Professional Documents
Culture Documents
Mental Health Nursing.: Lesson 1
Mental Health Nursing.: Lesson 1
• Hysteria.
• Anxiety.
• Neurotic depression.
• Obsessive-Compulsive neurosis.
• Hypochondriasis.
• Phobia
Summary of the causes of mental illness.
• All the factors which causes mental illness are divided into two
classes.
1. Predisposing factors.
2. Precipitating factors.
• Predisposing factors:
• These are the factors which are latent in an individual and which
make one susceptible to mental illness.
• Examples:
• Hereditary factors.
• Childhood experiences e.g. over protection/sexual abused
child/Painful childhood experience.
• Severe dependence.
• Faulty communication
Precipitating factors.
• These are the incidences which occurs before
the onset of the mental illness.
• The lay men call them the causes of mental
illness.
• Examples:
• Abuse of alcohol/Drugs/Epilepsy/Cerebral
malaria.
• Brain injury/Brain haemorrhage/Brain tumours.
• Loss of property/Status/Part of your body.
Difference between psychosis and neurosis.
• Severity:
• Psychosis is very severe form of mental illness.
• Neurosis is a minor mental illness
• Insight:
• A psychotic patient is not aware of his illness.
• Neurotic patient is aware of his illness, hence come to the
hospital for help.
• Personality:
• The total personality of an individual with psychotic illness is
completely destroyed.
• Neurotic illness only destroy a part of the personality.
Differences ct.
• Contact with reality:
• A psychotic patient has no contact with reality because
they suffer from delusion sand hallucinations.
• Neurotic patient has contact with reality because they
dont’ suffer from delusions and hallucination.
• Nature of illness:
• Psychosis is a genetic determined disease.
• Neurotic patient is reacting to stressful situation at the
unconscious mind.
Modern method of classification of mental
illness.
• Two methods of classification is used.
• International Classification of Disease [I.C.D].
• Diagnostic and Statistical Manual [D.S.M].
• DSM:
• Done by American Psychiatric Association.
• Only used in America.
• ICD:
• This method was developed by .W.h.O.
• Currently they are in 10th edition hence referred to as [ICD
IO].
ICD 10 CT.
• FO…….Organic disorders.
• F1……..Mental and behaviour disorders due to
• psychoactive substance.
• F2………Schizophrenia.
• F3……….Mood[affective] disorders.
• F4………..Neurotic disorders.
• F5…………Behavioural syndrome associated with
physiological disturbances.
• F6………..Personality disorders [adult].
ICD 10 ct.
• F7……..Mental retardation.
• F8………Disorders of psychological
development.
• F9……….Behavioural and emotional disorders
of childhood or adolescents.
Mental health act.
• Mental health act:
• Act of parliament to amend and consolidate
the law relating to the care of person suffering
from mental disorder or mental abnormality,
for custody of the person[patient] and the
management of their resources and the
management of mental hospitals.
• It was 1st developed in Feb 1949,
• Then revised in 1962,1968.
• The current one was revised in 1989.
Type of patients by this Act.
1. Voluntary patient.
2. Involuntary patient.
3. Emergency patient.
4. Armed force patient.
• Voluntary patient:
• A mentally sick patient who has an insight of his problem
and come for help.
• Or a parent has observed an abnormal behaviour and
brought his child for treatment.
Legal requirement for admission.
• If above 16years:
• A written application in duplicate on
prescribed form Medical[ med]613.
• This form is filled and signed by patient.
• Medical recommendation med615 filled by
doctor who is referring the patient in duplicate.
• The two forms must be brought to the hospital
before 14 days are over.
Voluntary patient ct.
• If below 16years:
• The relative or guardian allowed by the law to fill the med
form 637 in duplicate.
• And the doctor fill med 615 in duplicate.
• The two forms brought to the hospital before 14 days are
over.
• Note:
• This patient should be discharged on his own request but
must give a written notice of about 72hrs.
• If the patient has not improved within 42 days, the law
requires that the mode of admission be changed to
Involuntary admission.
Admission procedure ct.
• Involuntary patient:
• The mentally sick patient who have no insight of his/her
illness, hence brought to the hospital by his relatives.
• Legal requirement:
• The relative is allowed by the Law to fill med 614 in
duplicate.
• The referring doctor fill medical form 615.
• The patient taken to the hospital within a period of 14
days.
Emergency patient.
• Any mentally ill patient who have no relative to care
for him . Such a patient is a danger to himself and
community.
