SHORT ESSAY

Unit I& II
1.Discuss Multidisciplinary team or Mental
health team.
Multidisciplinary approach refers to collaboration between members of
different disciplines who provide specific services to the patient. The
multidisciplinary 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 dietician
• A Counsellor
A ) A Psychiatrist is a medical doctor with special training in psychiatry.
He is accountable for the medical diagnosis and treatment of patient.
Other important functions are:
• 😊Admitting patient into acute care setting
• 😊Prescribing and monitoring psychopharmacologic agents
•😊 administering electroconvulsive therapy (ECT) .
• 😊Conducting individual and family therapy.
• 😊Participating in interdisciplinary team meetings

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B) A Psychiatric nurse is a registered nurse with specialized training in
the care and treatment of psychiatric patients; she may have diploma,
MSc.,M.Phil. / Ph.D. in psychiatric nursing.
Functions include:
• 😊 Administering and monitoring medications.
• 😊Assisting in numerous psychiatric and physical treatments.
• 😊Participate in interdisciplinary team meetings.
•😊 Teach patients and families.
.😊Take responsibility for patient's records.
•😊 Act as patient's advocate.
C )A Clinical psychologist: should have a Masters Degree in Psychology
/Ph. D in clinical psychology with specialized training in mental health
settings. He/she is accountable for psychological assessments, testing,
and treatments. He/she offers direct services such as individual family
or marital therapies.
D )A Psychiatric social worker should have a Masters Degree in Social
Work or Ph.D. degree with specialized training in mental health
settings. He is accountable for family case work and community
placement of patients. He conducts group therapy sessions.
E )An Occupational therapist or an Activity therapist is accountable for
recreational, occupational and activity programs. Help them cope more
effectively to gain or retain employment, to use leisure time.
F )A Counsellor provides basic supportive counselling and assists in
psycho educational and recreational activities.

2. Enlist the objectives of national mental

health programme

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NATIONAL MENTAL HEALTH PROGRAMME (INDIA)
Mental health is an integral component of health, INDIA which is
defined as a “positive state of well-being physical, mental and social
and not merely an absence of illness”, With this aim in mind, an expert
group was formed in 1980. The final draft was submitted to the Central
Council of Health and Family Welfare (the highest policy making body
for health in the country) on 18-20 August 1982, which recommended
its implementation objectives
😊To regulate admission into psychiatric hospitals and psychiatric
nursing protect society from the presence of mentally ill persons.
😊 To protect citizens from being detained in psychiatric hospitals
nursing homes without sufficient cause.
😊 To regulate maintenance charges of psychiatric hospitals/nursing
homes.
😊To provide facilities for establishing guardianship of mentally ill
persons who are incapable of managing their own affairs.
😊 establish central and state authorities formental health services.
😊 To regulate the powers of the government for establishing,
licensing and controlling psychiatric hospitals/nursing homes.
😊 To provide legal aid to mentally ill persons at state expense in
certain cases. The Act contains 10Chapters.
-To encourage application of mental health knowledge in general
health care and in social development.
.😊To promote community participation in the mental health service
development and to stimulate efforts towards self-help in the
community

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3. Discuss the Nature & scope of mental health
nursing
NATURE OF MENTALHEALTHNURSING
Psychiatric nursing is a profession, possessing its unique history,
ideology, knowledge and skills. It provides services to individuals whose
primary health needs are related to mental, emotional and
developmental problems, especially Serious disorders and persistent
disabilities. Is Committed to the maintenance, promotion and
restoration of optimal mental health for Individual, families, community
groups and Society through the use of therapeutic relationships and
interventions.
Psychiatry nursing is a specialized area nursing practice, employing the
wide range of explanatory theories of human behaviour as its Science
and purposeful use of self as its are(American Nurses Association, 2000)
.Psychiatric nursing is both an art and science During actual practice,
the art of caring professionally embodied in a therapy alliance and that
develops between the nurse and patient, and is referred to as the nurse
patient relationship. The alliance is a vehicle for the patient to learn and
practice skills for the purpose of gaining insight, effecting change
healing mental and emotional wounds an promoting growth. The
science of psychiatric nursing includes understanding and use of
principles of nursing on all levels. In addition, there is required
commitment to remain current in knowledge and to practice all learned
skills and procedure that ensure patient safety and well being

Scope OF MENTAL HEALTH NURSING

The areas of concern for the psychiatric mental health nurse include a
wide range of actual or potential mental health problems, such as
emotional stress or crisis, self-concept changes, developmental issues,
physical symptoms that occur with psychological changes, and
symptom management of patient with mental disorders. To understand

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the problem and select an intervention, integration of knowledge from
the biological, psychological social domain is necessary. Today is the
scope of mental health nursing is not restricted within the continues of
the 'bedside nursing care. A mental health nurse needs to be skilled
and clinically competent, sensitive to the social Environment the
advocacy needs of the patients and their families as well as be aware of
the ligament, a and ethical.

4. Explain the factors affecting the level of

nursing practice.
FACTORS AFFECTING LEVEL OF NURSING PRACTICE
The level at which psychiatric nurses practices determined by various
factors such as:
😊Nurse practice acts (Laws).
☺️ Professional practice standards
😊.educational qualification and experience.
😊Health care organization's philosophy
😊Self motivation and personal initiatives.
Nurse practice acts regulate entry into the profession and define the
legal limits of nursing practice that must be adhered to by all nurses.
Nurses must be familiar with the nurse practice act of their state and
limit their practices accordingly.
Professional practice standards define nursing practice and
performance; first developed by the ANA in 1973 and recently revised
in 2000.
Nurses qualifications include education, work experiences and
certification status which determine the level of practice. The ANA has
identified two levels of psychiatric nurses(Box1.5)

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.A health care organization's philosophy of mental health and mental
illness and its approach towards treatment help to share expectations
of both the nurse and patient.
The personal competence and initiative of the individual nurse
determine one's interpretation of the nursing role and the success of its
implementation. Other personal factors which influence the nurse's
level of performance is -willingness to act as an agent of change,
thorough knowledge of personal strength and weakness, realization of
clinical competence.

5. Discuss the concept of normal & abnormal

behaviour.
CONCEPTS OF NORMAL AND ABNORMAL BEHAVIOR
Psychiatry as evident from the above is concerned with abnormal
behaviour in its broadest sense, but defining the concepts of normal
and abnormal behaviour as such has been found to be difficult. These
concepts are much under the influence of sociocultural factors.
Several models have been put forward in order to explain the concept
of normal and abnormal behaviour. Some of them are:
Medical Model
Medical model considers organic pathology as the definite cause for
mental disorder. According to this model abnormal people are the ones
who have disturbances in thought, perception and psychomotor
activities. The normal are the ones who are free from these
disturbances.
Statistical Model
It involves the analysis of responses on a tester a questionnaire or
observations of some particular behavioural variables. The degree of
deviation from the standard norms arrived at statistically, characterizes

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the degree of abnormality. Statistically normal mental health falls
within two standard deviations (SDs) of the normal distribution curve.
Sociocultural Model
The beliefs, norms, taboos and values of a society have to be accepted
and adopted by individuals. Breaking any of these would be considered
as abnormal. Normalcy is defined in context with social norms
prescribed by the culture. Thus cultural background has to be taken
into account when distinguishing between normal and abnormal
behaviour.
Behaviour Model
Behaviours that is adaptive, is normal, maladaptive is abnormal.
Abnormal behaviour is a set of faulty behaviours acquired through
learning.

