharmony
Contraindications
1. Severe psychotic illness
2. Unresponsive, unmotivated and in cooperated patient.
3. Violent/ excitement
4. Unconscious patient
5. Assaultive and destructive behaviour
6. Negativism
7. Organic Psychosis
8. Psychotic Depression
9. Group psychotherapy in hysteria and hypochondriasis.
Advantages:
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86
Q.15
87
Ans.
Psychotherapy
Superficial or
short term
(supportive
psychotherapy)
Deep or long
term (analytical
psychotherapy)
Psycho-Educative
(Group Discussion)
Counseling
I. Individual Psychotherapy
Psychoanalysis
Hypnosis
Abreaction
Reality
Insight
Supportive therapy
Mental Ventilation
Persuasion
Re-education
Re-Assurance
Suggestion
II. Group therapy
III. Behavioral psychotherapy
Systematic desensitization
Flooding
Aversion therapy,
Assertive therapy
Modelling
Shaping
Cognitive behavior therapy
Token economy
IV. Inter personal psychotherapy
Marital therapy
Family therapy
V. Other psychotherapy:
Therapeutic Community/Milieu therapy
Attitude therapy
Activity therapy
Recreational therapy
Occupational therapy
Play therapy
Art therapy
Music therapy
Dance therapy
Education therapy
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o Attractive
o Patience
In occupational therapy, nurse help the patient to teach new skills related to as a
job.
Sexual disorder
Marital disharmony
90
4. Reality therapy
5. Uncovering or insight psychotherapy
6. Supportive psychotherapy :
o Mental ventilation
o Environmental modification
o Persuasion
o Re-education
o Re-assurance
o Suggestion
Q.18 Define group therapy. Write in detail about the objective, types of groups,
steps & merits and demerits of group therapy.
Ans.: Definition : Group therapy is a mean of psychotherapy of psychological problem
in which a group of patients is provided psychotherapy by a group of psychiatrist as well
as the patient interact with each other & help in problem solving.
Description:
1. Group therapy is less time consuming
2. Group consist of 8-10 patient.
3. Session of psychotherapy are held once in a week & generally continue for 12-18
months.
4. Duration of session longer than individual therapy. It is one or two hour.
5. It uses many type of psychotherapy technique.
6. The patient in group generally have some problem eg. alcoholic patient.
Objective:
1. The member of group gain personal insight
2. The group member Improve their IPR
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3. The patient can change their destructive behaviour & can modify their
behavior.
4. The patient can share their intimate feelings, ideas, experiences.
5. It provide an environment of mutual respect that further improve respect & self
understanding.
Types of Groups
1. Therapeutic groups: It is groups of patient. This group works together under
the guidance of a therapist to improve the mental health usually the patient self
help group.
2. Adjunctive group: It is not the group of patients it helps the other selective
group of patient by providing stimulation as music therapy, art therapy &
dance therapy.
3. Traditional group: The members of traditional group are patient from
hospital in patient department. The method of psychotherapy are lecture film
show. The therapist first says few words & then allows the patient to interact
with each other.
4. Non- traditional group: It is also called psychodrama. In this the group
member act out various drama based upon situation. This role play helps him
in expression of feeling, idea.
5. Encounter Group /"T" Group (Training Group): In this group, the focus is
on the expression & feeling of people that remain unexpressed. It is not
necessary for a group of member by ill patient. The inter action between
member of encounter groups is more intense or rapid.
6. Homogenous group: The members of homogenous are similar on basis of
sex, age, race, socio economical level in society etc.
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7. Heterogeneous group: The group member does not have similarity on basis
of sex, age, socio-economic in society. It is just opposite to homogenous
group.
8. Open or close group: In open group member are free to join or leave the
group at any time. Closed group have certain number, certain duration. Patient
can not join or leave the group any time.
9. Group according To mental illness: The group classified according to their
nature of illness.
Psychotic group
Neurotic group
10. Psychodrama group : The group acts event from the life of one member.
2. Initial/orientation phase :
3. Working phase :
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4. Termination phase :
Evaluation of result
94
Anxiety
Phobia
Hysteria
Nocturnal enuresis
Sexual disorder
Migraine
Anorexia nervosa
Bulimia nervosa
Obesity
95
Contra Indications:
Psychotic disorder that have acute pervasive symptoms and in which reinforcement is not
applicable
Steps: it has 3 steps
1. Training of relaxation technique before the main therapy.
2. Hierarchy formation - Patient is asked to construct a hierarchy of anxiety
causing stimulus.