• Or a suicidal mentally ill patient with nobody to take
care.
• Such a patient is admitted under emergency mode.
• Who should take him to hospital?.
• Any administrative officer is allowed to take the
initiative[Chief/Police officer/Headmaster/Principal
etc.
Admission of emergency ct.
• The law requires that the officer take the
patient to the police station.
• The police must ensure the patient is taken to
the hospital within24hours.
• Requirement:
• The officer fill med 638 in duplicate.
• No medical requirement is needed.
Admission of armed forces.
• Admitted through their medical officers.
• They should have observed him for 48hrs.
• On admission, they should only be treated for
only 28days.
• If he need more than28 days need to be
reviewed by two doctors, a psychiatrist and
general doctor.
• Discharge give a notice of 72hrs
Offences under this act.
• Forgery of documents: Un authorised person filling and
signing the document.
• Giving false information about the patient.
• Assisting a mentally patient to escape from the hospital.
• Permitting the patient to escaping from the hospital
through wilful neglect or connivance.[ Being involved in
illegal or immoral behaviours]
• Ill- treatment of patient like: Abusing/Striking/
• Wilfully neglecting patients.
• Giving/Selling/Bartering of any commodity to patients
without permission.
Offences ct.
• Publishing /or taking photograph of mentally
sick person.
• Note:
• If you are guilty of one of the above offences,
you can be jailed for a period not less than 12
months or fined not less than 10,000.00 or
both.
Kenya Board of Mental Health.
• This board is allowed by the Mental Health Act.
• Members of the board:
• Director of medical services or his deputy.
• Psychiatrist appointed by Ministry of Health.
• Psychiatric Clinical Officer.
• Psychiatric Nursing Officer.
• Commissioner of Social Services.
• Director of education.
• A representative from each Province[County]
•
Functions of the board.
• Co-ordinate mental health services in the country.
• Advice Government on matters related to mental
health.
• Inspection of mental health hospitals.
• Approve mental health hospitals.
• Assist the administration of the mental health hospitals.
• They receive and investigate any allegations from
patients, relatives and take an appropriate action.
• They initiate and organize Community health services
like Community psychiatry.
. History taking from psychiatric patient
•
END.
Principles of psychiatric nursing.
• Respect the patient:
• Respect him despite all him weakness.
• Respect him with no conditions attached Address him by him
name/Explain all the procedures/Listen to him.
• Offering self :
• Be available to patient.
• Sit and talk with the patient.
• Even when the patient is not responding be with him.
• Spontaneity:
• To be official/or being very firm or strict.
• Not very good for psychiatric patient.
Principle ct.
• Be informal with them/discuss with them/be friendly with them/Dance with
them.
• Acceptance:
• We accept them just like any other patient.
• No harsh treatment/avoid being rude to them.
• No judgement/no punishment.
• Sensitivity:
• We must ensure that the ward environment is safe the patient: No broken brooms
around the ward/No broken chairs around/No naked electrical wires in site.
• Empathy:
• The process of putting our self into some ones’ condition.
• You feel with him but no emotional attach.
• Empathy leads to actions where you help him as much as possible.
Principles ct.
• Observation:
• You must be a good observant.
• Observe facial expression which could suggest aggression.
• Observe drug reaction etc.
• After observation take an appropriate action.
• Keen listener:
• You must be a good listener to their problems.
• It help you to assess their progress.
• Listening make them talk more which releases them.
Treatments used in psychiatric patients.
• Several forms of treatments are used in the management of mental illness.
• All of them classified into two categories:
1. Physical treatment.
2. Psychological treatment.
Physical treatment:
Physical agents are used are used.
Example drugs and Electrical current[E.C.T.].
:Psychological treatment
Also referred to as Psychotherapy.
Treatment of mind without physical agent.
End of Lesson 1
Lesson 2
Physical treatment.
• Use of drugs to treat mental illness.
• Classification of these drugs:
• Phenothiazine: Used to treat Psychotic
conditions.
• Anti-depressants: Used to treat psychotic
depression.
• Phenothiazine:
• Also called Tranquilizers/Or Psychotropic drugs.
Phinothiazine ct.
• Phinothiazines is also divided into two classes.
• Major phinothiazine and Minor phinothiazine.
• Major phinothiazines:
• Patients who benefit:
• Schizophrenia.
• Manic psychosis.
• Drug abusers.
• Psychosis associated with child birth.
Effects of this drugs.