6. Explain the functions of mental health nurse in various settings.

7.Explain Mental health act

The act was divided into 4 parts and 8chaptersconsisting of 100
sections. The enactment of Indian Lunacy Act of 1912 was followed d
by opening of many new asylums, an improvement in the general
conditions ot asylums and an increase in awareness regarding the
prevailing situation of lunatics in such asylums
in 1946, the Bhore committee submitted its recommendations. The
Indian psychiatric society, established in January 1947, was quick to
react to the recommendations of Bhore committee. In January 1919 an

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adhoc draft in committee was appointed which consist of distinguished
psychiatrists, they prepared draft bill is called as national Mental Health
Act which was redrafted and final1zed in January 1950 and forwarded
to the Government of India. After 37 years the Mental Health Act
(MHA) 1987was finally passed by the Lok Sabha on 19thmarch 1987.
Later, the Government of Indiaissued orders that the act came into
force with effect from April 1, 1993 in all the states and unionterritories
of India. It is an "act to consolidate and aimed the law relating to the
treatment and care of mentally ill persons, to make better provision
with respect to their property and affairs and for matters connected
those with or incidental there to". The Actis divided into 10 chapters
consisting
of 98 sections.

8. Discus factors influencing abnormal behaviour.

9.Explain the current trends in Mental health

nursing
A psychiatric nurse faces various challenges because of changes in
patient care approach. Some of these changes that affect the role are
as follows:
Demographic Changes
• Type of family (increased number of nuclear families)
• Increasing number of the elderly group

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Social Changes
• The need for maintaining intergroup and intragroup loyalties
• Peer pressure
Economic Changes
• Industrialization
• Urbanization
• Raised standard of living
Changes in Illness Orientation
Shift from illness to prevention (modification of style), specific to
holistic, quantity of care to quality of care
Changes in Care DeliveryCare
delivery is shifted from institutional services to community services,
genetic services to counselling services, nurse-patient relationship to
nurse-patient partnership.
Technological Changes
• Mass media
• Electronic systems
• Information Technology
Consumer Enmpowerment
. 😊consumer awareness.
😊Awareness of the community in early detection and treatment of
mental illness as well As proper utilization of available psychiatric
hospitals.
😊Patients are health care consumers demanding quality health care
services at affordable cost with less restrictive and more human Rates.
Deinstitutionalization

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😊Bringing mental health patients out of the hospital and shifting care
to community.

Physician Shortage and Gaps in Service

Physician shortage can provide the opportunity for w roles r example,
nurse practitioner. In respect to gaps in services,
Mental Health Care Changes
• Increased awareness in the public regarding mental health
• Need to maintain mental stability
• Increased mental health problems The above changes set the current
trends in mental health care. Some of these are:

10.Explain the characteristics of Mentally

healthy personCharacteristics of a Mentally
Healthy Person
• He has an ability to make adjustments.
• He has a sense of personal worth, feels worthwhile and important.
• He solves his problems largely by his own effort and makes his own
decisions.
• He has a sense of personal security and feels secure in a group, shows
understanding of other people's problems and motives.
• He has a sense of responsibility.
• He can give and accept love.
• He lives in a world of reality rather than fantasy.
• He shows emotional maturity in his behaviour, and develops a
capacity to tolerate frustration and disappointments in his daily life.
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• He has developed a philosophy of life that gives meaning and purpose
to his daily activities.
• He has a variety of interests and generally lives a well-balanced life of
work, rest and recreation.

11.Explain the Factors affecting mental illness

Many factors are responsible for the causation of mental illness. These
factors may predispose an individual to mental illness, precipitate or
perpetuate the mental illness.
Predisposing Factors
• Genetic make up
• Physical damage to the central nervous system
• Adverse psychosocial influenare Precipitating Factors
• Physical stress
• Psychosocial stress
Perpetuating Factors
These factors are responsible for aggravating or prolong in stress
diseases already existing in an individual. Psychosocial stress is an
example.
Thus etiological factors of mental illness can be:
• Biological factors
• Physiological changes
• Psychological factors
• Social factors
Biological Factors
Heredity

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Studies have shown that three-fourths of mental defectives and one-
third of psychotic individuals owe their condition mainly to
unfavourable heredity.

Biochemical Factors
Biochemical abnormalities in the brain are psychological disorders.
Disturbance in neurotransmitters in the brain is found to play an
important role
Brain Damage
Any damage to the structure and functioning of the brain can give rise
to mental illness. Damage to the structure of the brain may be due to
one of the following causes:
😊 Infection:
😊Injury
😊Intoxication
😊Tumor
• 😊Degenerative diseases: Dementia
😊 Endocrine disturbances: Hypothyroidism
😊Vitamin deficency
😊Malnutrition
Physiological Changes
It has been observed that mental disorders aremore likely to occur at
certain critical periods of life namely-puberty, menstruation,
pregnancy, delivery, puerperium and climacteric
Psychological Factors

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•😢strained interpersonal relationships at home, place of work, school
or college, bereavement, loss of prestige, loss of job, etc.
• 😢Childhood insecurities due to parents Social and recreational
deprivations resulting in boredom, isolation and alienation.
• 😢Marriage problems
😢Sexual difficulties
😢Stress ,frustration
Social Factors
• Poverty, unemployment, injustice, insecurity, migration, urbanization
• Gambling, alcoholism, prostitution, broken homes, divorce, very big
family, religion, traditions, political upheavals and other social crises

12.Explain the Standards psychiatric nursing

The purpose of Standards of Psychiatric and Mental Health Nursing
practice is to fulfil the profession's obligation to provide a means of
improving the quality of care. The standards presented here are a
revision of the standards enunciated by the Division on Psychiatric and
Mental Health Nursing Practice in 1973.
Professional Practice Standards
Standard I: Theory The nurse applies appropriate theory that is
scientifically sound as a basis for decisions regarding nursing practice.
Standard II: Data Collection
The nurse continuously collects data that are comprehensive, accurate
and systematic. Effective interviewing, behavioural observation,
physical and mental health assessment enable the nurse to reach so
und conclusions and plan appropriate interventions with the client
Standard Ill: Diagnosis

