UNIT 1 ROLE OF PSYCHIATRIC NURSE

IN VARIOUS THERAPIES
Structure
1.0 Objectives
I .I Introduction
1.2 Psychopharamacology
1.3 Electroconvulsive Therapy
1.4 Restraining
1.5 Psychosocial Therapy
1.5.1 Definition of Psychotherapy
1.5.2 Goa!s of Psychotherapy
1.5.3 Qpes of Psychosocial Therapy
1.6 Let Us Sum Up
1.7 Key Vk'orcls
1.8 Answers to Check Your Progress
1.9 Further Readings

1.0 OBJECTIVES '

After going through the content of this unit, you should be able to:
define psychotropic dmgdagent;
classify them according to various subgroups;
enlist the indication and contraindication of various subgroups of drugs;
describe the side effects of drugs;
identify and explain the nurse's role;
develop medication sheet;
acquire the concept of ECT;
develop slcill in preparing patient for ECT;
demonstrate skill i.e. pre and post ECT care of patient;
build up knowledge on types of Psychotherapies;
observe the effectiveness of each therapy: and
develop skill in conducting group therapy, milieu therapy along with a
psychotherapist.

1.1 INTRODUCTION
In Blocks 2 and 3 you h a w learnt about various therapeutic interventions for
mental disorders like anxiety neurotic disorders, psychotic disorders and others.
The nurse has an important role in treatment modalities used for mentally ill
patient.
The focus of this unit is the study of Psychopharmacology and its impact on
psychiatric-mental health nursing. The advent of psychotropic medications have
generated dramatic results in the treatment of mentally ill. The drugs have been
Advanced Concepts of Mental
Health and Pychiatric
Nursing
used extensively with various actions but the side effects have also increased
extensively because of increased side effects patient's compliance to medicine
decreases, so there is recurrent episodes of mental illness. The role of a nurse
needs to help the patient and family members to continue taking drugs until
advised by psychiatrist to reduce or stop the medicine. Responsibilities of the
nurse include recognizing the desired actions and adverse reactions of the drugs
and normal therapeutic dosage, documenting medication, administration and
keeping abreast of current literature on psychotropic drugs.
Somatic therapy or physical therapy is one form of treatment given to mentally ill
patient. In this therapy electric current is used to produce grandma1 type of
convulsion in the patient. In this unit you will learn about Electro Convulsive
Therapy (ECT) and role of psychiatric nurse.
Psychological treatment or psychotherapy is one of the approaches helping the
patient from suffering any type of mental and behavioural disorders.
Psychotherapy is also used for patient with emotional and personality problems.
Psychotherapy is used frequently by nurse therapist to help the patient.
Psychotherapy is given independently by the nurse or it is also done jointly with
the team members. In this unit you will also learn about the types of
psychological therapies and role of mental health psychiatric nurse.
1.2 PSYCHOPHARMACOLOGY
Psychotropic drugs are drugs used for mentally ill patients for psychotic and
neurotic condition.
1) Antipsychotic or Neuroleptic Drugs and Anti-parkinsonian Drugs
Definition
Aatipsychotic or Neuroleptic drugs are the major group of drugs used for
mentally ill patients with psychotic disorder (psychosis). Psychosis is serious
illness of personality which involves impairment of ego functions. Reality function
is markedly impaired. There are great signs of grave maladjustment of life.
These Antipsychotic drugs are also known as major tranquilizers or phenothiazine
group of drugs.
Indication
Antipsychotic agents are commonly used in schizophrenic disorders, mania, acute
brain syndrome, paranoid disorder and organic dementia. Antipsychotics are
contraindicated in children under three years of age, comatose patients, patients
with drug hypersensitivity. Antipsychotic are used cautiously in patients with
history of epilepsy, pregnancy, peptic ulcer, parkinson's disease, etc. (Reference
Birnla Kapoor, Text Book of Psychiatric Nursing, Vol. 2)
Table 1.1: Classification of Antipsychotic Agents
Role of Psychiatric Nurse
in Various Therapies
Advanced Concepts of Mental
Health and Psychiatric
Nursing
Side Efleects of Antipsychotic Drugs
The most common side effects are symptoms of central nervous system i.e.
Extrapyramidal Symptoms (EPS) including such as:
Parkinsonism, which occurs in 40 percent of presenting EPS. Patient present
difficulty in mastication movement, weakness and muscle fatigue.
Akathisia, occur in 50 percent of all patient presenting EPS. Patient has strong
urge to move about and has difficulty in sitting still. It occurs within two weeks
of treatment. Dystonia occurs less than EPS. Patient develops contraction of
muscles of the tongue, eye. jaw, and neck (producing torticollis) and extraoccular
muscles.
Tardive Dyskinesia, is less frequent side effect of EPS. It occurs in 3 per cent
of patient due to sudden withdrawal of drugs after giving for long time.
The other side effect ill EPS is Neuroleptic Malignant Syndrome (NMS), This is
very rare but can be futal.
The treatment for extra pyramidal symptoms are use of antiparkinsonian drugs.
Antiparlunsonian drugs includc the anticholinergic and antihistamine drugs.
Anticholinergic drugs block the secretion so they reduce the symptoms of
akathisia and acute dystonia, whereas antihistamines have effect like
anticholinergic drugs but ir is also effective to prevent tardive dpskinesia.
Nurse's Role
According to Bimla Kapoor ( 1994) it is evident that the role of the nurse is very
significant in the therapestic effect of the antipsychotic drug, early observation
and prevention of complizations, limiting the complications if already occurred are
given as follows:
Close observation
Extrapyramidal reaction
Observe drowsilless
Record blood pressilre
Accurate route of medication
The patient on antipsychotic drugs may have weight gain. Weight record
should be maintained,
The patient may complain of gastric irritation. He should be discouraged to
take antacids as there will be decreased absorption of antipsychotic drugs.
An intake o~itpzltchart should be maintained.
The patient sl~oultlbe explained not to increase or decrease or stop raking
drugs without discussing with his doctor.
The nurse should find out the rnenstr~ialchanges from the female patient.
Reasurance to relalives.
2) Antidepressant IJrugs
Definition
Antidepressant drugs are used for depressive disorders.
Indications
Antidepressant are used in pathological grief, endogenous depression and agitated
; n l m l ~ a t ; n n , > lr n ~ 1 ~ m r h n l ; o
Antidepressant drugs are given with caution to patienl with cardio-vascular Role of Psychiatric Nurse
disorders because they czuse arrhythamias. Drugs are given with caution to in Various Therapies
patient with liver disorders.

