MENTAL HEALTH NURSING

UNIT-I Introduction
Perspectives of Mental Health and Mental Health nursing : evolution of mental health services,
treatments and nursing practices,
Prevalence and incidence of mental health problems and disorders
Mental Health Act
National Mental health policy vis a vis National health policy
National Mental health programme
Mental Health team
Nature and scope of mental health nursing
Role and functions of mental health nurse in various settings and factors affecting the level of
nursing practice
Concepts of normal and abnormal behaviour

UNIT-II Principles and Concepts of Mental Health Nursing

Definition: mental health nursing and terminology used
Classification of mental disorders : ICD
Review of personality development, defense mechanisms
Maladaptive behaviour of individuals and groups: stress, crisis and disaster(s)
Etiology: bio-psycho-social factors
Psychopathology of mental disorders: review of structure & function of brain, limbic system
and abnormal neuro transmission
Principles of Mental health Nursing
Conceptual models and the role of nurse:
o Existential Model
o Psycho-analytical models
o Behavioural model
o Interpersonal model

UNIT-III Assessment of mental health status

History taking
Mental status examination
Mini mental status examination
Neurological examination : review
Investigations : Related Blood chemistry, EEG, CT & MRI
Psychological tests Role and responsibilities of nurse

UNIT-IV Therapeutic communication and nurse-patient relationship

Therapeutic communication: types, techniques, characteristics
Types of relationship,
Ethics and responsibilities
Elements of nurse patient contract
Review of technique of IPR-Johari Window
Goals, phases, tasks, therapeutic techniques
Therapeutic impasse and its intervention

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UNIT-V Treatment modalities and therapies used in mental disorders
Psycho Pharmacology
Psychological therapies: Therapeutic community, psychotherapy-individual: psycho-analytical,
cognitive & supportive, Family, Group, behavioural. Play, Psycho-drama, Music, Dance,
Recreational & Light therapy, Relaxation therapies : Yoga, Meditation, bio feedback
Alternative systems of medicine
Occupational therapy
Physical Therapy: electro convulsive therapy
Geriatric considerations
Role of nurse in above therapies

UNIT-VI Nursing management of patient with Schizophrenia, and other psychotic disorders
Classification: ICD
Etiology, psycho-pathology, types, clinical manifestations, diagnosis
Nursing Assessment - History, Physical & mental assessment
Treatment modalities and nursing management of patients with Schizophrenia & other
psychotic disorders
Geriatric considerations
Follow up and home care and rehabilitation

UNIT-VII Nursing management of patient with mood disorders

Mood disorders: Bipolar affective disorder, Mania depression & dysthymia etc
Etiology, psycho-pathology, clinical manifestations, diagnosis,
Nursing Assessment –History, Physical and mental assessment
Treatment modalities and nursing management of patients with mood disorders
Geriatric considerations
Follow-up and home care and rehabilitation

UNIT-VIII Nursing management of patient with neurotic, stress related and somatization
disorders
Anxiety disorder, Phobias, Dissociation and Conversion disorder, Obsessive compulsive
disorder, somatoform disorders, Post traumatic stress disorder
Etiology, psycho-pathology, clinical manifestations, diagnosis
Nursing Assessment-History, Physical & mental assessment
Treatment modalities and nursing management of patients with neurotic, stress related and
somatization disorders
Geriatric considerations
Follow-up and home care and rehabilitation

UNIT-IX Nursing management of patient with substance use disorders

Commonly used psychotropic substance: Classification, forms, routes, action, intoxication &
withdrawal
Etiology of dependence: tolerance, psychological and physical dependence, withdrawal
syndrome, diagnosis,
Nursing Assessment - History, Physical, mental assessment and drug assay
Treatment (detoxification, antabuse and narcotic antagonist therapy and harm reduction) &
nursing management of patients with substance use disorders

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 Geriatric considerations
Follow-up and home care and rehabilitation