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The nurse utilizes nursing diagnoses and/ or standard classification of
mental disorders to express conclusions supported by recorded
assessment data and current scientific premises.
Standard IV: Planning
The nurse develops a nursing care plan with specific goals and
interventions delineating nursing actions unique to each client's needs.
The nursing care plan is used to guide therapeutic intervention and
effectively achieve the desired outcomes.
Standard V: Intervention
The nurse intervenes as guided by the nursing care plan to implement
nursing actions that promote, maintain or restore physical and mental
health, and prevent illness and effect rehabilitation.
(a) Psychotherapeutic interventions :
Health teaching
Activity if daily living
Somatic therapy
Therapeutic environment
Psychotherapy
Standard VI: Evaluation
The nurse evaluates client responses to nursing actions in order to
revise the data Professional Performance Standards
Standard VII: Peer Review
The nurse participates in peer review and other means of evaluation to
assure quality of nursing care provided for clients.
Standard VIII: Continuing Education
The nurse assumes responsibility for continuing education and
professional development and contributes to the professional growth
of others.
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Standard IX: Interdisciplinary Collaboration
The nurse collaborates with other health care providers in assessing,
planning, implementing and evaluating programs and other mental
health activities.
Standard X: Utilization of Community Health Systems:
The nurse participates with other members of the community in
assessing, planning, implementing and evaluating mental health
services
Standard XI: Research
The nurse contributes to nursing and the mental health field through
innovations in theory and practice and participation in research

13. Explain the Principles of Mental Health

Nursing
These principles are based on the concept that each individual has an
intrinsic worth and dignity and has potentialities to grow.
1. Patient is Accepted Exactly as He is
2. Use Self-understanding as a Therapeutic Tool
3. Consistency is used to contribute to Patient's Security.
4. Reassurance should be given in a Subtle and Acceptable Manner
5. Patient's Behaviour is changed through Emotional Experience and
not by Rational Interpretation
6. Unnecessary Increase in Patient's Anxiety should be Avoided
7. Objective Observation of Patient to Understand his Behaviour
8. Realistic Nurse-Patient Relationship
9. Avoid Physical and Verbal Force as Much as Possible

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10.Nursing Care is Cantered on The Patient as a Person and not on
the Control of Symptoms
11.All Explanations of Procedures and other Routines are Given
According to the Patient's Level of Understanding
12. Many Procedures are modified but Basic Principles Remain
Unaltered.
1. Patient is Accepted Exactly as He is
Accepting means being non-judgmental. Acceptance conveys the
feeling of being loved and cared A nurse should be able to convey to
the patient that she may not approve everything what he does, but he
will not be judged or rejected because of his behaviour.
Acceptance is expressed in the following ways:
(a) 🔴Being Non-judgmental and Non-punitive
The patient's behaviour is not judged as right or wrong, good or bad.
Patient is not punished for his undesirable behaviour.
(b) 🔴Being Sincerely Interested in the Patient
(c)🔴 Recognizing and Reflecting on Feelings
which Patient may Express When patient talks, it is not the content that
is important to note, but the feeling behind the conversation, which has
to be recognized and
reflected.
(d)🔴 Talking with a Purpose
(e) 🔴Listening
Listening is an active process. The nurse should take time and energy to
listen to what the patient is saying. She must be a sympathetic listener
and show genuine interest.
2. Use Self-understanding as a Therapeutic Tool

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A psychiatric nurse should have a realistic self-concept and should be
able to recognize one's own feelings, attitudes and responses. Her
ability to be aware and to accept her own strengths and limitations
should help her to see the strengths and limitations in other people too
3. Consistency is used to Contribute to Patient's Security
This means that there should be consistency in the attitude of the staff,
ward routine and in defining the limitations placed on the patient

4. Reassurance should be given in a Subtle and Acceptable Manner

Reassurance is building patient's confidence. To give reassurance, the
nurse needs to understand and analyse the situation as to how it
appears to the patient.
5. Patient's Behavior is Changed through Emotional Experience and
not by Rational Interpretation
Major focus in psychiatry is on feelings and not on the intellectual
aspect. Advising or rationalizing with patients is not effective in
changing behaviour. Role-play and socio-drama are a few avenues of
providing corrective emotional experiences to a patient and facilitating
insight into his own behaviour
6. Unnecessary Increase in Patient's Anxiety should be avoided Like ,
• Showing nurse's own anxiety.
• Showing attention to the patient's deficits.
• Making the patient to face repeated failures.
• Placing demands on patient which he obviously cannot meet
7. Objective Observation of Patient to Understand his Behavior

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Objectivity is an ability to evaluate exactly what the p Maintain patient
wants to say and not mix up one's own feelings, opinion or judgment
8. Realistic Nurse-Patient Relationship Realistic or professional
relationship focuses upon the personal and emotional needs of the
patient and not on nurse's needs.
9. Avoid Physical and Verbal Force as Much as Possible.
10.Nursing Care is Centred on the Patient as a Person and not on the
Control of Symptoms
Analysis and study of symptoms is necessary to reveal their meaning
and their significance to the patient. Two patients showing the same
symptoms may be expressing two different needs.
11.All Explanations of Procedures and other Routines are Given
According to the Patient's Level of Understanding
The extent of explanation that can be given to a patient depends on his
span of attention, level of anxiety and level of ability to decide.
12.Many Procedures are Modified but Basic Principles Remain
Unaltered

14.Explain Behavioural Mode

BEHAVIORAL MODEL
Prominent theorists of behavioural theory include Ivan Pavlov, John
Watson, BFSkinner, etc.
Basic assumptions of behavioural model are:
• All behaviour is learnt (adaptive and maladaptive).
• All behaviour occurs in response to a stimulus.
• Human beings are passive organisms that can be conditioned or
shaped to do anything if correct responses are rewarded or reinforced.

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• Maladaptive behaviour can be unlearnt and replaced by adaptive
behaviour if the person receives exposure to specific stimuli and
reinforcement for the desired adaptive behaviour.
• Deviations from behavioural norms occur when undesirable
behaviour has been reinforced. This behaviour is modified through
application of learning theory.
Therapeutic Approaches
• Systematic desensitization
• Token reinforcement
• Shaping
• Chaining
• Prompting
• Flooding
• Aversion therapy
• Assertiveness and social skills training
Roles of the Patient and the Behaviora Therapist
The approach is that of a learner and a teacher.
Therapist
The therapist is an expert in behavior therapy who helps the patient
unlearn his symptoms and replace them with more satisfying behavior.
• The therapist uses the patient's anxiety as a motivational force
towards learning
Patient
• As a learner the patient is an active participant in the therapy process.
• Patient practises behavioral techniques.
• Does homework and reinforcement exercise

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Application to Nursing
Nurses commonly use behavioral techniques in a wide variety of mental
health settings. Additionally, nurses who work with clients having
physical disability, chronic pain, chemical dependency and
rehabilitation centers also apply these techniques.