Table 1.2: Antidepressant Drugs

Side Effects Role of Psychiatric Nurse
in Various Therapies
Side effects of antidepressant drugs are drowsiness, sedation, delusion,
hallucination and EPS. Patient presents with dry mouth, urinary retention,
constipation, nausea, vomiting and loss of appetite .. endocrine disorders such as
hyperglycemia and hypoglycemia may be presented by the patient.
Nursing Implications
Observation, Monitoring and recording of side effects to prevent
complications.
Give plenty of fluid to reduce dryness of mouth. Lemon or chewing gum can
be also given to prevent dryness of mouth.
Give antidepressants drugs after giving something to reduce nausea and
vomiting and irritation to the mucosa of stomach.
Maintain JIO chart to check whether there is retention of urine.
Encourage the patient to get up from bed or chair slowly. Dizziness can be
reduced which may result due to orthostatic hypotension while getting up.
Maintain recoi-d of vital signs that is B.P. and pulse.
Check the symptoms of agranulocytosis such as sore throat, fever and
malaise.
Record,and report the side effects.
Explain to the patient that the effect of drugs will be seen within four to
eight weeks. Hence, patient must continue taking drugs.
Ensure that the psychiatrist is informed and drugs are stopped immediately if
patient complains of pressure of speech, increased motor activity, elated
mood or sexual dysfunction.
Activity 1
List any of the following groups of drugs being given in the ward:
a) Tricyclic Antidepressants
b) Tetracyclic Antidepressants
c) M A 0 Inhibitors (Refer the Content)
Advanced Concepts of Mental
Health and Pychiatric
Nursing