• They calm the patients.
• They reduce or abolish mental symptoms like delusions
and hallucinations.
• They reduce anxiety and emotional tension.
• They reduce psychomotor activities.
• Examples:
• Chlorpromazine[Largactil]
• Dose:100-600mgs tds.
• Promazine[Sparine].
• Dose:50-150mg tds
• Fluphenazine[Modicate].
Drug therapy ct.
• Medicate is a long acting phenothiazine.
• Only given as maintenance dose.
• Only given I.M.
• Dose:25-50mgs once per month.
• Thioridazine [Melleril].
• Dose:50-100mgs tds.
• Haloperidol[Serenace]
• Dose:o.5-5mgs tds.
• Very good for Manic patients.
Anti-Parkinson drugs
• These drugs are prescribed together with phenothiazine to prevent
severe side effects.
• Effects:
• Reduce muscle rigidity.
• Reduce severe salivation.
• Improve ataxias.
• Examples:
• Benzhexol[artane].
• Dose:2-5mgs tds.
• Benztropine[cogentin].
• Dose:0.5-2mgs tds.
Anti-Parkinson drugs ct.
• Procycline[Kemadrin]
• Dose:5-10mgs.
• Side effects of phenothiazine's:
1. Dizziness.
2. Fainting episodes.
3. Blurred vision.
4. Increased appetite.
5. Retention of fluids in the body.
6. Impotence for men.
7. Menstrual irregularities.
8. Skin rash.
9. Sensitivity for sun light.
Minor phenothiazines.
• Also referred to as Anti-anxiety drugs.
• Or Benzodiazepines.
• These drugs are used for treatment of all those
patients with Minor mental illness.
• Indications:
• All neurotic patients.
• Patients with muscle spasms.
• Patients with tensional head aches
• Patient with severe back pains.
Minor phenothiazine ct.
• Examples:
• Chlordiazepoxide[Librium].
• Dose:5-10mgs tds.
• Diazepam[Valium].
• Dose: 2-20mgs tds.
• Lorazepam[Ativan].
• Dose:2-3mgstds.
• Halazepam[Paxipam]
• Dose:20-40mgs tds.
Anti-depressants.
• Used for the treatment of those patients
suffering from Psychotic Depression.
• Patients take about 3weeks after the drugs
have been started.
• These drugs are divided into classes:
1. Tricyclic anti-depressant.
2. Mono-Amine Oxidase Inhibitors[M.A.O.I.].
Anti-depressants ct.
• Tricyclic anti-depressants:
• They are the 1st line of treatment.
• They are cheap and available.
• They have fewer side effects.
• Indications:
1. Psychotic depression.
2. Prophylaxis for conditions like Migraine[Amitriptyline].
3. Chronic muscle pains[Imipramine].
4. Enuresis[Imipramine].
5. Given to those patient with severe insomnia.
6. Very good for those with panic disorders.
Tricyclic anti-depressant ct.
• Examples of tricyclic anti-de presents:
• Amitriptyline [Carboxyl/ Trytizol].
• Very good anti-depressant.
• Dose:100-300mgs tds.
• Imipramine[Tofranil].
• Dose:100-150mgs tds.
• Anafranil[Clomipramine]
• Dose:100-200mgs.
• Mechanism of action:
• They raise the level of neurotransmitters in the brain expecially
Epinephrine and Serotonin.
Mono Amine Oxidase Inhibitors.
• The 2nd class of anti depressant.
• Only used when the 1st line fails.
• Examples:
• Phenelzine[Nardil].
• Dose:15-90mgs tds.
• Always start with a smaller dose.
• Tranylcypromine[Parnate].
• Dose:10-20mgs tds.
• Marplan[Isocarboxazid].
• Dose:10-30mgs tds.
• :
Mono amine ct.
• Mono amine react with Tyramine[amino acid].
• Causing severe hypertensive crisis.
• The patient present with:
1. Severe headache.
2. Severe palpitation.
3. Intracranial haemorrhage.
• That is why this class of anti-depressants is avoided.
• If patient is on this drugs should avoid all food with
tyramine eg cheese/bear/chicken/yeast.
Side effects of anti-depressants.
• Three categories of side effects:
1. Anticholinergic side effects.
2. Cardiovascular side effects.
3. Others.
Anti-cholinergic side effects:
These drugs interfere with the functions of cholinergic nerve
fibres.
This nerve fibres are part of autonomic nervous system.