15.Explain Interpersonal Model

INTERPERSONALMODEL
Harry SSullivan isthe originator ofinterpersonal relations theory. Basic
assumptions of interpersonal model are:
• Human being are essentially social beings.
• Human personality is determined in the Context ofsocial interactions
with other human beings.
• Anxiety plays a central role in the formation ofhuman personality by
serving as a primary motivator of human behavior. Especially, anxiety is
important in building self-esteemand enabling a person to learn from
their life experiences.
• Self-esteem is an important facet of human personality that forms in
reaction to the experience of anxiety. Security mechanisms are used to
reduce or avoid the experienceof anxiety
• Human development proceeds through six stages of development:
infancy, childhood, juvenility, pre-adolescence, early adolescence and
late adolescence. According to interpersonal theory, juvenile and
preadolescent stageshold the greatest potential for correction of
previous behavior and personality difficulties.
Interpersonal Therapeutic Process
The interpersonal therapist, like the psychoanalyst, explores the
patient's life history The process oftherapy is essentially a process of re-
education as the therapist helps the patient identify interpersonal

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problems and then encourages him to try out more successful styles
ofrelating.
Therapy is terminated when the patient has developed the
ability to establish satisfying human relationships thereby meeting his
basic needs.
Roles of the Patient and the Interpersonal Therapist
Sullivan describes the therapist as a participant observer, who should
not remain detached from the therapeutic situation. The therapist's
role is to actively engage the patient to establish trust and to
empathize. He will create an atmosphere of uncritical acceptance to
encourage the patient to speak openly.
The patient's role is to share his concerns with the
therapist and participate in the relationship to the best of his ability

Application to Nursing
Sullivan's interpersonal theory has been the cornerstone ofpsychiatric-
mental health nursing curricula in the undergraduate and graduate
levels.

16.psychopathology in mental disorder

PSYCHOPATHOLOGY OF MENTAL DISORDERS
Psychopathology is a term which refers to either the study of mental
illness or mental distress, or the manifestation of behaviors and
experiences which may be indicative of mental illness or psychological
impairment, such as abnormal, maladaptive behavior or mental activity
(Atkinson, L et al. (2004). It is that branch of psychiatry, which deals
with the study of manifestation of behaviors and experiences,
indicative of mental illness. The term psychopathology may also be
used to denote behaviors or experiences which are indicative of mental
illness, even if they do not constitute a formal diagnosis.
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17. Classify Mental Disorders according to ICD -10

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18.Explain Psycho-analytical model
Psychoanalytical model has been derived from the work of Sigmund
Freud and his followers.
• All human behavior is caused and thus is capable of explanation.
Human behavior, however insignificant or obscure, does not occur

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randomly or by chance. Rather, all human behavior is determined by
prior life events.
• All human behavior from birth to old age is driven by an energy called
the libido.The goal ofthe libidoisthe reduction oftension through the
attainment ofpleasure.Thelibidois closely associated with physiological
or instinctual drives (e.g., hunger, thirst, elimination andsex).
• The personality of the human being can be understood byway
ofthreemajorhypothetical structures, viz. id, ego and superego. Id
represents the most primitive structure ofthehuman personality.
• The ego represents that part of the human personality, which is in
closest contact with reality
• The superego is the personality structure containing the values, legal
and moral regulations and social expectations that free expression of
pleasure-seeking behaviors. The superego thus functions to oppose the
id
Psychoanalytical Process
Psychoanalysis, described by Freud, makes use of free association and
dream analysis to affect reconstruction of personality. Free association
refers to the verbalization of thoughts as they occur,without any
conscious screening. Analysis of the patient's dreams helps to gain
additional
insight into his problem and the resistances. Thus dreams symbolically
communicate areas of intrapsychic conflict.
The patient is an active participant, freely revealing all thoughts
exactly as they occur and describing all dreams. By termination of
therapy, the patient is able to conduct his life
Roles of the Patient and the Psychoanalyst
The patient is to be an active participant, freely revealing all thoughts
exactly as they occur and describing all dreams. The psychoanalyst is a

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shadow person; while the patient is expected to reveal all his thoughts
and feelings, the analyst reveals nothing personal.
Application to Nursing
This theoretical perspective has helped mental health professionals to
understand psychopathology and stress related behaviors. More
importantly, this theory illustrates the importance of not taking human
behavior at face value. an accurate assessment of external reality

19.Explain Existential model

Existential Mode!
The existential model centers on a persOn's present experiences rather
than his past ones. The theorists who particularly emphasized the
importance of existential model are Perls, Glasser, Ellis, Rogers, Frankl
.Roles of Patient and Therapist
Patient participates in meaningful experiences to learn about real self.
Therapist helps patient recognize value of self, clarify realities of
situation and explore feelings
Applications
to Nursing .Based on the existential model of behavior,nursing
developed the concept that the nurse works to restore the patient to a
state of 'full life",from a state of self-alienation.

20.Define Defense mechanism. Enlist the

various defence mechanisms with an example
each.
DEFENSE MECHANISMS
Coping is the way one adapts to a stressor psychologically, physically
and behaviourally. The ego usually copes with anxiety through rational
means. When anxiety is too painful, the individual copes by using
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defence mechanisms to protect the ego and diminish anxiety. Defense
mechanisms are methods of attempt to protect self and cope with
basic drives or emotionally painful thoughts, feelings or events.
1. Repression: unconscious or involuntary forgetting painful idea.
Eg .forgetting a loved once birthday after a fugh
2. Denial:
3. Displacement: a husband comes home after a bad day at work and
yells at his wife
4. Reaction formation: A jealous boy who hates his elder brother
unacceptable feelings with their exact may show him exaggerated
respect and opposite’s affection towards him
5. Rationalization: A student who fails in the examination may
Individual justifies his failures and socially complain that the hostel
atmosphere is not unacceptable behavior by giving socially favorable
and has resulted in his failure approved reasons
6. Sublimation: Aggressiveness might be transformed into
competitiveness in business or sports
7 Compensation: A student who fails in his studies may compensate by
becoming the college champion in athletics
8. Projection: For instance, you might hate someone, but your
superego tells you that such hatred is unacceptable. You can
'solve' the problem by believing that they hate you.
9. Intellectualization: a person no emostional expresson when talking
about a serious car accident
10. Undoing: give a treat to a child who is being punished for a wrong
doing .
11. Regression: A child may begin to suck their thumb again or
wet the bed when they need to spend some time in the hospital.

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21. Explain the aetiology of mental disorders.(study n make note)

SHORT ANSWERS

UNIT I & II- GENERAL CONCEPTS OF PSYCHIATRIC NURSING

1.Enlist the members of Mental health team
Multidisciplinary approach refers to collaboration between members of
different disciplines who provide specific services to the patient. The
multidisciplinary 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
Aims/goals:
1. Prevention and treatment of mental neurological disorders and their
associated disabilities.
2. Use of mental health technology to improve general health services.
3. Application of mental health principles in total national development
to improve quality of life.