UNIT-X Nursing management of patient with Personality, Sexual & Eating disorders
Classification of disorders
Etiology, psycho-pathology, characteristics, diagnosis,
Nursing assessment-History, Physical and mental assessment
Treatment modalities and nursing management of patients with Personality, Sexual & Eating
disorders
Geriatric considerations
Follow-up and home care and rehabilitation

UNIT-XI Nursing management of child-hood and adolescent disorders including mental

deficiency
Classification
Etiology, psycho-pathology, characteristics, diagnosis, Nursing assessment-History, Physical,
mental and IQ assessment
Treatment modalities and nursing management of childhood disorders including mental
deficiency
Follow-up and home care and rehabilitation

UNIT-XII Nursing management of organic brain disorders

Classification : ICD
Etiology, psycho-pathology, clinical features, diagnosis, and Differential diagnosis (parkinsons
and Alzheimer’s)
Nursing assessment-History, Physical, mental and neurological assessment
Treatment modalities and nursing management of organic brain disorders
Geriatric considerations
Follow-up and home care and rehabilitation

UNIT-XIII Psychiatric emergencies and crisis intervention

Types of psychiatric emergencies and their management
Stress adaptation Model: stress and stressor, coping, resources and mechanism
Grief: theories of grieving process, principles, techniques of counseling
Types of crisis
Crisis Intervention: Principles, Techniques and Process
Geriatric considerations
Role and responsibilities of nurse

UNIT-XIV Legal issued in Mental Health Nursing

The Mental Health Act 1987: Act, sections, Articles & their implications etc.
Indian Lunacy Act 1912
Rights of mentally ill clients
Forensic psychiatry
Acts related to narcotic and psychotropic substances and illegal drug trafficking
Admission and discharge procedures
Role and responsibilities of nurse

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UNIT-XV Community Mental Health Nursing
Development of Community Mental Health Services:
National Mental Health Programme
Institutionalization Versus Deinstitutionalization
Model of Preventive Psychiatry: Levels of Prevention
Mental Health Services available at the primary, secondary, tertiary levels including
rehabilitation and Role of nurse
Mental Health Agencies: Government and voluntary, National and International
Mental health nursing issues for special populations: Children, Adolescence, Women, Elderly,
Victims of violence and abuse, Handicapped, HIV/AIDS etc.

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SEXUAL DISORDERS

The sexual disorders can be classified into four main types:

Gender identity disorders.
Psychological and behavioural disorders associated with sexual development and
maturation.
Paraphilias (disorders of sexual preference).
Sexual dysfunctions.

Gender identity disorders

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Long Essays

1. Define psychotherapy. Enlist the types of psychotherapy. Explain the techniques of

behaviour therapy
2. Define therapeutic community. Describe the components of therapeutic community.
Explain the role of nurse in therapeutic community
3. Define therapeutic nurse patient relationship. Explain the tasks & barriers during each
phase of nurse patient relationship
4. Write down the classification of psychotropic drugs. Explain the Indications of anti-
anxiety drugs and the role of nurse in administration of anti-anxiety drugs?
5. Classify psychotropic drugs and write the nurses’ responsibility in caring for a patient
receiving antipsychotic drugs.
6. Define mood stabilizers. Enlist the types of mood stabilizers with its doses. Explain
lithium toxicity and its management
7. Define psychotherapy. Enlist the types of psychotherapy .Explain the techniques of
behaviour therapy
8. Describe the components of therapeutic community and the nurses’ role in therapeutic
community.
9. Define ECT and explain the nurses’ role in ECT
10. Define therapeutic nurse patient relationship and explain the phases of nurse patient
relationship.
11. Describe the signs and symptoms of paranoid schizophrenia and explain the nursing
management.
12. Define Mania. List the types of Mania. Explain the nurse’s responsibility in caring for a
patient with acute Mania
13. Define dementia. List down the causes of dementia. Explain the nursing management of
a patient with dementia

14. Explain the causes of depression. Describe the nursing management of a patient with
severe depression.
15. Describe the etiology of schizophrenia. Explain the nursing management of a patient
with Catatonic Schizophrenia.
16. Enlist the etiology of delirium (acute organic brain syndrome). Explain the nursing
intervention for a patient with delirium
17. Define dementia .Explain the stages of dementia and the nursing management of a
patient with dementia
18. Define Depression. Explain the clinical features of Depression.Develop a nursing care
plan for a patient with Severe Depression
19. Define schizophrenia. Describe in detail catatonic schizophrenia and its nursing
management.