3. Systemic desensitization:It is done in two ways:
(a) SD-1 the stimulus is confronted in imagination
(b) SD-2 The stimulus is confronted in reality
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Basic Requirement:
1. Knowledge levels of patient
2. Background of patient
3. Psychological problem/diagnosis.
4. Capacity or skills of patient.
5. Therapeutic nurse patient Relationship.
6. Interest of patient.
7. Continuous evaluation of progress.
Type of activity in occupation therapy :
Craft work
Needle and tailoring work
Basket making
Carpentry
Gardening
Painting
Mat weaving
Cooking
Various setting in occupation therapy :
1. Psychiatric hospital
2. Nursing home
3. Psycho-social rehabilitation centre
4. Physical rehabilitation centre
5. Sheltered workshop
6. Community group homes.
7. Community mental health centre
8. Day care centers
9. Half way homes
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99
Substance abuse
100
Conduct disorder
Depression
Anorexia nervosa
Relapse in schizophrenia
1. Psychodynamic: This approach is based on this concept that the entire family
problem arise from past experiences of each member & unconscious conflicts. The
therapist helps to gain insight that how their own problems, unconscious conflict
effect the inter relations.
2. Systemic Approach: It concentrates on the present problems rather than past
experiences. This therapy has 5-10 session with interval of month long. The
therapist arrange family interview to assess the family disagreement, ways of
communication.
3. Structural approach: The term family structure refers to the hierarchy in the family
& to a set of unspoken rules regarding task & responsibility.
Eg. Usually in every family both parents have more authority & responsibility. In
this therapy, the therapist identifies the rules which be family tension & try to
bring about changes.
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4. Elective family therapy: It is a short term method planned to bring about restricted
changes in the family. It also concentrates on the present situation of family & the
way of communication.
Q.23 Write a short note on activity therapy?
Ans. Activity therapy: Many patients in psychiatric hospital spend their energy in
destructive activities. For example: manic, violent patient: An activity therapy is an effort
to re-direct their energy into useful or meaningful activity. The example of activity
therapies are:
1. Occupational therapy
2. Recreational therapy
3. Play therapy
4. Biblio therapy
5. Dance therapy
6.
Art therapy
7. Education therapy
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103
Cerleti and bini are the first neuropsychiatric who used ECT in 1937.
Method/Techniques of ECT :
ECT can be given by direct or indirect method.
I. Direct ECT
ECT has been used directly on the patient. The patient is administered atropine
subcutaneously (SC) 0.6 mg to 1.0 mg, half an hour before the treatment or IV
immediately before the treatment minor tranquilizers like calmpose is also used.
A gland mal seizure is induced in the patient by passing an electric current through
the temporal lobe Atropine prolongs the period of disorientation after the seizures.
It also reduces vomiting. Immediately after The ECT treatment appropriate
resuscitative and other emergency management equipment and supplies are kept
ready A skilled person & nurse to resuscitate the patient should be available.
ECT given by this technique causes a lot of anxiety to the patient.
II.
Placement of Electrode :
The location of electrode depends on the unilateral or bilateral ECT.
Bilaterally, ECT involves the placement of electrodes in the bitemporal
region.
To minimize post convulsive confusion & amnesia, unilateral ECT has
been devised in which electrodes are placed so as to avoid the dominant
temporal area.
104
Amount of current :
The nature and range of a stimulus intensity setting varies from device to device.
70 to 1.50 volts for .1 to 1 sec. will produce a convulsive effect.
The actual amount, range from 200-600 milliamphers
2.
3.
Informed consent of the patient & the relatives for the treatment is obtained.
The patient & the relatives are explained the risks & complications of
treatment before obtaining the consent.
Complete physical examination is absolutely necessary.
X-ray of the chest haemogram urine analysis and ECG should be given whenever
indicated.
4. Removal of denture if any is desirable
5. Mouth gag is put resting on the 3rd molar to prevent the tongue bite, cheek bite
and lip bite.
6. Physical restraints may be necessary to prevent powerful jerky movement of the
body.
7. The patient lies down comfortable on a bed in a supine position.
Observation following the ECT
105
The patient must be observed for at least half an hour after the treatment is
given.