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 2.Define Mental Health Nursing
PSYCHIATRIC NURSING It is a specialized area of nursing practice,
employing theories of human behavior as it is a scicnce, 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 problenms
(American Nurses Association, 1994).

4. Define Confabulation
Confabulation is the unintentional filling of gaps of memory with
material which is untrue and fanciful. Such recall clhanges from
moment to moment and occurs in clear consciousness where
organically determined amnesias coexist

5. Differentiate circumstantiality and tangentiality

In circumstantiality the thought reaches its ultimate goal in a long and
round about manner - taking too many digression and irrelevant
elaborations on its way. In tangentiality The goal is not reached in
tangentiality where the thought is sidetracked more and more away
from the natural end. Tangentiality is a form of derailment.

6.DescribeDenial with example

:Unconscious refusal to admit an unacceptable idea or behavior.
Usually the first defense learned and used

Example The mother of a child who is fatally ill may refuse to admit
that there is anything wrong even though she is fully informed of the
diagnosis and expected outcome. It is because she cannot tolerate the
pain that acknowledging reality would produce.

28
7. Describe Projection with example: Unconsciously
(or consciously) blaming someone else for one's difficulties

Example
A person who blames another for his own mistakes is using the
projection mechanism. A surgeon whose patient does not respond as
he anticipated, may tend to blame the theater nurse who helped that
surgeon at the time of operation

8 Differentiate Suppression&Repression with

example

29
9.Define delusion and list down the types.
Delusions are defined as fixed false beliefs which are not shared by
others, are out of keeping with one's educational, social and spiritual.

30
Types.
10.Describe types of auditory hallucination
🔴. Elementary auditory hallucinations (i.e. hearing simple sounds
rather than voices)
🔴Thought echo’ (‘ audible thoughts’)
🔴Second person hallucinations :are auditory hallucinations in which a
voice appears to address the patient in the second person.
🔴‘Third person hallucinations’ :(‘voices heard arguing’, discussing the
patient in third person)
🔴‘Voices commenting: on one’s action’.

11.Define amnesia and its types

Amnesia is the partial or total failure to recall past happenings and is
due to disturbances of memory. Defective registration occurs when the
level of consciousness is diminished, person is inattentive, drowsy or
under the effect of drugs like alcohol. lt also occurs in various tesions of
the brain due to trauma, infection, etc

Types
There are two main types of amnesia:
🔴 retrograde amnesia :effect recently formed memory

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.
Examples of Repression A An example of
child suffers abuse by a suppression is a
parent, represses the government stopping
memories, and becomes citizens from participating
completely unaware of in a certain activity
them as a young adult.

12. Differentiate hallucination and illusion.

13. Differentiate echolalia and Echopraxia.

32
UNIT IV & V (LONG ESSAYS)
THERAPEUTIC COMMUNICATION &
TREATMENT MODALITIES

1.Define psychotherapy. Enlist the types of

psychotherapy. Explain the techniques of
behaviour therapy .
Psychotherapy is a form of treatment for patients
suffering from psychological or mental health
issues that affect their ability to function.

Types
There are several kinds of psychological therapies:
Psychoanalytic therapy
🔴 Behavior therapy
🔴Cognitive therapy
🔴 Hypnosis
🔴 Abreaction therapy
🔴Relaxation therapies
🔴Individual psychotherapy
🔴Supportive psychotherapy
🔴Group therapy

33
🔴Family and marital therapy

Behavior Techniques
(A)Systematic desensitization It was developed by Joseph Wolpe,
based on the behavioral principle of counter conditioning. patients
attain a state of complete relaxation and are then exposed to the
stimulus that elicits the anxiety response.
The negative reaction of anxiety is inhibited by the relaxed state, a
process called reciprocal inhibition.
It consists ofthree main steps:
1. Relaxation training
2. Hierarchy construction
3. Desensitization of the stimulus
1. Relaxation training: There are many methods which can be used to
induce relaxation, some of them are:
• Jacobson's progressive muscle relaxation
• Hypnosis
• Meditation or yoga
• Mental imagery
• Biofeedback
2. Hierarchy construction: Here the patient is
asked to list all the conditions which provoke
anxiety. Then he is asked to list them in a
descending order of anxiety provocation.
3. Desensitization of the stimulus: This can either be done in reality or
through imagination. At first,the lowest item in hierarchy is confronted.
The patient is advised to signal whenever anxiety is produced. With
34
each signal he is asked to relax. After a few trials, patient is able to
control his anxiety gradually.
Indications:
🔴Phobias
🔴Obsessions
🔴Compulsions
🔴Certain sexual disorders
B. Flooding:The patient is directly exposed to the phobic stimulus, but
escape is made impossible.
By prolonged contact with the phobic stimulus, the therapist's guidance
and encouragement and his modeling behavior reduce anxiety.
C. 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:
1. Alcohol abuse
2. Paraphilias
3. Homosexuality
4. Transvestism.
D. Operant conditioning proceduresfor increasing adaptive behavior
1. Positive reinforcement: When a behavioral response isfollowed by a
generally rewarding event such as food, praise or gifts, it tends to be
strengthened and occurs more frequently than before the reward.
Thistechnique is used to increase desired behavior.
35
2. Token economy:This program involvesgiving token rewards for
appropriate or desired target behaviors performed by the patient. The
token can later be exchanged for other rewards. .
E. Operant conditioning procedures to teach new behavior
1. Modeling: Modeling is a method of teaching by demonstration, .
2. Shaping: In shaping the components of a particular skill,the behavior
is reinforced step by step. The therapist starts shaping by reinforcing
the existing behavior. Once it is established he reinforcesthe responses
which are closestto the desired behavior, and ignores the other
responses.
3. Chaining: Chaining is used when a person fails to perform a complex
task. The complex task is broken into a number of small steps and each
step is taught to the patient. In forward chaining one starts with the
firststep, goes on to the second step, then to the third and so on. In
backward chaining, one starts with the last step and goes on to the next
step a backward fashion. Backward chaining is found to be more
effective in training the mentally disabled.
Operant conditioning proceduresfor decreasing maladaptive behavior
1. Extinction/Ignoring: Extinction means removal of attention rewards
permanently, following a problem behavior. This is commonly used
when patient exhibits odd behavior.
2. Punishment: Aversive stimulus (punishment) is presented contingent
upon the undesirable response. The punishment procedure should be
administered immediately and consistently
3. Timeout: Timeout method includes removing the patient from the
reward or the reward from the patient for a particular period of time
following a problem behavior. This is often used in the treatment of
childhood disorders.