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20. Describe the clinical features of a patient suffering from mania. .Develop a nursing care
plan for a patient suffering with mania by nursing process approach.

Short Essays
1. Discuss Multidisciplinary team or Mental health team
2. Enlist the objectives of national mental health programme
3. Discuss the Nature & scope of mental health nursing
4. Explain the factors affecting the level of nursing practice
5. Discuss the concept of normal & abnormal behaviour
6. Explain the functions of mental health nurse in various settings
7. Explain Mental health act
8. Discuss the factors influencing abnormal behaviour
9. Explain the current trends in Mental health nursing
10. Explain the characteristics of Mentally healthy person
11. Explain the Factors affecting mental illness
12. Explain the Standards psychiatric nursing
13. Explain the Principles of Mental Health Nursing
14. Explain Behavioural Model
15. Explain Interpersonal Model
16. Explain the psychopathology of Mental Disorders
17. Classify Mental Disorders according to ICD -10
18. Explain Psycho-analytical model
19. Explain Existential model
20. Define Defense mechanism. Enlist the various defense mechanisms with an example each.
21. Explain the etiology of Mental Disorders
22. Explain Johari Window
23. Explain Process Recording
24. Enlist the Signs and symptoms of Lithium toxicity and management of lithium toxicity
25. Discuss the Nurses responsibility for a patient receiving antipsychotics
26. Explain Behaviour therapy
27. Explain Relaxation therapy
28. Enumerate Advantages and disadvantages of therapeutic community
29. Define communication and explain the techniques of therapeutic communication
30. Explain about nurse patient contract
31. Explain about dynamics of therapeutic nurse patient relationship
32. Explain therapeutic impasses in nurse patient relationship
33. Explain group therapy
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34. Explain the role of nurse in preparing for ECT
35. Describe occupational therapy
36. Describe recreational therapy
37. Describe play therapy
38. Describe the Clinical features of Obsessive Compulsive Disorder.
39. List the signs and symptoms of Post traumatic stress disorder and Explain the nursing
intervention
40. Explain the types of Dissociative disorder.
41. Explain treatment modalities and Nursing management of a patient with generalized Anxiety
disorder
42. Define Hypocondriasis. List down the signs and symptoms of Hypocondriasis
43. Describe phobia , its types and management
44. Explain the clinical features and management of OCD
45. Explain dissociative disorders in detail
46. Explain conversion disorders
47. Explain psychosomatic disorders.
48. Describe the etiological factors in substance use disorders.
49. Describe the etiological factors in Substance use disorders
50. List down the Psychiatric disorders due to Alcohol dependence syndrome. Explain withdrawal
syndrome
51. Explain Alcohol deterrent therapy
52. Explain Alcohol induced Psychiatric disorders. Explain the Nursing management of a patient
with Alcohol abuse.
53. Explain the nursing intervention for a patient with acute drug intoxication
54. Explain about narcotic and psychotropic substances and its abuse
55. Explain the management of Alcohol Dependence Syndrome
56. Explain the psychiatric complications of ADS
57. Explain the management of a patient with long term alcohol abuse
58. Define Mental retardation. List down the Etiology of Mental retardation
Definition:" Mental retardation refers to significantly sub average general intellectual
functioning resulting in or associated with concurrent impairments in adaptive behavior and
manifested during the developmental period"
Etiology of Mental Retardation
Genetic Factors
Chromosomal abnormalities: Down's syndrome, Fragile X syndrome, Trisomy X syndrome,
Turner's syndrome, Cat-cry syndrome, Prader-willi syndrome
Metabolic disorders: Phenylketonuria, Wilson's disease, Galactosemia,
Cranial malformation: Hydrocephaly, Microcephaly
Gross diseases of brain: Tuberous scleroses, Neurofibromatosis, Epilepsy