When these nerve fibres are stimulated ………production of
Neurotransmitters called Acetylcholine.
Anti-cholinergic side effect ct.
• These anti-cholinergic side effects include:
1. Dry mouth.
2. Urinary retention.
3. Constipation.
4. Sweating.
5. Blurred vision.
• Cardiovascular side effects include:
• Tachy cardia/Arrhythamia/Palpitation.
• Orthostatic hypotension[Hypotension related to position
Side effects ct.
• Others include:
• Skin rash/Insomnia/Tremours/Weight gain or loss.
• Advice of the patient with orthostatic hypotension:
• Not to stand quickly.
• Do some exercises before leaving the bed.
• Not to have hot bath.
• To dangle the feet before ambulance.
• Check his blood pressure when patient is standing
and while lying in bed.
Electro-Convulsive Therapy[ E.C.T.].
• Another physical treatment.
• Where the electric current is used to produce an artificial
convulsion[Fit]
• The same like Epileptic convulsion.
• The treatment was discovered in 1938.
• Was discovered by two doctors who were working in an Epileptic ward.
• They had observed that Epileptic usually become
aggressive/nervous/irritated before getting an attack.
• They also observed that, once they get attack they get settled and
relaxed.
• From there they started working on how they can introduce an artificial
attach on mental patients .
• Expeciary the aggressive patient.
E.C.T. CT.
• The treatment utilises the ordinary electric current passed to a
special machine.
• The special machine is connected to the patient around the
Temporal lobes both sides.
• Then the machine is pressed and only releases enough current
to produce a convulsion.
• Types:
• Straight ECT.
• Treatment is given when the patient is conscious.
• Need a lot of staff to restrain him.
• Most of these patient end up with fractures and dislocations.
• Not recommended these days.
ECT CT.
• Modified ECT.
• Treatment is done when the patient is under general anaesthesia.
• Requires few staffs to restrain the patient.
• Also few patient end up with fractures and dislocation.
• The most recommended.
• Procedure:
• Done by the doctors.
• Patient put on the couch lies on the dorsal position.
• Machine is connected to the patient.
• Then the doctor presses a button and the machine.
ECT CT.
• When the machine is put on, it release only 70-130 volt which
produces a convulsion.
• The success of the treatment is production of a convulsion.
• Preparation of the patient before ECT.
• Explain the procedure to the patient.
• Ensure the consent is given.
• The patient need to reviewed by the doctor before the procedure.
• Starve the patient 6 hrs before the treatment.
• Morning of treatment, patient have bath.
• Observation of T/P/R/Blood pressure.
• Premedication: Atropine 0.6 mg I.M.
Preparation for ECT.
• Remove the dentures if any.
• Escort the patient to the treatment room.
• Care during the treatment:
• Let the patient lie on the treatment couch on dorsal position.
• No pillow.
• Apply the mouth gag to prevent patient from biting his
tongue.
• Support the major joints of shoulders/hips/knees.
• Support those joint with draw sheet or blanket to equally
distribute force of the support.
Care ct.
• Also observe the patient to ensure the treatment is successful.
• Care after treatment:
• After the treatment, the patient is taken to recovery ward.
• If the patient is unconscious, put him on recovery position.
• Take the vital signs of T/P/R/BP.
• Do the physical observation Head-toe to rule out fractures
and dislocations.
• Check the mouth to rule out trauma on the tongue.
• Ensure you patient does not inhale secretions.
• When your patient become fully conscious return him to the
ward.
• Serve him with break fast.
ECT CT.
• Indications:
• Depressive patient.
• Schizophrenia.
• Manic-depressive psychosis.
• Psychosis associated with child birth.
• Contra-indications:
• U.R.T. Infection.
• Heart conditions.
• Epileptic patient.
ECT CT.
• Complications:
• Injuries to the tongue.
• Fractures.
• Dislocation.
• Confusion.
• Amnesia temporary.
• Severe head aches.
Psychotherapy.
• The treatment of mind without use of drugs or ECT.
• The aim of Psychotherapy is to uncover the
information which is repressed at the unconscious
mind.
• This information is thought to cause a lot of
anxiety………Minor mental illness.
• Levels of mind:
• Our mind operates at three levels.
• Conscious level:
Levels of mind
• The 1st level of mind.
• The part of mind that make you aware of the
environment.
• Helps you to make decisions: It is hot remove your
coat. I am in the classroom so no noise.
• Help you to solve daily problems.
• The part of mind that leads you to attention.