36
4. Restitution (Over-correction): Restitution means restoring the
disturbed situation to a state that ismuch better than what itwas before
the occurrence ofthe problem behavior.
5. Response cost: This procedure is used with individuals who are on
token programs for teaching adaptive behavior.
G. Assertiveness and social skill training: Assertive training is a
behavior therapy technique in which the patient is given training to
bring about change in emotional and other behavioral pattern by being
assertive. Assertive behavior training is given by the therapist, first by
role play and then by practice in a real life situation. Attention is
focused on more effective interpersonal skills.Social skills training helps
to improve social manners like encouraging eye contact, speaking
appropriately, observing simple etiquette, and relating to people

3. Define therapeutic community. Describe the

components of therapeutic community. Explain the
role of nurse in therapeutic community
Stuart and Sundeen defined therapeutic community as "a therapy in
which patient's social environment would be used to provide a
therapeutic experience for the patient by involving him as an active
participant in his own care and the daily problems of his community.”
Components of Therapeutic Community

1.Daily Community Meetings💗These meetings are composed of 60-90

patients. All levels of unit staff are involved,

including administrative personnel. Acute patients are not involved in

the meetings.

2.Meetings should be held regularly for 60 minutes.🔴 Discussion should

focus mainly on day-today life in the unit.🔴During discussions patients'
feelings and behaviors are examined by other members.🔴Patient
37
Government or Ward Council💗 The purpose of patient government isto
deal with practical unit details such as housekeeping functions, activity
planning and privileges.🔴A group of 5-6patients will have specific
responsibilities, such as house keeping, physical exercise,personal
hygiene, meal distribution, a group to observe suicidal patients, etc.
Staff members should be available always.

• All decisions should be feedback to the community through the

community meetings Staff Meetings or Review A staff meeting should
be held following each community meeting (Patients are excluded and
only staff are present). In this meeting the staff would examine their
own responses, expectations, and prejudices.

Living and Learning Opportunities,Learning opportunities are to be

provided within the social milieu, which should provide realistic

Learning experiences for the patients.

Advantages of Therapeutic Community

1. Patient develops harmonious relationships with other members of

the community.

2. Gains self-confidence.

3. Develops leadership skills.

4. Learns to understand and solve problems of self and others.

5. becomes socio-centric.

6. Learns to live and think collectively with the members of the

community.

7. Lastly therapeutic community provides opportunities to participate

in the formulation of hospital rules and regulations that affect

38
Patient’s personal liberties like bedtime, meal time, weekend
permission, control of radio or TV, social activities, late night privileges,
etc.

Disadvantages of Therapeutic Community

1 Role blurring between staff and patient.

2. Group responsibility can easily become nobody's responsibility.

3. Individual needs and concerns may not be met.

4. Patient may find the transition to community difficult

Role of the Nurse

1. Providing and maintaining a safe and conflict free environment

through role modeling and group leadership.

2. Sharing of responsibilities with patients.

3. Encouraging patient to participate in decisionmaking functions.

4.Assisting patients to assume leadership roles.

5. Giving feedback.

6.Carrying out supervisory functions.

In conclusion, therapeutic community is an approach which is:

• Democratic as opposed to hierarchical.

• Rehabilitative rather than custodial.

• Permissive instead of limited and controlled.

Unit IV& V (short essays)

39
1. Explain Johari Window
The Johari window is a technique that helps people better understand
their relationship with themselves and others The goal of increasing
self-awareness by using the Johari window is to increase the size of the
quadrant that represents the open or public self.
🔴 The individual who is open to self and others has the ability to be
spontaneous and share emotions and experiences with others.
🔴 Increased self-awareness allows an individual to interact With others
comfortably and accept the difference in others and ovserve each
persons right to respect and diginity

🔴In creating a Johari window, the first step is for the nurse to appraise
her own qualities by creating a list of them: values, attitudes, feelings,
strengths, behaviors, accomplishments, needs, desires and thoughts

40
🔴. The second step is to find out the perceptions of others by
interviewing them and asking them to identify qualities, both positive
and negative, they see in the nurse. To learn from this exercise, the
opinions given must be honest.
🔴The third step is to compare lists and to assign qualities to the
appropriate quadrant. If quadrant 1 is the longest list, this indicates
that the nurse is open to others; a smaller quadranf I means that the
nurse shares little about herself with others. If quadrants 1 and 3 are
both small, the person demonstrates little insight. Any change in one
quatrant is reflected by changes in other quadrants. The goal is to work
towards moving qualities from 2, 3 and 4 into quadrant indicates that
the nurse is gaining self-knowledge and awareness.

2.Explain Process Recording

Process recording is the recording of the conversation during the
interaction or the interview between the nurse and the patient in the
psychiatric setup with the nurse's inference. It may be written during
the interaction or immediately after the one-to-one interaction.
Purpose and uses:
The aim of process recording isto improve the quality ofthe interaction
for better effect to the patient and as a learning experience for the
nurse to continuously improve her clinical interaction pattern.
🔴assists the nurse or student to plan
🔴 helps to consciously apply theory to practice;
🔴helps her to develop an increased awareness of her habitual, verbal
and non-verbalcommunication
🔴helps the nurse to learn to identify thoughts and feelings in relation to
self and others;
🔴helps to increase observational skills,
🔴helps to increase the ability to identify problems and gain skills in
solving them;
Thus process recording is a/ an
41
🔴Educative tool
🔴 Teaching tool
🔴 Diagnostic tool
🔴 Therapeutic tool, and a pre-requisite for nursing process

Pre-requisites for Process Recording

1. Physical setting
2. Getting consent of the patient for the possibility of cassette
recording
3.Confidentiality
Suggested Outlines for Process Recording
Introductory Material
🔴This should include a short description of the patient, his name, age,
educational level, health problems and length of stay in the hospital.
🔴The date, time, place of interaction and a short description of the
milieu of the ward immediately prior to the interaction will be helpful in
understanding the thoughts and feelings of the patient.
🔴To understand the patient in a better way, process recording also
includes personal history, family history, socio-economic history,
medical history, present complaints, past psychiatric history if any, and
provisional diagnosis.
Objectives
They can be different on different days of the interview. In the
beginning, setting short-term goals may be more appropriate.
Record of Interaction between Nurse and the Patient
This should include truthful recording of what the nurse said and did
and what the patient said and did, including any non-verbal behavior of
the patient, such as changing the position, looking at various things, eye
contact, biting the nails, pacing, etc.

42
 Analysis of the Interaction
An analysis of the interaction should include the interpretation of the
verbal and non-verbal behavior and patient’s thoughts and feelings as
evident from the process. The nurse’s thoughts and feelings at the end
of the interaction and the plans made for further interactions should be
stated.
.🔴 Total time spent on the recording can be around 30 minutes. The
active time can be 20 minutes, with 10 minutes for conclusion and
recording.