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 Prenatal Factors
Infections: Rubella, Cytomegalovirus, Syphilis, Toxoplasmosis, herpes simplex
Endocrine disorders: Hypothyroidism, Hypoparathyroidism, Diabetes mellitus
Physical damage and disorders: Injury, Hypoxia, Radiation, Hypertension, Anemia,
Emphysema
Intoxication: Lead, Certain drugs, Substance abuse
Placental dysfunction: Toxemia of pregnancy, Placenta previa, Cord prolapse, Nutritional
growth retardation
Perinatal Factors: Birth asphyxia, Prolonged or difficult birth, Prematurity (due to
complications), Kernicterus, Instrumental delivery (resulting in head injury, intraventricular
hemorrhage)
Postnatal Factors: Infections-Encephalitis, Measles, Meningitis, Septicemia
Accidents
Lead poisoning
Environmental and Sociocultural Factors: Cultural deprivation, Low socioeconomic status,
Inadequate caretakers, Child abuse;

59. Classify Mental retardation and explain the signs and symptoms
Classification of Mental Retardation:
Mild (Educable)-------------------------------- 50-70IQ
Moderate (Trainable)------------------------- 35-50IQ
Severe (Dependent retarded)--------------- 20-35IQ
Profound (Life support)---------------------- Less than 20IQ

60. Explain the prevention of Mental retardation

Prevention of Mental Retardation: Primary, Secondary and Tertiary
Primary Prevention
Preconception
Genetic counseling, which is an attempt to determine risks of occurrence or recurrence of
specific genetic or chromosomal disorders; parents can then make an informed decision as to
the risks of having a retarded child.
Immunization for maternal rubella.
Blood tests for marriage licenses can identify the presence of venereal diseases.
Adequate maternal nutrition can lay a sound metabolic foundation for later childbearing.
Family planning in terms of size, appropriate spacing, and age of parents can also affect a
variety of specific causal agents.
During Gestation
Two general approaches to prevention are associated with this period:
a. Prenatal care
b. Analysis offetus for possible genetic disorders.
61. Explain the care and rehabilitation of mentally retarded child
62. Describe the clinical features of childhood autism
63. Explain the clinical features of Attention deficit hyperactivity disorder
64. Explain the Nursing intervention for child with conduct disorder
65. Explain the management for a child with Enuresis.

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66. .Explain the prevention of mental retardation
67. Explain the role of nurse in managing a child with conduct disorder.
68. Explain in detail about Attention deficit hyperactivity disorder
69. Define autism and explain the various clinical features of childhood autism.
70. Describe specific developmental disorders in children
71. Explain conduct disorders in children
72. Describe Attention Deficit Hyperactivity disorder
73. Explain the nurse’s responsibility caring for a person with attempted suicide
74. Management of person with suicidal tendency
75. Explain the stages of Grief according to Kubler Ross
76. Explain the different types of Crisis
77. Discuss in detail Crisis intervention
78. Discuss the principles and techniques of Crisis intervention
79. Explain the techniques of Crisis intervention
80. Explain the role of a nurse in Crisis intervention
81. Explain crisis intervention
82. Describe grief with its stages
83. Explain stress adaptation model
84. Describe grief process
85. Discuss about management of a patient with suicidal tendency
86. Explain about suicide prevention
Suicide is a type of deliberate self-harm and is defined as an intentional human act of killing oneself.

87. Explain the management of a patient with aggressive behaviour

88. Explain the role of a nurse in Primary prevention of psychiatric illness
89. Explain the objectives and approaches of National Mental Health Programme
90. Explain the role of a nurse in secondary prevention of psychiatric illness
91. Explain the role of a nurse in tertiary prevention of psychiatric illness
92. Explain the role of a nurse in Psychiatric rehabilitation
93. List down the mental health services available for Psychiatric rehabilitation. Explain half way
home
94. Define Community mental health nursing. Explain the goals of community mental health
nursing
95. Explain the nursing management of a patient with HIV/AIDS.
96. Explain the levels of prevention
97. Describe rehabilitation

98.