The production of gland mal seizure is necessary.
In direct ECT, the tonic phase i.e. muscle contraction last for 10 sec.
approximately. The clonic phase i.e. movement or convulsions last for 2530 sec. approximately. Then patent goes into relaxation phase.
Pulse & respiration recorded every 15 min.
The patient should be prevented from fall & injury.
If the patient become excited & rowdy IM inj. 8-10 ml of paraldehyde or
50-100 mg. if chlorpromazine or diazepam 5-10 ml have to be given to
control the patient.
Indication of ECT :
The indication of ECT depends upon the availability and non-availability of psychotropic
drugs. The common condition for ECT are :
1. Major depressive episode is primary indication 80 90 patient.
2. Involutional melancholia 80-90 %
3. Depression
Suicidal & stuporous patient
Endogenous depression of moderate to severe degree.
Delusional & psychotic depression
Unipolar - bipolor depression
Post partum depression
Depression of old age as long as there is no atherosclerosis & brain
changes.
4. Manic phase (mania)
1. Severe attack
2. Delirium Mania
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107
Contraindication
No absolute contraindication
1. Patient with increased ICP
2. Including tumors.
3. Hematomas
4. Subarachnoid hemorrhage
5. Presence of an acute MI, hypertension
6. Patient with cardiac disease, aneurysm , thrombophlebitis, bleeding disorders
embolism
7. First trimester of pregnancy
8. Disease of bone like osteomalacia, fracture
9. Systemic disease involving heart, kidney, lung & other wise versa
Complication or side effect :
Complication may be reduced with modified ECT.
Complications are few and rarely serious.
Immediately after ECT body ache, headache, painful masticatory movement to
drowsiness
1. Abrasions on the lip of tongue bite
2. Dislocations of joints like shoulder & temporomendibular.
3. Fracture of bones like spine of vertebra
4. Confusion & excitement
5. Dyspnea & Apnea
6. Cardiac irregularities including arrest
Delayed Compilations i.e. after the patient had a few ECT.
1. Amnesia for recent events.
2. Confusional psychosis
108
Impairment of memory may vary from mild tendency to forget name to sevre confusion.
Neurological & cardiac complications are very rare.
Q.
Ans.
109
Resuscitation tray
Mouth wipes.
B.P. apparatus, sterile syringe, spirit swab
3. Recovery Room
Observation of vital sign
Mouth wipe & toilet facilities
4. Role of nurse before ECT
Thorough physical examination
Informed consent
NBM (Nothing by mouth) before treatment
Remove metallic articles from body.
Remove lipstick, nail polish
Loosen the tight cloth
Empty bowel & bladder
Maintain personal hygiene
Give premedication, atropine, calmpose
Nurse should display a warm supportive attitude.
Take the patient to the waiting room
5. Role of nurse during ECT
Transfer the patient on a well padded bed placed in supine position.
Place tongue depressor in between teeth
Give short acting anesthetic to the patient
Support the shoulder or arm
Restraint the thigh with the help of sheet
Hyperextension of head with support to the chin give few breath of O2
(Oxygen)
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Unit-VIII
How a mentally ill patient get admitted in a mental hospital and how he get
discharged?
Admission and discharge of the clients in a psychiatric unit/mental hospital is
based on section 31,34 of Indian lunacy Act (ILA) 1912 later it was modified on
1st October, 1931.
Admission and discharge can be made in one of following:
1. Admission procedure on voluntary basis :
(a) For major client and desires to have admission into the mental
hospital based on his suffering:He will approach medical superintendent of hospital, along with two
visiting medical officers (who are appointed by state govt.) will observe
the case, at their own discretion, they can admit the case into the hospital,
provided the client has to submit the filled up performa stating that he is
interested to be admitted.
(b) For minor cases: the nearest guardian has to apply request for admission,
medical officer within 24 hours of receipt such application can admit the
case cast into the hospital.
Discharge Procedure :
(a) For major client: If he feels his condition is better, he can ask for discharge by
writing a written notice of 24 hours.
(b) For minor client: If minor attains "major" and "cured", he has to write an
application. The medical superintendent will observe and decide whether he
can be discharged or not, within a month.
112
Admission is made, if the family members or the relatives of the patient have
to submit the request or petition for admission of the client into mental
hospital.