3.Enlist the Signs and symptoms of Lithium

toxicity and management of lithium toxicity
Signs and symptoms of lithium toxicity (serum
🔴 ataxia
🔴 coarse tremor (hand)
🔴nausea and vomiting
🔴 impaired memory
🔴impaired concentration
🔴 nephrotoxicity
🔴 muscle weakness
🔴convulsions
🔴muscle twitching
🔴dysarthria
🔴lethargy
🔴confusion
🔴coma
🔴hyperreflexia
🔴 nystagmus
Management of Lithium Toxicity
💗Discontinue the drug immediately.
43
🔴 Forsignificantshort-term ingestions, residual gastric content should be
removed by induction of emesis, gastric lavage and adsorption with
activated charcoal.
🔴Ifpossible instruct the patient to ingest fluids.
🔴Assess serum lithium levels, serum electrolytes,renal
functions,ECGassoon as possible.
🔴 Maintenance offluid and electrolyte balance.
🔴In a patient with serious manifestations of lithium toxicity,
hemodialysis should be initiated

4.Discuss the Nurses responsibility for a patient

receiving antipsychotics
🔴 Instruct the patient to take sips of water frequently to relieve dryness
ofmouth. Frequent mouth washes, use of chewing gum, applying
glycerine on the lips are also helpful.
🔴 A high-fiber diet, increased fluid intake.
🔴Advise the patient to get up from the bed or chair very slowly.
🔴Check BP before and after medication is given. This is an important
measure to prevent falls and other complications resulting from
orthostatic hypotension.
🔴Differentiate between akathisia and agitation and inform the
physician. A change of drug may be necessary if side-effects are severe.
🔴Administer antiparkinsonian drugs as prescribed.
🔴Observe the patient regularly for abnormal movements.
🔴Take all seizure precautions.
🔴Patient should be warned about driving a car or operating machinery
when first treated with antipsychotics. Giving the entire dose at
bedtime usually eliminates any problem from sedation.
🔴 Advise the patient to use sunscreen measure for photosensitive
reactions.

44
🔴Teach the importance of drug compliance, side-effects of drugs and
reporting if too severe,
🔴regular follow-ups. Give reassurance and reduce unfounded fears and
anxieties.
🔴A patient receiving clozapine is at risk for developing agranulocytosis.
Monitor TC,DC essentially in the first few weeks oftreatment. Stop the
drug if the WBCcount drops to less than 3000/mm3 of blood.
🔴 The patient should also be told to report if sore throat or fever
develop, which might indicate infection.
🔴Seizure precautions should also be taken as clozapine reduces seizure
threshold. The dose should be regulated carefully and the patient may
also be put on anticonvulsants such as option.

5.Explain Behaviour therapy

It is a form of treatment for problems in which a trained person

deliberately establishes a professional relationship with the client, with
the objective of removing or modifying existing symptoms and
promoting positive personality, growth and development.
🔴Behavior therapy is a short duration therapy,
🔴Therapists are easy to train and it is cost-effective.
🔴The total duration oftherapy isusually 6-8weeks. 🔴Initial sessions are
given daily but the later sessions are spaced out.
🔴where the therapist is a shadow person, in behavior therapy both the
patient and therapist are equal participants.

Major Assumptions of Behavior Therapy

💗 All behavior is learned
🔴 Human beings are passive organisms

45
🔴Maladaptive behavior can be unlearned and replaced by adaptive
behavior
🔴 Behavioral assessment is focused more on the current behavior
rather than on historical antecedents.
🔴Treatment strategies are individually tailored.
Behavior Techniques
(A)Systematic desensitization In this patients attain a state of complete
relaxation and are then exposed to the stimulus that elicits the anxiety
response.
It consists ofthree main steps:
🔴. Relaxation training
🔴 Hierarchy construction
🔴Desensitization of the stimulus
B. Flooding:The patient is directly exposed to the phobic stimulus, but
escape is made impossible. By prolonged contact with the phobic
stimulus,The therapist’s guidance and encouragement and his modeling
behavior reduce anxiety.
Indications: Specificphobias
C.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.
Indications:
1. Alcohol abuse
2. Paraphilia’s
3. Homosexuality
4. Transvestism.
D. Operant conditioning procedures for increasing adaptive behavior
1. Positive reinforcement
2. Token economy:
E. Operant conditioning procedures to teach new behavior
1. Modeling: Modeling is a method of teaching by demonstration,
46
2. Shaping: In shaping the components of a particular skill,the behavior
is reinforced step by step. The therapist starts shaping by reinforcing
the existing behavior.
3. Chaining: Chaining is used when a person fails to perform a complex
task.

F. Operant conditioning procedures for decreasing maladaptive

behavior
1. Extinction/Ignoring: Extinction means removal of attention rewards
permanently, following a problem behavior.
2. Punishment: . The punishment procedure should be administered
immediately and consistently following the undesirable behavior with
clear explanation.
3. Timeout:
4. Restitution (Over-correction):
5. Response cost:
G. Assertiveness and social skill training: Assertive training is a
behavior therapy technique in which the patient is given training to
bring about change in emotional and other behavioral pattern by being
assertive.

6. Explain Relaxation therapy

Relaxation produces physiological effects opposite those of anxiety:
slowed heart rate, increased peripheral blood flow and neuromuscular
stability. There are many methods which can be used to induce
relaxation.
🔴Jacobson's Progressive Muscular Relaxation
Patients relax major muscle groups in fixed order, beginning with the
small muscle groups of the feet and working cephalad or vice versa.
🔴Hypnosis
🔴Mental Imagery
47
It is a relaxation method in which patients are instructed to imagine
themselves in a place associated with pleasant relaxed memories.

💗Use of Tape-recorded Exercises or Instructions

Which allows patients to practice relaxation on their own.
🔴Yoga or Meditation
It is concentrating on the spirit by using certain postures to prepare the
body to sit motionless, remain alert and focus on one particular point.
Yoga is highly useful in reducing stress and treating anxiety.
🔴Bio-feedback
Bio-feedback is based on the idea that the autonomic nervous system
can comeunder voluntary control through operant conditioning. Thus it
helps people to control usually involuntary physiological functions so as
to change them, for instance,by relaxing.
Uses of bio-feedback include treatment of enuresis, and treatment of a
host of ailments brought on by stresssuch asmigraine headaches,
tension headaches, idiopathic hypertension, cardiac problems, etc.

7.Enumerate Advantages and disadvantages of

therapeutic community
Stuart and Sundeen defined therapeutic community as "a therapy in
which patient's social environment would be used to provide a
therapeutic experienceforthe patient by involving him as an active
participant in his own care and the daily problems of his community."
Advantages of Therapeutic Community
🔴 Patient develops harmonious relationships with other members ofthe
community.
🔴Gains self-confidence.
🔴 Develops leadership skills.
🔴Learns to understand and solve problems of self and others.
🔴 Becomessocio-centric.
48
🔴Learns to live and think collectively with the members ofthe
community.
🔴Lastly therapeutic community provides opportunities to participate in
the formulation of hospital rules and regulations that affect patient's
personal liberties like bedtime, meal time, weekend permission, control
ofradio or TV,social activities, late night privileges, etc.