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SHORT ANSWERS
1. Enlist the members of Mental health team
Multidisciplinary approach/ Mental Health Team refers to collaboration between members of
different disciplines who provide specific services to the patient.
The Mental Health Team includes:
A Psychiatrist
A Psychiatric nurse
A Clinical psychologist
A Psychiatric social worker
An Occupational therapist or an Activity therapist
A Pharmacist and a dietitian
A Counselor

2. Enlist the goals of National Mental Health Program

The National Mental Health Program was launched in 1982 in India and aims to provide
mental health care to the total population within the available resources.
Goals of National Mental Health Program:
Basic mental health care to all the needy especially the poor from rural, slum and tribal
areas.
Application of mental health knowledge in general health care and in social development.
Promotion of community participation in mental health service development and increase
of efforts towards self-help in the community.
Prevention and treatment of mental and neurological disorders and their associated
disabilities.
Use of mental health technology to improve general health services.
Application of mental health principles in total national development to improve quality of
life.

3. Define Mental Health Nursing

It is a specialized area of nursing practice, employing theories of human behavior as it is a
science, and the purposeful use of self as it is an art, in the diagnosis and treatment of human
responses to actual or potential mental health problems.
Psychiatric nursing deals with the promotion of mental health, prevention of mental illness,
care and rehabilitation of mentally ill individuals both in hospital and community.

4. Define Confabulation
Confabulation: The unconscious filling of memory gaps by imagined or untrue experiences
due to memory impairment. It is most often associated with organic pathology.

5. Differentiate Circumstantiality & Tangentiality

Circumstantiality: A pattern of communication that is demonstrated by the speaker's
inclusion of many irrelevant and unnecessary details in his speech before he is able to come to
the point.
Tangentiality: A form of thinking/ speech in which the client tends to wander away from the
intended point, and never returning to the original idea.

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6. Describe Denial with example
Denial: Refusal to accept or believe in the existence of something that is very unpleasant.
For example, an addict takes alcohol every day and he cannot think of a day without it.
However he says "I am not an addict, if I decide I can give up."

7. Describe Projection with example

Projection: Unconscious attribution of one's own attitudes and urges to other persons,
because of intolerance or painful affect aroused by those attitudes and urges. A person who
blames another for his own mistakes is using the projection mechanism.
For example, a surgeon whose patient does not respond as well as he anticipated may tend to
blame the theater nurse who helped the doctor at the time of operation.

8. Differentiate Suppression & Repression with example

Suppression: Suppression is an intentional pushing away from awareness of certain
unwelcome ideas, memories or feelings.
For example, a student consciously decides not to think about her weekend so that she can
study effectively.
Repression: It is a process of unconscious forgetfulness of unpleasant and conflict producing
emotions. Unconsciously excluding from conscious awareness of anxiety provoking ideas
and/or feelings
For example, ‘Forgetting’ and Slips of the tongue

9. Define delusion and list down the types.

10. Describe types of auditory hallucination
11. Define amnesia and its types.
12. Differentiate hallucination and illusion
13. Differentiate echolalia and echopraxia
14. Differentiate Transference & counter transference
15. Explain the types of communication
16. DifferentiateEmpathy and sympathy
17. Define Process Recording and list down the purposes
18. Define Akathesia
19. Define Token economy
20. Describe Aversion therapy
21. Enlist the symptoms of Dystonia
22. Explain Psychodrama
23. Define tardive dyskinesia
24. Define EPS and list down the symptoms of EPS
25. Explain the Components of therapeutic relationship
26. Enumerate the Types of relationship