3) Antimanic Drugs

Definition
Antimanic drugs are given in manic phase of bipolar disorders. Bipolar disorders
are mania and manic depression.
Indication
The major use of antimanic drugs is for mania. Lithium is a drug of choice.
Antimanic drug reduces the effect of norepinephrine and serotinin which effects
on emotions. Lithium helps in maintaining the sodium concentration of brain
thereby regulating the mood swings.
Antimanic drugs are contraindicated for patients, patients with renal problems Role of Psychiatric Nurse
because the drug is absorbed excreted by the kidney. In patient with in Various Therapies
cardiovascular problem or hypothyrodism also the antimanic drugs are
con traindicated.
In pregnant women antimanic may cause foetal abnormalities, hence, it is
contraindicated.
Table 1.3: Antimanic Agents

Side Eflects
Due to increased serum lithium level patient may show nausea, vomiting, fine
hand tremors, if the serum level is below l m EqL. if it is high for example, 1.2m
Eq/L patient will have drowsiness, vomiting, abdominal pain, lethargy, ataxia. In
case patient's blood serum level for lithium is not done and if increases, the
symptom will be blurred vision, seizures, acute circulatory failure, stupor, coma or
death.
The other side effects may be tinnitus (ringing or tingling sounds in the ears),
slurred' speech, bradycardia, generalized oedema, alopecia, etc.
Nursing Implications
a Medicine should be given after meal to reduce gastric irritability.
a Record and report side effects.
* Check for serum lithium reports and ensure that it is done regularly.
a Check for oedema, maintain weight record.
Intake/output chart should be maintained to check renal functioning.
Maintain proper intake of diet.
a See that patient does not miss any dose.

4) Antianxiety Agents or Anxiolytic Drugs

These are the drugs used for patient having symptoms of anxiety.
Sedatives and Hypnotics
Definition: Sedative and hypnotic,drugs are'glso used to reduce anxiety and
induce sedation.
Indication: Indication are to redpce anxiety, which may be associated with
emotional or physical disorders. These drugs are also given in neurosis. These
drugs are contradicated for patients with renal, respiratory and liver impairment.
Advanced Concepts of Mental Table 3.4: Sedatives and Hypnotics
Health and Pychiatric
Nursing

Table 1.5: Classification of Anti Anxiety Drugs

Role of Psychiatric Nurse
in Various Therapies
Advanced Concepts of Mental
Health and Pychiatric
Nursing

Side Effects of Sedatives and Hypnotics

Side effects are same like anti anxiety drugs such as hypotension, palpitation,
syncope (fainting), change in libido, physical or psychologic~ldependence.
Sedatives like barbiturntes can be fatal when taken in overdose usually for
suicidal attempt.
Nursing Implications
If the sleep pattern is disturbed provide calm and quiet environment, a cup of
hot milk, good back care or reading of magazine will induce sleep.
Daily dose should be given at bed time to induce sleep.
I/M injection should be given deep intra-muscular to prevent tissue irritation.
Observe, record and report any side effect.
If patient feels drowsy, do not allow himher to do any activity.
Patient should be checked if she is developing drug dependence.
Record vital signs and symptoms.
5) Antiparkinsmian Drugs
Antiparkinsonian drugs are the specific drugs to treat the extrapynnidal side
effects of antipsychotic agents.
Anticholinergic drugs block the secretion, thereby reducing the symptoms of
akathesia and acute dystonia. It is not effective against tardive dyskinesia.
Antihistamines have effects like anticholinergic drugs. Amantadines are
doparnine-releasing agents from central neurones. Studies show that this drug
may affect some clients with Pardive dyskinesia.

Table 1.6: Classification of Antiparkinsonian Drugs

 I

Side Effects of Antiparkinsonian ,Drugs Role of Psychiatric Nurse

in Various Therapies
The side effects are dry mouth, flushed, dry skin, blurred vision, drowsiness,
dizziness, anorexia, nausea, vomiting, slurred speech, insomnia, inability to
concentrate.
, ..
Nurse's Role
Observation j'
Maintain an intake output chart.
~ n c o u r a.,,~adequate
,
e intake of fluids and roughage in the diet.
!' f

Record vitdi signs.