• It is the part of mind which is continuously
stimulated by environment.
Levels of mind ct.
• Semi-conscious mind:
• Also called sub-conscious mind.
• It act like a store.
• We keep all the information we shall use in future here.
• Any important information that can be used in future.
• Information kept here can be retrieved easily.
• All you need is to try and remember and the information
comes to the conscious.
• All the notes you are writing is kept here because you will
use it in examination.
Levels of mind ct.
• Unconscious mind:
• All the information which was once in the conscious is pushed here and
forgotten.
• All painful information and painful experience during the childhood is
pushed here and forgotten.
• All painful emotional thought are kept here.
• According to Sigmud Freud:
• These information keep on influencing the individual behaviours.
• Although the individual is not able to explain his behaviours.
• Example, if a small girl at 2/3years was raped by the father,
• She will push this painful experience at the unconscious mind and forget it.
• But at her adult age she may develop great hatred toward her father or all
men but she cant’ know the cause.
Unconscious level of mind ct.
• According to Freud, there is a barrier that prevent information
from escaping from the unconscious mind to the conscious mind.
• But there are factors that weakens this barrier making this
information to reach conscious causing severe anxiety.
• These factors include:
• Sleep/Anxiety/Alcohol/Psychotropic drugs like khart.
• Evidence of this theory:
1. Slip of the tongue.
2. Forgetting of what is causing anxiety.
3. Dreams.
4. Neurotic mental illness.
The main objective of psychotherapy.
• To weaken the barriers so that the information
held in the unconscious mind is retrieved into the
conscious mind.
• Once this information is in the conscious, the
patient will talk about it freely.
• Effects of this behaviour:
• After the patient has talked, he becomes relieved,
that reduces or eradicates the anxiety all together.
• The information the patient has released can be
used to counsel him/her.
Methods used in psychotherapy.
• Hypnosis:
• Done when the patient is either comfortably seated or lying
on a couch.
• The treatment is done by a trained person.
• The patient is driven into a complete relaxation both
mentally and physically.
• The patient is driven into a state of halfway awake and a
sleep.
• At this level the patient’ breathing will be reduced.
• When he is at this state, he is interviewed in all aspect of
life.
• No drugs are used.
Methods ct.
• Abreaction:
• The same concept of weakening the barrier to release the
information.
• But in abreaction the drugs are to weaken the barrier.
• The drugs which are used:
1. Thiopentone.
2. Methedrine.
• These drugs are given i.v. very slowly.
• As it is given, the patient is asked to count 100 backwards.
Example 100,99,98,97,96,etc.
• When the patient start coughing or repeating him self, the
interviewed.
Methods ct.
• Ventilation therapy:
• Here the patient is allowed to talk all she has without
interruption.
• The therapist talk very little to encourage the patient to
continue talking.
• He should also guide the patient the aspect he want the
patient to talk.
• Example:
• Tell me about your childhood, your parents ,your
schooling your sexual life ,etc.
• The therapist must be concerned, maintains eye to eye.
• He should not show some sign of hurriness or boredom
Group therapy.
• Also referred to as Psychotherapeutic activity.
• This where the patients are put into a group and allowed to
discuss any problem which affect them all.
• If possible the patients having the same diagnosis eg
Alcoholics/Drug abusers/Schizophrenia.
• The problems they can discuss could be:
• Importance of taking drugs.
• Side effects of drugs.
• Problems of taking alcohol or smoking.
• The group should have 5-6 patients.
• The patients on the group are those who are recovering.
• The activity should take place after the ward routines are done.
Group therapy ct.
• Role of a nurse:
• Prepare the venue.
• Introduce the topic of discussion.
• Control the group.
• Ensure every patient contributes to the topic.
• Control the domineering patients
• Controls the tempers if it arises.
• Return the group to the main topic of discussion.
Group therapy ct.
• Benefits of group therapy:
1. It helps the patients to gain insight.
2. It improve their communication skills.
3. It make the patient feels a member of the community.
4. It allows the emotional discharge.
5. The patient benefit from one another as they realize
that others have the same problem.
6. The nurse will get an opportunity to observe the
patient and assess those who are recovering.
Behaviour therapy.
• Behaviour therapy is a treatment procedure which is
aimed at modifying a deviant behaviour.
• The patient is trained to achieve a socially accepted
behaviour.
• Some unacceptable behaviours:
1. Alcoholism.
2. Sexual problems like homosexuality.
3. Phobias.
4. Drug dependence.
Behaviour therapy ct.