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27. List down the various techniques of therapeutic communication
28. Explain lithium toxicity
29. Enlist the steps of Systematic desensitization
30. Explain assertive skill training
31. Explain time out
32. Explain the types of family therapy
33. Differentiate restitution and response cost
34. Define therapeutic community
35. List down the indications of ECT
36. List down the contraindications of ECT
37. Explain the types of ECT
38. List down the side effects of ECT
39. Explain the characteristic features of catatonic stupor
40. List down the negative symptoms of schizophrenia
41. List down the symptoms of paranoid schizophrenia
42. Explain the characteristic features of catatonic excitement
43. Enlist 4 A’s of Bleuler
Eugen Bleuler’s Fundamental Symptoms of Schizophrenia (Also called as 4 A’s of Bleuler)
1. Ambivalence: Marked inability to decide for or against
2. Autism: Withdrawal into self
3. Affect disturbances: Disturbances of affect such as inappropriate affect
4. Association disturbances: Loosening of associations; thought disorder

44. Explain the characteristic features of hebephrenic schizophrenia

45. Explain the four stages of elevated mood
46. Differentiate cyclothymia and dysthymia
Cyclothymia refers to a persistent instability in mood in which there are numerous periods of
mild elation or mild depression.
Dysthymia (neurotic/ reactive depression) is a chronic, mild depressive state persisting for
months or years. It is more common in females with an average age of onset in late third
decade. An episode of major depression may sometimes become superimposed on an
underlying neurotic depression. This is known as 'double depression.'

47. List down the classification of BPAD

48. Classify depression
49. Explain depressive cognitions
50. List down the symptoms of hypomania
51. Classify antidepressants with examples
52. List the psychological therapies for depression
53. Enlist the somatic symptoms of depression

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54. Differentiate delirium and dementia
55. Define Alzheimer’s disease
56. Explain the stages of dementia
57. Define vascular dementia
58. Define panic attacks with its characteristic features.
59. Define hypochondriasis
Hypochondriasis: Exaggerated concern with one's physical health, not based on organic
pathology. Hypochondriasis is defined as a persistent preoccupation with a fear or belief of
having a serious disease despite repeated medical reassurance.

60. What are the types of somatoform disorders

These disorders are characterized by repeated presentation with physical symptoms which do
not have any physical basis, and a persistent request for investigations and treatment despite
repeated assurance by the treating doctors.
Types of somatoform disorders:
Somatization disorder
Hypochondriasis
Somatoform autonomic dysfunction
Persistent somatoform pain disorder

61. List down the types of anxiety disorders.

62. Differentiate panic anxiety disorder and generalized anxiety disorders.
63. Enlist the Symptoms of Opioid Use Disorders
64. Explain the procedure of Disulfiram Therapy
65. Define Aversion therapy
Aversion therapy: Pairing of the pleasant stimulus with an unpleasant response, so that even
in absence of the unpleasant response the pleasant stimulus becomes unpleasant by
association. Punishment is presented immediately after a specific behavioral response and the
response is eventually inhibited. Unpleasant response is produced by electric stimulus, drugs,
social disapproval or even fantasy.
Indications: Alcohol abuse, Paraphilias Homosexuality and Transvestism

66. Mention withdrawal symptoms in alcoholic patients.

67. Explain the types of phobia
68. Describe agoraphobia
Agoraphobia: It is characterized by an irrational fear of being in places away from the familiar
setting of home, in crowds, or in situations that the patient cannot leave easily. As the
agoraphobia increases in severity, there is a gradual restriction in normal day-to-day activities.
The activity may become so severely restricted that the person becomes self-imprisoned at
home.

69. Define Obsessive Compulsive Disorder

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 According to ICD9, obsessive-compulsive disorder is a state in which "the outstanding
symptom is a feeling of subjective compulsion - which must be resisted - to carry out some
action, to dwell on an idea, to recall an experience, or ruminate on an abstract topic. Unwanted
thoughts, which include the insistency of words or ideas are perceived by the patient to be
inappropriate or nonsensical. The obsessional urge or idea is recognized as alien to the
personality, but as coming from within the self.Obsessional rituals are designed to relieve
anxiety, e.g. washing the hands to deal with contamination. Attempts to dispel the unwelcome
thoughts or urges may lead to a severe inner struggle, with intense anxiety."