Adivse the phtient not to get up quickly from a lying-down position to sitting.
Activity 2
Write the medication sheet for all the drugs you have given to your patient during
clinical work in psychiatric ward or OPD. (Follow the format giveh below.)

6) GuidefSamples Format Writing Medication Sheet

Topic : Medication Sheet
instructions

During your clinical posting write the medication sheet for all the drugs you have
given to your patients according to the following format given as your clinical
assignment.
Medication Sheet

I
1 3 ELECTROCONVULSIVETHERAPY
1) ConceptlMeaning of Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) is a painless form of electric therapy. It is
called as physical therapylsomatic therapy. Patient is anaesthetized or sometimes
without anaesthesis electric current is applied for a fraction of a second with the
help of electrodes placed on the temporal region. Due to this CUIrent
convulsion or seizure (like Grand Mal Epilepsy) are produced
2) Purpose of ECT
when drugs are not available or not proving to be very effective for the
patient.
for the quick recovery of the patient.
when patient needs to get back to work quickly.

3) Indications of ECT
Treatment of ECT depends upon condition of patient, availability or non-
availability of drugs. However, some of the common condition in which ECT
treatment is given are:
Major depression.
Involutional Melancholia.
Post-partum psychosis.
Catatonic Schizophrenia.
Suicidal thoughts and suicidal attempts.
Manic patient who is exhausted.
Contraindications of ECT
Increased intracranial pressure, tumor, hematomas and subarachnoid hemorrhage
are the major contraindications.
4) Methodwpes of ECT
ECT can be given by:
Direct method
Indirect/modified method
Direct ECT: In direct ECT patient is given 0.6mgm to lmgm of atropine
sulphate subcutaenously half an hour before the treatment or W immediately
before the treatment. Tranquilizers like calmpose is also used. Atropine reduces
vomiting and salivation after the convulsion. Convulsion are produced with the
help of electric current. Resuscitative article and emergency equipments should
always be kept near the patient. The method causes lot of anxiety in the patient.
Indirect/Moditled ECT: ECT is modified with the use of anaesthesia. A short
acting barbiturate such as Theopental 5 to 10 ml (1 rnl:10 mgm) and ultra and
short acting depolarizing agent succinylcholine 0.3 ml to 0.5 rnl (1 ml=20 mgm) is
given W.
Use of anaesthesia reduces anxiety in the patient. Force of convulsion is also
less thereby chances of fractures are reduced to minimal. This can also be used
for patients who are recovering from heart conditions. This meth0d.i~commonly Role of Psychiatric Nurse
used for the treatment. in Various Therapies

5) Placement of Electrodes and Amount of Current

The placement of electrodes can be unilateral or lateral.

Iq bilateral ECT, the electrodes are placed on both the sides of temporal region.
Whereas in the unilateral one electrode is placed on the temporal region. In left
handed person it is placed on right temporal region and vice-versa.

Amount of current is 70 to 130 volts given for 1 to 8 seconds which produces

the following stages of seizure/convulsion.

It is necessary that grand ma1 seizure must be produced by direct or indirect

ECT.

Direct ECT Modified ECT

Tonic Phase Muscle contraction Mild grimace or
lasts for 10 Blepharospasm
seconds approximately. (tonic spasm of
eyelid muscle .
Clonic Phase Convulsion lasts Slow planter flexion
for 25 to 30 seconds (reverse Babinski)
and fine movement of
toes.
Relaxion Stage Patient goes in relaxation Patient goes in
relaxation.

6) Number of Frequency in ECT

Number of frequency in ECT depends upon the condition of the patient. Peak
response is attained between five treatments, 20 to 25 treatment may be required
for chronic schizophrenic patients.

7) Complications of ECT
Complications of ECT are reduced due to modified ECT. Some of the risks are
as follows:

Mild impairment of memory which may lead to severe confusion teinporarily.

Memory returns within a few weeks to'a month.

Dislocation or fractures are caused due to muscle contraction.

Compression fracture of dorsal vertebrae between third and fourth or fourth

and fifth vertebrae is common.