The petitioner must be a major and personally observed the client within 14
days of making the petition. Petition Has to be written on a special form,
denoting all the particulars of an individual which has to be supported by two
medical certificate (one form greeted govt. medical officer and other from
registered medical practitioner) Both medical officers have to
be
Discharge Procedure:
In this clause, the clients can be admitted for a period not exceeding 90 days.
If relative feels that medical officer is misusing the lunatic, he can obtain
permission from magistrate for discharge. The magistrate will verify the
condition of the client through personal inquiry and if he satisfies, thinks that
the client condition was improved, he recommends for discharge.
The petitioner has to apply to the superintendent of the mental hospital for
discharge. If the person is not dangerous and is fit to live safely, he can be
discharged.
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in-charge feets that it is necessary to bring the legal authorities into the scene,
he can apply to the magistrate or relatives can approach magistrate to issue an
reception order for treatment. This order is valid for 6 months. In these cases
only one medical certificate is required.
Discharge: After recovery, if medical officer feels he can be fit to live safely
in the society, he will discharges.
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If the mentally ill patient is very dangerous, and the medical officer in charge
think that patient needs hospitalization, he can admit the patient but within 72
hours. The patient need to be examined by the magistrate to produce a
reception order.
Discharge procedure
If the client condition improves, he can be able to take care and found to be
sound, he will be discharged.
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1. Those who suffering with unsound mind and incapable of making their
defense.
2. Those who committed the crime, but were acquitted on the ground of
unsound mind at time of committing suicide.
3. Those who contacted the disease after imprisonment.
Discharge procedure: The visitors of the hospital has to report every 6 month once about
the client's mental status and authority which has ordered detention. As soon as the client
is fit to lead normative life they have to inform about the same to authority concerned.
The person will be handed over to the prison officer for the further legal action.
Q.2
Ans.: It is derived from English lunacy Act, 1890, contain eight chapters. ILA extends
whole of India except Jammu and Kashmir in act no-4.
Chapter I Terminologies
It contain some terms, preliminary conditions and its definition. Some of the terms used
are:
Asylum.
Cost maintenance
Lunatics
Criminal Lunatics
Reception order etc.
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State govt. will appoint board of visitors (at least 3 members one medical officer not
necessary to have psychiatrist. Other two may by PSW or politicians)
Chapter V
Lunatic properties, court amendments for assessing, disbursement of properties
Fine of Rs.500/- will be collected by manager of lunatic appointed by court, if he
is not maintaining properly.
Chapter VI
Establishment of Asylums
Board of visitors has to conduct monthly visits and periodically they have to observe
standard diet, medical checkup, parameters etc. and report it to govt.
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Q.3 Write a short on Indian mental Health Act, 1987 (IMHA, 1987) ?
Ans.: IMHA, 1987 is an amendment of Indian lunatic Act, 1912
Mental Health Act was introduced in Rajya Sabha in 1981, mental health bill no. XLI act
14 came into practice as a MHA from 22nd may 1987. Later government of India issued
order that came in force with effect from April, 1 1993 in all state and union territories of
India. It includes ten chapters. This act is applicable throughout India.
Objectives:
1. To formulate rules and regulation for the procedure related to admission and
discharge of the client in psychiatric hospital units
2. To regulate establishment & maintenance charges of psychiatric hospitals
3. To provide facilities for establishing the guardianship of mentally ill, who are
incapable of managing their own affairs.
4. Discarding custodial care, safeguarding mental patient from community and
incorporating better provision relating to treatment & care.
5. Judicial safeguard for patient right to prevent any dignity or cruelty to mentally ill.
6. Introduces humanitarian consideration
7. To establish and coordinate the central and state authorities for mental health
services.
8. To regulate the power of government for establishing, licensing and controlling
psychiatric hospitals.
Mental health act is divided in the ten chapters consisting 98 sections.
Chapter-I Terminologies (preliminary)
It deals with definitions related to mental health practice.
Mentally ill person :
A person who is in need of treatment of reasons of any mental disorder other than mental
retardation. The lunatic changed into mentally ill person.
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Judicial inquisition regarding alleged mentally ill persons possessing property, custody of
his persons and management of his property court may appoint guardian to look after self
and property.
Chapter VII
It deals with liability to meet the cost of maintenance of mentally ill person detained in
psychiatric hospital or nursing homes.
Chapter VIII
It aimed at protection of human right of mentally ill person. No, mentally ill
person during treatment will be subject during treatment to any indignity.