70. Explain exposure and response prevention technique in Obsessive Compulsive Disorder
71. Explain thought stoppage in Obsessive Compulsive Disorder
72. Enlist the symptoms of post-traumatic stress disorder
73. Enlist the types of dissociative disorder
74. Explain dissociative fugue
Dissociative Fugue: Psychogenic fugue is a sudden, unexpected travel away from home or
workplace, with the assumption of a new identity and an inability to recall the past. The onset
is sudden, often in the presence of severe stress. Following recovery there is no recollection of
the events that took place during the fugue. The course is typically a few hours to days and
sometimes months.

75. Define conversion disorder and enlist the types.

Dissociative (conversion) disorders: Conversion disorder is characterized by the presence
of one or more symptoms suggesting the presence of a neurological disorder that cannot be
explained by any known neurological or medical disorder. Instead, psychological factors like
stress and conflicts are associated with onset or exacerbation of the symptoms. Patients are
unaware of the psychological basis and are thus not able to control their symptoms.
Types:
disso
76. Explain dissociative identity disorder
Multiple Personality Disorder /Dissociative Identity Disorder
In this disorder, the person is dominated by two or more personalities of which only one is
manifest at a time. Usually one personality is not aware of the existence of the other
personalities. Each personality has a full range of higher mental functions and performs
complex behavior patterns. Transition from one personality to another is sudden, and the
behavior usually contrasts strikingly with the patient's normal state.

77. Enlist the symptoms of Korsakoff’s syndrome

Korsakoff's syndrome is a chronic phase of amnestic syndrome is caused by Thiamine
deficiency due to chronic alcoholism.
Symptoms:
Gross memory disturbance.
Disorientation
Confusion
Confabulation

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 Poor attention span and distractibility
Impairment of insight

78. What are the types of somatoform disorders?

These disorders are characterized by repeated presentation with physical symptoms which do
not have any physical basis, and a persistent request for investigations and treatment despite
repeated assurance by the treating doctors.
Types of somatoform disorders:
Somatization disorder
Hypochondriasis
Somatoform autonomic dysfunction
Persistent somatoform pain disorder

79. Enlist the characteristics of Wernicke’s syndrome

Chronic alcohol abuse associated with thiamine (vitamin 'B') deficiency is the most frequent
cause of amnestic disorders.
Symptoms of Wernicke's syndrome:
Prominent cerebellar ataxia
Palsy of the 6th cranial nerve
Peripheral neuropathy
Mental confusion.

80. List down the commonly used psychotropic substances.

81. Define obsessional thoughts.
List the common types of obsessional thoughts content.
82. Define Alcoholic Anonymous group
Alcoholics Anonymous (AA): This is a self-help organization founded in the USA by two
alcoholic men, Dr. Bob Smith and Bill Wilson, a stockbroker on the 10th of June, 1935. It has
since then spread to many countries in the world. AA considers alcoholism as a physical,
mental and spiritual disease, a progressive one, which can be arrested but not cured. Members
attend group meetings usually twice a week on a long-term basis. Each member is assigned a
support person from whom he may seek help when the temptation to drink occurs. In crisis he
can obtain immediate help by telephone. Once sobriety is achieved he is expected to help
others.

83. Define simple phobia with examples.

Phobia is an unreasonable fear of a specific object, activity or situation.
Simple phobia (Specific phobia): Simple phobia is an irrational fear of a specific object or
stimulus. Simple phobias are common in childhood. By early teenage most of these fears are
lost, but a few persist till adult life. Sometimes they may reappear after a symptom-free period.
Exposure to the phobic object often results in panic attacks.
Examples of some specific phobias:
Acrophobia-fear of heights
Hematophobia-fear of the sight of blood
Claustrophobia-fear of closed spaces

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 Gamophobia-fear of marriage
Insectophobia-fear of insects
AIDSphobia-fear of AIDS

84. Define narcisstic personality disorder

Narcissistic personality disorder is one of several types of personality disorders.
It is a mental condition in which people have an inflated sense of their own importance, a deep
need for excessive attention and admiration, troubled relationships, and a lack of empathy for
others.