Headache, backache, paiafnl mastication are the other complaints patient

may express.
Activity 3

i) List the diagnosis of all the patients who are getting ECT during your clinical
work in the psychiatric ward, compare it with indication mentioned in the
text. (At least 15 patients. You may refer case records).

ii) During your clinical work, interview 5 patients whoare getting ECT and list
Advanced Concepts of Mental
Health and Psychiatric
Nursing
 Role of Psychiatric Nurse
' in Various Therapies

8) Nursing Care of Patient for ECT and Preparation

Psychiatric nurse has significant role from the time ECT therapy is planned for
the patient till the treatment is over. For the purpose of effective learning of this
practical it will be discussed under the following heading:

Preparation of physical set up i.e. Waiting room, ECT room and Recovery room.

i) Preparation
Preparation of the the patient is explained as given below:

Patient from the ward is received in waiting room. Toilet should be attached so
that patient can empty bladder and bowel 'before' treatment. Preanasthetic drugs
should 'be kept ready.
The ECT room should have low level beds with side railings to prevent fall. ~

Articles required for ECT are: ECT machine in working condition; Electrodes
well padded with gauze pieces on both the sides; Normal saline to clean the
temporal region; ~ndotrachealtubes; Suction and 0, catheters; Mouth wipes and
cotton balls; Covered tray containing all emergency drugs and syringes; with
spirit swabs; In the lower shelf of the trolley put ambu bag; B.P. apparatus;
Mouth gag well padded (to avoid injury in the mouth); Tongue depressor; Small
pillow to go under patient's back; Kidney tray and paper bag to throw swabs.

After the patient is brought to recovery room, a floor Eed or low level bed should
be kept ready. All the emergency drugs, mouth wipes to clean salivation or
excessive secretiqn should be handy. An extra set of clothes to change if patient
had soiled it with urine or stoo1,during convulsion. Toilet facilities should be
available in the recovery room.

ii) Nursing Care of Patient

Before ECT

Ensure that patient had thorough physical examination including ECG, Hb,
urine for sugar, X-ray skull and cHest. This is important to rule out any
problem which ma$ lead to complication duringlafter K T .
Take written consent from the patient's close relative.

Explain to the relatives the whole procedure and to patient that sh&e will
be getting injection, avoid the word ECT as patient gets apprehensive that
hefshk will be getting elect& current.
Explain the patient and to relative not to give anything orally not even tea 4
to 6 hours before the treatment. Because during the convulsion patient may
vomit and regurgitate leading to respiratory distress.
Advanced Concepts of Mental Remove all the metal articles like bangles, watch, any rings as metal is good
Health and Pychiatric
Nursing
conductor of electricity and current may be passed to the areas.
Encourage patient to remove tight clothes like tight blouse or undergarment
in women, necktie in men. So that patient can be helped in respiration.
In women, do not allow them to wear nailpolish, lipstick or blush on because
it will be difficult to check for cyanosis.
Give premedication as prescribed and record (Inj. atropine and calmpose) to
reduce secretions and anxiety.
Encourage the patient to remove oil from hair because oil is a bad conductor
for electricity.
Ensure that patient has passed stool and urine or if helshe wants to just prior
to ECT. Patient feels embarrassed when wakes up in soiled bed.
Accompany the patient preferably on wheel chair till the ECT room and
hand over to the ECT room nurse.
During ECT
In the ECT room patient is put on a well padded bed and placed in supine1
dorsal position with a small pillow under the lumber region.

For modified ECT short acting anaesthetic agent theopental 0.25gms. to

O.5gms W and 30 to 50 mgm scoline is given as prescribed by the
psychiatrist.
Padded mouth gag or tongue depressor is placed in between the teeth to
prevent biting of tongue or lips.
Hyperextension of head prevent falling of tongue back, and support at all the
joints will prevent dislocation or fracture.
Observe for grand ma1 convulsion/seizure, tonic stage which lasts for 10-15
seconds.
Restore respiration by immediate suctioning and 0, by mask if required.
After ECT

Check the patient's pulse, respiration and blood pressure immediately and
record.
Prevent the patient from fall.
Transfer the patient to recovery room once the patient responds to simple
questions.
Allow the patient to sleep for 112 an hour to one hour, if the patient wants to
sleep.
Record pulse, respiration, B.P. every 15 minutes. Once the vital signs
stabilize record after every 30 minutes till the patient is fully oriented.
Patient should be given reorientation to the ward, toilet etc. as helshe may
be confused.
Make note of any injuries of complaints such as headache or bodyache.
Give clear tea, if patient does not vomit, give breakfast.
 Encourage the patient to do his daily activity and make observation of any Rde of Psychiatric Nurse
change in the behaviour. in Various Therapies

Record the treatment and observation made of patient's behaviour.