• Flattened mood.
• Severe withdrawal from the community.
• Sever lack of interest in nearly everything.
• Inappropriate mood.
• Aloofness, not concerned with people around.
• Neologism.
• Note:
• The 2nd rank symptoms are too general and there fore
not diagnostic.
Types of schizophrenia.
• Simple schizophrenia:
• The disease start at puberty 12-13years.
• Very gradual onset.
• The patient withdrawn from community,
• He drop out from school, start staying at home.
• At home he with draw from the sitting room to his bed room.
• With time he lack interest with nearly everything.
• If you observe him through the key hole in his bed room he seem
to be day dreaming.
• Start neglecting personal hygiene.
• Star some petty crimes like stealing hens or prostitution.
• No delusions and hallucinations.
Simple schizophrenia cts.
• The person can stay with this disease for a long time without being
noticed.
• The patient may be labelled a difficult child.
• Prognosis is very poor.
• Hebephrenic schizophrenia:
• The disease start from 15-25years.
• Continuation of simple schizophrenia.
• The patient now is very sick.
• Very confused,
• Severe thought disorders.
• Develop concrete thinking.
• Full of silly giggling.
• Develop primitive behaviour like eating faeces/smearing him self with
faeces.
Hebephrenic ct.
• The patient now suffers from hallucination and delusions.
• Full of mannerism.
• His personality is completely destroyed.
• The prognosis here is very poor.
• Catatonic schizophrenia.
• The disease is of sudden onset.
• It affect the body much more than the mind.
• It comes into two forms:
1. Catatonic stupor,
2. Catatonic excitement.
Catatonic stupor
• The psychomotor activities are severely reduced.
• Movement/thinking/speech are all affected.
• Patient stays at one position for a long time.
• At the corner of a ward.
• They assume the position of foetus at breech position.
• They are very negative and Echolalia.
• Muscle tone:
• May be quit rigid and hard like board.
• Other time the muscles could be like wax.
• The limbs can be folded in any manner called Flexibilities or
Waxy flexibility.
Catatonic stupor ct.
• When the condition is severe, the patient
becomes completely motionless.
• No feeding, no opening the bowels, no
emptying the blander.
• The patient becomes completely helpless.
• Note:
• The patient usually records everything which
happening in the around.
Catatonic excitement.
• The patient suddenly shift from stupor to excitement.
• Psychomotor activities suddenly increased.
• He becomes very mobile and destructive.
• He cant be controlled. Full of pressure of activities.
• Purposeless activities.
• Full of hallucinations/incoherent speech.
• No time to feed/sleep/going to the toilet/resting etc.
• If not controlled can collapse with exhaustion.
• This patient can be very dangerous especially if you made
a negative comment about him.
Paranoid schizophrenia.
• Some called intellectual psychosis.
• The patient uses projection defence mechanism.
• The disease start from 35years when the personality is
already developed.
• The patient could be a professional working some where.
• The main symptom which is displayed by the patient is
delusion of persecution and grandeur.
• The patient does not have any thought disorder.
• He start thinking that a p
Types of clinical presentation
• Positive symptoms.
1. Hallucination: sensing things while awake that appear to
be real, but instead have been created by the mind.
Types of hallucination
(a) Auditory hallucinations : Hearing voices when no one has
spoken (the most common type of hallucination).These
voices may be command someone to do something that
may cause harm to themselves or to others.
Hearing sounds, such as music ,footsteps, windows or doors
banging.
Continuation of positive symptoms
• Visual hallucination : seeing patterns lights or objects
that are not there .
• Olfactory hallucinations smelling's a foul or pleasant
odor odor are smelled that appear to be coming from
specific or unknown place.
• Tactile hallucinations feeling bodily sensations such
as a crawling feelings on the skin or the movement of
internal organs.
Continuation of positive symptoms
• Delusions beliefs very common especially
persecutory delusion ideas of reference are in which
unrelated notices signs or remarks are believed to
be messages with specific meaning for the patient
• Thought insertion thought broadcast and thought
withdrawal .patient believes that other people know
why they are thinking either because they can be
heard or they are transmitted through TV or Radio.
Continuation of positive symptoms
• Formal though disorder individuals have difficulty in
expressing their thoughts have loosening of
associations word salad or neologism
• Excitement or agitation
• Hostility or aggressive behavior
• Suicidal tendencies
• Suspiciousness or ideas of reference.
Negative symptoms