Mentally ill persons under treatment cannot be used for research purpose, Unless it
benefit him.
Consent has to be obtained either from client or from relatives for discharge.
No communication or no letter has to be sent to mentally ill cannot be read or
interpreted or detained or destroyed.
Chapter IX
It deals with penalties and procedures for establishment of maintenance of psychiatric
hospital or psychiatric nursing home.
Chapter X
It deals with provision for miscellaneous action.
It deals with clarification pertaining to certain procedure to be followed by the medical
officer incharge of the psychiatric hospital.
The Medical Officer prepares the report of hospital operations every 6 months once and
will send it to the authorities.
Incharge Medical Officer is responsible for the supply of requisites (like food, sanitation
etc)
in the psychiatric hospitals,
Q.4 what are the legel responsibilities of a nurse in care of mentally sick patient?
Ans.: Legals responsibilities/legal aspect :
A psychiatric nurse have many responsibilities while caring a psychiatric patient.
She is responsible for providing quality nursing care to reduce malpractice
litigation. Quality nursing care can only be legally proved by its accurate,
complete documentation. So a psychiatric nurse has some legal responsibilities are
as following :
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have right to informed consent before any nursing intervention for e.g.: before
ECT. Concept can defense a nurse against litigation.
Informed consent means the patients should:
Have a clear and full understanding of the nature of illness to be treated.
Should agree freely to receive the treatment
Should know about the procedure available and their probable side effect.
The competent to take decisions.
When consent is refused: The consent may be refused by both competent and
incompetent patient.
Consent is refused by competent patient due to misunderstanding or fear about the
illness and treatment. For this nurse should explain once made some patient
continue to refuse the treatment.
When consent is refused by incomplete patient there is provision for a form of
proxy consent such as the application of a guardian.
Situation when consent is not required:
When death is likely to occur without intervention and there is doubt the
competency of patient
Substituted consent: In minor cases and involuntary admission and when patient is
unable to understand their surroundings, the consent is obtained from another
person or from court appointed guardian on behalf of patient.
2.
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3. The information can be shared with the parents who have a legal duty to act in
their children's best interest
4. Patient's permission should be obtained before information in sought from
other persons.
5. Patient should know from the start that information can be shared among the
members of health care team.
6. Rules of confidentiality can be breached in following condition:
In patient's interest
In the public interest
For legal representatives
7. The patient should be told in advance about the special condition in which all
the information may be revealed such as group therapy and family therapy.
Census report
Inter department report
Special report on unusual condition of patient.
Reports on mistakes.
Reports on complaints
Evaluation on report etc.
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3. Nurse
should
review
periodically the
mechanism
that
provides
right
accountability.
4. Nurse should review periodically the rights & issues of violation
5. Nurse should know the right of psychiatric patient in specific condition for eg.
Involuntary patient have limited right to refuse medication:
a. Psychotherapeutic Intervention
b. Health Education
c. Self care activities
d. Somatic therapies
e. Therapeutic environment
f. Psychotherapy
Standard VI : Evaluation of her nursing action.
Standard VII: Peer Review
Standard VIII: Continuing Education/Action
Standard IX : Interdisciplinary collaboration
Standard X : Utilization of community health system
Standard XI : Research
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Unit IX
Psychiatric Emergency
Over activity/
Underactive
Over excitement
Patient
1. Violent
2. Anxious
3. Drunkenness
4. Drug withdrawal
Suicide
1. Depression
2. Catatonic stupor
Others
1. AIDS associated
2. Adolescent crisis
3. Post partum psychosis
Ans.
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Nurse have to assume overall in-charge for interventions and seeks guidance from
the psychiatrist whenever necessary.
Handle the case tactfully
Provide calm & watchful environment
Emergency cases has to be shifted as early as possible where he will be
safeguarded against injury either to himself or to the others.
Protect other patient.
Encourage verbal expression of feeling.
Provision of care in meeting the client's need accordingly.
Use communication techniques
Always remain with patient.
Build trusting relationship with patient.
Talk in simple language and slow volume.
Do not threaten theater the patient but set limit on his behaviour
Remain aware of pt's right, feeling & dignity
Constant observation on patient activity
Crises intervention
Education to family and friends of patient.
Q.3
Ans.
Define suicide, what are the risk factors of suicide? Classify the suicide and
how the patient with suicidal ideation be managed?