Sample Chart for Prisser Recording

Name Mrs., Satwant Kaur

Diagnosis Major depression with suicidal attempt

Age 38 years
Sex Female

Bed No. 10

Temperature : 37OC
Pulse 78/mt

Res. 18/mt

B.P. 120180 mrn of Hg

Time of ECT : 9.00 A.M.

Patient received back at 9.30 A.M.

Activity 4
Select a patient in the ward/OPD who has to get hisher first ECT. Carry on the
following activities:
Explanation to the relative and patient.
Preparation of patient for ECT.
Advanced Concepts of Mental Care of patient during and after ECT.
Health and Pychiatric
Nursing Maintaining post ECT chart (at least two patient)

1.4 RESTRAINING
Several treatment alternatives exist for intervention in assaultive behaviour.
Medication, physical restraints and seclusion rooms may be used separately or in
combination, according to protocols in given treatment settings. The 1982
Supreme Court decision in Youngberg V. Romeo held that professional decision
to seclude or restrain a patient is presumptively valid and that liability for
secluding or restraining a patient may be imposed only when the professional's
decision is a substantial departure from accepted professional judgement, practice
or standard.

The purpose of restraining:

Containment of injurious actions.

To reduce difficult interpersonal relationship.

To decrease sensory input to reduce sensory overload.

Uncontrolled and unsafe behaviour of the patient.

Nurse's Role

One staff member should act as a team leader and direct the actions of
everyone according to established and practiced routines. The leader will tell the
patient what is occurring and why, keeping verbalizations concise and matter of
fact in tone. Other members of the team will be assigned to hold the limbs to
hold and transport the patient to the seclusion room or to apply restraints.
Restrictive therapies must have clear guidelines and Physician's guidelines.

Termination of Restraining

Restraining must depend on objective criteria rather than arbitrary feeling states
of the nursing staff.
Criteria for release from restraints may be grouped in the following categories: Role OF Psychiatric Nurse
in Various Therapies
Psychomotor Agitation: Assessed by means of decreased restlessness,
lowered blood pressure and pulse rate.

~tsbili&tionof Mood: Assessed by means of absence of physical threats,

lowered anxiety level, consistency of verbal and nonverbal behaviour and
feeling of trust in staff.
a Cognitive Process: Assessed by means of insight, increased ability to
concentrate and improve reality testing.

1 5 PSYCHOSOCIAL THERAPY
Psychosocial therapy is one of the important treatment modaIities used for the
patients with mental disorders. It is given along with other therapies or
separately.

1.5.1 Definition of Psychotherapy

Psychotherapy is defined as a form of treatment of an emotional nature in which
trained person purposefully develops a professional relationship with objective of
removing, modifying or reducing the presenting symptoms.

1.5.2 Goals of Psychotherapy

The goals of psychotherapy are to:

Establish therapeutic relationship with the patient.

a Change specific maladaptive patterns of behaviour.

Reduce or eliminate environment which may be causing such a behaviour.

a Help patient to develop sense of self identity, and

Help patient to improve in histher interpersonal and communication skill.

1.53 Qpes of Psychosocial Therapy

Psychosocial therapy can be studied under the following headings:

a Individual ~sychothera~y

a Behavioural Psychotherapy

a Interpersonal Psychotherapy

a Group Psychotherapy

a Milieu Therapy
1) Individual Psychotherapy

It is conducted on one to one basis. It is effective when a therapeutic rapport

develops between patient and therapist. The common types of individual
psychotherapy are:

Psychoanalysis, Hypnotherapy, Abreaction, Reality therapy, Uncovering and

Supportive therapy.
Advanced Concepts of Mental
Health and Psychiatric
Nursing
 Role of Psychiatric Nurse
in Various Therapies

Activity 5
Identify and list the individual psychotherapies being practiced in the-psychiatric
ward during your clinical work.