85. List down the features of sociopathic personality

Features of Sociopathic Personality:
Failure to sustain relationships
Disregard for the feelings of others
Impulsive actions
Low tolerance to frustration
Tendency to cause violence
Lack of guilt
Failure to learn from experience

86. Define gender identity disorder and its types

Gender Identity Disorder: The disorders, where the sense of one's masculinity or femininity
is disturbed. Types:
Transexualism
Gender identity disorder of childhood.
Dual-role transvestism.
Intersexuality

87. List down the characteristics of bulimia nervosa

Bulimia Nervosa Bulimia nervosa is described as repeated bouts of overeating and a
preoccupation with control of weight that leads to self-induced vomiting.
Characteristics
An irresistible craving for food: There are episodes of overeating in which large amount of
food are consumed within short periods of time (eating binges)
Attempt to counteract the effects of overeating by self-induced vomiting
There is usually no significant weight loss

88. Define pedophilia

Pedophilia is a sexual disorder which is characterized by persistent or recurrent involvement
of an adult in sexual activity with prepubertal children.

89. Differentiate sexual sadism and masochism

Sexual sadism: The person is sexually aroused by physical and psychological humiliation,
suffering or injury of the sexual partner.
Sexual masochism: Here the person is sexually aroused by physical or psychological
humiliation or injury inflicted on self by others
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90. Differentiate transexualism and transvestism
Transexualism is a persistent and significant sense of discomfort regarding one's anatomic
sex and a feeling that it is inappropriate to one's perceived gender. The person will be
preoccupied with the wish to get rid of one's genitals and secondary sex characteristics and to
adopt the sex characteristics of the other sex.
Transvestism: Sexual arousal occurs by wearing clothes of the opposite sex.

91. Enlist the complications of anorexia nervosa

Anorexia nervosa is characterized by highly specific behavioral and psychopathological
symptoms and significant somatic signs. Majority is females and the onset is during
adolescence. The core psychopathological feature is the dread of fatness, weight phobia and a
drive for thinness.
There is an intense fear of becoming obese.
This fear does not decrease even if the person loses weight grossly and becomes very thin.
The body weight is 15 percent below the standard weight.
There is a body image disturbance.
The patient is unable to perceive the body size accurately.
The pursuit of thinness may take several forms. Patients generally eat little and set
themselves daily calorie limits (often between 600 and 1000 calories). Some try to achieve
weight loss by inducing vomiting, excessive exercise, and misusing laxatives.
Other signs and symptoms are secondary to starvation and include sensitivity to cold,
delayed gastric emptying, constipation, low blood pressure, bradycardia, hypothermia and
amenorrhea in females.
Vomiting and abuse of laxatives may lead to a variety of electrolyte disturbances, the most
serious being hypokalemia.
Hormonal abnormalities also may be seen.

92. Define voyeurism

Voyeurism is a persistent or recurrent tendency to observe unsuspecting persons naked
(usually of the other sex) and engaged in sexual activity.

93. Define parole

Parole' refers to the Informed Consent 'permission given to patients to perform certain rituals
or attend certain family functions. During parole, the patient can leave the hospital any time
and can be brought back forcefully if he does not return within a maximum period of 90 days

94. Explain about leave of absence

On application by a relative or others to the medical officer-in-charge and a bond duly signed
stating that the patient will be taken proper care of and prevented from injuring self or others,
leave of absence may be granted (for a period of maximum 60 days

95. Enlist the legal responsibilities of a mental health nurse.

96. Enlist the types of admission in a psychiatric hospital
97. Enlist the types of discharge in a psychiatric hospital
Discharge of a patient admitted on voluntary basis

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 Discharge of a patient admitted under special circumstances
Discharge of a patient admitted on reception order
Discharge of a patient admitted by police
Discharge of a mentally ill prisoner

98. List down the objectives of Mental health act

99. Explain nursing malpractice.
100. Describe informed consent.
101. Describe admission on reception order
102. Describe admission not on reception order
103. Explain McNaughten’s rule
104. Explain testamentary capacity
105. Enlist basic rights of mentally ill
106. Describe Durham’s rule
107. Describe product rule
108. Enlist the civil responsibilities of a mentally ill person

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