Suicide:
It is commonest psychiatric emergency
It is act of killing on self.
Patient's threats, gestures are always taken seriously.
Definition of suicide:
"Aggression towards the self following the internalization of frustration or disappointment
related to loved one".
According to Clayton
"Ultimate act of self destruction"
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Myths about suicide:Suicidal threat is just a bid for attention and should not taken seriously
It is not harmful for a person to talk about suicide.
Only psychotic person commit suicide.
Nice home, good job, intact family prevent suicide.
Risk factors of suicide:
1. Psychotic disorder :
Schizophrenia
Depression
Alcoholism
2. Social Causes :
Failure in exam
Love failure
Marital disput
Social isolation
Parental separation
Family problem with substance abuse
Lack of parental & maternal care
More scholastic difficulty
Unemployment of parents
3. Medical disorder :
AIDS (Acquired Immune deficiency Syndrome)
Cancer
Estimation of lethality & degree of suicide
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High lethality
Low lethality
Use of gun
Wrist cutting
Hanging burning
Hypochondriasis
Classification of suicide :
In 1951 E-mail Durkheim classified social categories of suicide:
1. Egoistic suicide: one who may lose social integration with their social group.
2. Altruistic suicide: Results from a response to a cultural expectation e.g. sathee
sahagamanam which has followed in ancient India.
3. Anomic suicide: Occurs in response to the changes occurs in individual life. For
e.g.: divorce, loss of job.
4. Sam sonic suicide of revenge:
Experiencing as being unfriendly for e.g.: if the husbands is unfaithful to his wife.
She may attempt to commit suicide to take revenge from him.
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5. Continuous survey
6. Provide calm & safe environment to the patient.
7. ECT for major depression
8. Antidepressant for OPD patient.
9. Keep strict observation to prevent repeat attempt.
Nursing management :
1. Make a treatment plan
2. Conduct suicide assessment, lethality plan
3. Engage the client in purposeful activities by diverting the mind.
4. Careful observation of client is needed in vulnerable time.
5. Provide symptomatic psychotherapeutic treatment.
6. Administer the drug, if any prescribed.
7. Report to the team members if any clues related to suicide are identified.
8. Encourage the client to develop optimistic ideas or sense of hope and self
control.
9. Motivate the client to express his repressed feelings
10. Involve the family members in provisions of care and guide them to provide
situational support.
11. All psychiatric drugs should be kept under lock
12. Patient should not left alone.
13. Constant observation on patient activity.
14. Give the patient opportunities to express feeling.
15. Remove object which might be used as a means of suicide.
16. Teach better problem solving techniques, alternative expression, sense of
achievement in personal life, decision making ability and importance of
positive self esteem.
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17. Encourage the client to explore his hobbies one by one, restart it
constructively.
18. Staff has to be aware of problems raised by the client.
19. If client leave ward without intimation take immediate action.
20. Discharge plan has to be made in advance, inform follow up visits.
Q.4
Define crisis, what are the types of crisis situation? Which types of techniques
used in crisis intervention and describe nurses role in crisis intervention?
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2.
Situation crisis/External crisis/Accidental crisis: If biopsychosocial equilibrium
upsets because of external event or due to environment influence. It is sudden,
unexpected onset for example :
Death loved one
Loss of employment
An accident
Marital disput
Sexual assault
Change in living place
Severe suicidal ideation
Loss of status an acute illness
Loss of valued object
Technological changes
3.
Accidental crisis adventitious/community crisis: It is most common type, also
called unexpected crisis, results in multiple loses may be because of environment changes.
For Ex.
Any Accident
Severe illness
Loss of both parents
Natural disasters
Tidal waves
Nuclear war etc.
4. Crisis resulting from traumatic stress: It results when unexpected stress
over which individual has little or no control.
For e.g.:
Rape
Robbery
Terrorism
5.
6.
Socio cultural crisis : For e.g. Discrimination between race & robbery
Psychiatric emergencies :
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For e.g.:
Suicide
Addicts
Techniques used in crises intervention:
Aguilera modal of crises intervention:
Human being
Stressor Balanced condition stresses
Imbalance state
Felt need was not fulfilled
To restore equilibrium
Presence of Balancing
Factors
Adequate situational
Support
Inadequate situational
Support
Resolution of problem
No resolution
Normal condition
Crisis
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