2) Behavioural Psychotherapy
Definition: It is a form of psychotherapy modifying the faulty behaviour of
patientlclient. (Refer Birnla Kapoor: Text Book of Psychiatric Nursing, Vol. I1
in which the therapist helps the client)
Behaviour modification

Systematic desensitization
Aversion therapy
Assertiveness training, and
Positive reinforcement.
The other types of psychotherapies are implosive and cognitive behaviour
tderapy.
Advanced Concepts of Mental
Health and Psychiatric ,
Nursing

3) Interpersonal Psychotherapy
In interpersonal therapy the emphasis is mainly on the interpersonal relationship.
The common therapies used for interpersonal psychotherapy are marital therapy,
family therapy and transactional analysis. We will discuss mainly the family
therapy.
Family Therapy
It is used to improve relationship and also to modify home influence that may
be the cause of problem for one or more members. The therapist helps the
clientslmember to become aware of their disturbed behaviour due to
defensive pattern used by them, specially used in marital disharmony, HIVI
AIDS and Drug Abuse.
a Community mental health psychiatric nurse has significant role to play, to Role of ' Psychiatric Nurse
prevent these type of problems and reduce the number of patient with in Various Therapies
mental disorders.

4) Group Psychotherapy
Definition
Group psychotherapy is a treatment of psychological problem in which two or
more patients interact in the present of a psychotherapist.
Objectives of Group Therapy
To help the patient to:
a communicate with each other to improve in socialization.
a discipline herselfhimself by abiding the rules of group therapy.
a know reality about his disease.
a use appropriate behaviour.
a identify his problems and seek solution from the group.
a enhance his self concept by going through the positive reinforcement from
the group for his appropriate behaviour, and
a help others to identify their problems and provide solution.
Advanced Concepts of Mental
Health and Psychiatric
Nursing

5 ) Milieu Therapy
Milieu is a French word meaning "Middle place". In English language, milieu
means "Environment" or "Setting". Therapeutic milieu is a 24 hours environment
designed to provide a secure retreat for individuals whose capabilities for coping
with reaiity have deteriorated. The therapeutic milieu gives them opportunities to
acquire adaptive coping skills. It is the multidisciplinary therapeutic approach used
on inpatient psychiatric wards. The term milieu therapy reflects the idea of all
activities in a ward and are oriented towards increasing a patient's ability to cope '

in the ward and relate appropriately to others. Milieu therapy generally involves
groups and may include art therapy, occupational therapy, activities of daily living,
community meeting, group passes and social events.
It offers secured comfortable physical facilities for sleeping, dining, bathing and
engaging in recreational, occupational, social, psychiatric and medicinal therapies.
The functions of the Therapeutic Milieu are:
Shelters client physically from what they perceive as painful, terrifying
stressors.
Protects client physically from maladaptive behaviour.
Provide psychological support to clients.
Provides pleasant attractive sensory stimulation to clients.
Educate clients and their families about adaptive, effective coping.

1.6 LET US SUM UP

In this unit you have learnt about the Psychotropic drugs, classifications,
indications for use, contraindication, side effects and nurses implications to
.prevent the drug induced complications. You also have learnt ECT. ECT can be
given as direct and modified. Modified ECT is more common. Emphasis is also
given in nursing care of patient undergoing ECT. You have also learnt res~aining
which is not to be used unless unavoidable situations.
In this unit you have also learnt about the meaning of psychotherapy, its types Role of' Psychia~tricNurse
and the role of a nurse in Psychotherapies. The role may not be very evident in Various Thelrapies
because of inadequate preparation of nursing personnel in psychotherapy.

1.7 KEY WORDS

Alopecia Thinning and falling of hair due to drugs
leading to baldness.
Amnesia Refers to absence of memory. It may be
complete or partial.
Catharsis Permitting the patient to talk freely so -that,
s h e is able to ventilate all his emotions and
feel relieved
Cognitive Behaviour Therapy : It is a psychotherapeutic approach based
on the idea that emotional problems in an
individual arises due to faulty ways of
thinking and distorted attitude towards
oneself or others. Therapist takes the role
of a guide who helps the patient to correct
and revise these perceptions.
Compression To press together something.
Compliance Agreed to or continue taking medicine.
Dentures Set of a artificial teeth.
Drug Dependence A state of psychic, sometimes also physical,
resulting from taking drug continuously.
Embarrassed To be in awkward position.
Heterogeneous Group of different people. Could be male,
and female, patient suffering from
psychotic or neurotic orders.
Homogeneous People with similar sex or diseases like all
neurotic patients -make a group.
Implosive Therapy ' In implosive therapy an individual is
exposed direct to a maximum intensity fear
producing situation either in imagination or
in real life.
Involutional Melancholia It is a mental disorder occurring in the late
middle life duiing the menopausal period,
characterized 'by severe depression and less
often by pqanoid thinking. .c
Irreversible f i e symptoms cannot be relieved with any
treatment or incapable of being reversed.
Malaise . Feeling of sickness.

Regurgitate : Bring sGallowed food up again to the

mouth.
: To make a scrapping noise with feet. .
Submissive : Person can be easily explained and given
suggestions because helshe is meek.
Suggestible : Patient can be easily given suggestion as
helshe is ready to take suggestion.
Transactional Analysis : It is a form of psychotherapy which
focuses on characteristic interactions that
reveal internal 'ego states' of an individual.

1.8 ANSWERS TO CHECK YOUR PROGRESS '

Check Your Progress 1

1) a) Psychotropic drugs are the drugs used for mentally ill patients for
psychosis, affective and neurotic disorders.

b) Antipsychotic drugs are the drugs given to patients with psychotic

disorders.

c) Antiparkinsonian drugs are the specific to treat the extra pyramidal

symptoms (EPS) of antipsychotic drugs.

d) Extra pyramidal symptoms (EPS) are symptoms of C.N.S. due to

antipsychotic drugs such as parkinsonism, akathisia, acute dystonia and
tardive dyskinesia.

2) Close observation of EPS, recording and reporting.

Accurate route of giving antipsychotic drugs.

Monitoring vital signs and symptoms B.P., pulse and respiration.

Recording weight.
Maintaining If0 chart.
Compliance of medicine.
Recording of medicine.

3) a) Tofranil and Depsonil. .

b) Lidomil and tetradep.
c) Orthostatic hypotension.

d) Sexual dysfunction or elated mood.

e) Empty stomach.

Check Your Progress 2

a) Chlorpromazine
b) Anticholinergic
c) Lithium carbonate
d) Tetracyclic

e) Phenobarbital
 3
Check Your Progress 3 Role of Psychiatric Nurse
in Various Therapies
i) a
ii) a
iii) a
iv) c
v) C

vi) c

vii) b
viii) c

Check Your Progress 4

a) anxiety. -
b) respiratory Tract.
c) fractures.
d) modified ECT.
e) vomiting.
Check Your Progress 5
1) Individual psychotherapy is defined as psychotherapy conducted on a one to
one basis, the therapist treats one person at a time.
2) Goals of psychotherapy:
Changing maladaptive behaviour.
Modifying environment.
Improving interpersonal skills.
Helping in developing self identity.

3) Types of individual psychotherapy are:

Psychoanalysis.
Hypnosis or hypnotherapy.
Abreaction.
Reality therapy.
Uncovering.
Supportive psychotherapy.
Check Your Progress 6
1) a) Behaviour modification
b) Systematic desensitization.
Advanced Concepts of Mental
Health and Pychiatric
Nursing
c) Aversion therapy.
d) Assertiveness training.
e) Positive reinforcement.
f) Implosive therapy.
g) Cognitive behaviour therapy.

2) To help the patients to communicate with each other.

- To help patients to socialize.
- To help patient to identify his problem and seek solution.
- To help patient to know reality of hislher disease.
- To help patients to use appropriate behaviour.

1.9 FURTHER READINGS

Drugs Today, Lorina Publications (India) Inc., Delhi; 0ct.-Dec. 1999.
Kapoor, Bimla, Text Book of Psychiatric Nursing, Vol. 11, Kumar Publishing
House, New Delhi.