Disadvantages of Therapeutic Community

💗 Roleblurring between staff and patient.
🔴Group responsibility can easily become nobody's responsibility.
🔴Individual needs and concerns may not be met.
🔴Patient may find the transition to community difficult

8.Define communication and the techniques

of therapeutic communication
According to Keith Davis: Communication is a process of passing
information and understanding from one person to another.
THERAPEUTIC COMMUNICATION TECHNIQUES
💗Listening: It is an active process of receiving information. Responses
on the part of the non-verbal communication convey to the patient
that he is being listened to and understood.
🔴 Broad openings: Encouraging the patient to select topics for
discussion.
Therapeutic value Indicates acceptance by the nurse and the value of
patient's initiative.
🔴 Restating: Repeating the main thought expressed by the patient.
Therapeutic value Indicates that the nurse is listening and validates,
🔴 Clarification: Attempting to put vague ideas or unclear thoughts of
the patient into words

49
Therapeutic value It helps to clarify feelings,ideas and perceptions of
the patient
🔴. Reflection: Directing back the patient's ideas, feelings, questions and
content.
Therapeutic value Validates the nurse's understanding of what the
patient is saying and signifies empathy, interest and respect forthe
patient.
🔴 Humor: The discharge of energy through comic enjoyment ofthe
imperfect.
Therapeutic value Can promote insight
Informing: The skill of information giving.
Therapeutic value Helpful in health teaching or patient education about
relevant aspects of patient's well-being and self-care.
🔴Focusing: Questions or statements that help the patient expand on a
topic of importance.
Therapeutic value Allows the patient to discuss central issues and keeps
the communication process goal-directed.
🔴Sharing perceptions: Asking the patient to verify the nurse's
understanding of what the patient is thinking or feeling.
Therapeutic value Conveys the nurse's understanding to the patient
and has the potential for clearing up confusing communication.
🔴Theme identification: This involving identification of underlying issues
or problems experienced by the patient
Therapeuticvalue It allows the nurse to promote the patient's
exploration and understanding of important problems.
🔴Silence: Lack of verbal communication for a therapeutic reason.
Therapeutic value Allows the patient time to think and gain insight,
🔴Suggesting: Presentation of alternative ide 🔴Suggesting: Presentation
of alternative ideas for the patient's consideration relative to problem
solving.
Therapeutic value Increases the patient's perceived notions or choices.
50
9.Explain about nurse patient contract
10.Explain about dynamics of therapeutic
nurse patient relationship
🔴Therapeutic use of self
🔴. Gaining self-awareness
🔴 The Johari window
The therapeutic use of self is defined as "the ability to use one's
personality consciously and in full awareness in an attempt to establish
relatedness and to structure nursing inter- ventions.
🔴Peplau (1952) described that nurses must clearly understand
themselves to promote patient's growth, change and heal.
Self awareness is the process of understan- ding one's own beliefs,
thoughts, motivations, biases and limitations and recognizing how they
affect others.
The Johari window is a representation of the self and a tool that can be
used to increase self-awareness.
The Johari window is divided into four quadrants .

The goal of increasing self-awareness by using the Johari window is to

increase the size of the quadrant that represents the open or public
self. The individual who is open to self and others has the ability to be
51
spontaneous and share emotions and experiences with others.
Increased self-awareness allows an individual to interact with others
comfortably, to accept the differences in others and to observe each
person's right to respect and dignity.

11.Explain therapeutic impasses in nurse

patient relationship
Therapeutic impasses are blocks in the progress of the nurse-patient
relationship. Impasses pro- voke intense feelings in both the nurse and
the patient, which may range from anxiety and apprehension to
frustration, love or intense anger.
🔴 Resistance: Resistance is the patient's attempt to remain unaware of
anxiety producing aspects within the self.
🔴Transference: Transference is an unconscious response in which the
patient experiences feelings and attitudes toward the nurse that were
originally associated with significant figures in the patient's early life.
Transference can be positive if patients view the nurse as helpful and
caring. Negative transference is more difficult because of unpleasant
emotions that interfere with treatment such as anger and fear.
🔴Countertransference refers to a specific
emotional response by the nurse towards the patient that is
inappropriate to the content and context of the therapeutic
relationship or inappropriate in its emotional intensity.
Countertransference reactions are usually of three types:
🔴 Reactions of intense love or caring,
🔴reactions of intense hostility or hatred
🔴 reactions of intense anxiety often in response to a patient's resistants

52
💗Boundary violation: Occurs when a nurse goes outside the boundaries
of the therapeutic relationship and establishes a social, eco- nomic or
personal relationship with a patient

12.Explain group therapy

Group psychotherapy is a treatment in which carefully selected people
who are emotionally ill meet in a group guided by a trained therapist,
and help one another effectpersonality change.
Selection
💗Homogeneous groups
🔴Adolescents and patients with personality disorders
🔴 Families and couples where the system needs change
Contraindications
🔴 Antisocial patients
🔴 Actively suicidal or severely depressed patients
🔴Patients who are delusional and who may incorporate the group into
their delusional system
Group Size
Optimal size for group therapy is 8 to 10 members. Most group
psychotherapists conduct group sessions once a week; each session
may last for 45minutes to 1hour.
Approaches to Group Therapy
💗The therapist's role is primarily that of a facilitator; he should provide
a safe,comfortable atmosphere forself-disclosure
🔴Focus on the "here and now"
🔴 Use any transference situations to develop insight into their problems
🔴Protect members from verbal abuse

🔴provide positive reinforcement,

🔴 Handle circumstantial patients,
🔴Develop ability to recognize when a group member is" fragile";
53
🔴• Use silence effectively to encourage introspection and facilitate
insight
🔴Laughter and a moderate amount of joking can act as a safety valve
and at times can contribute to group cohesiveness
🔴Role-playing may help a member develop insight
Therapeutic Factors Involved in Group Therapy
These involve
🔴sharing experiences
🔴support to and from group members, 🔴socialization
🔴,imitation
🔴 interpersonal learning.
Some Techniques Useful in Group Therapy
💗Reflecting or rewarding comments of group members
🔴 Asking for group reaction to one member's statement
🔴Asking for individual reaction to one member's statement
🔴Pointing out any shared feelings within the group
🔴Summarizing various points at the end of session
.

13.Explain the role of nurse in preparing for ECT

a Pre-treatment evaluation
💗Detailed medical and psychiatric history, including history of allergies.
🔴Assessment of patient's and family's knowledge of indications, side-
effects, therapeutic effects and risks associated with ECT.
🔴An informed consent should be taken.
🔴Assess baseline vital signs.
🔴Patient should be on empty stomach for 4-6 hours prior to ECT.
🔴 Withhold night doses of drugs, which increase seizure threshold like
diazepam, barbiturates and anticonvulsants,

54
🔴Withhold oral medications in the morning.
🔴 Head shampooing in the morning since oil causes impedance of
passage of electricity to brain.
🔴 Any jewellery, prosthesis, dentures, contact lens, metallic objects and
tight clothing should be removed from the patient's body.
🔴Empty bladder and bowel just before ECT.
🔴 Administration of 0.6 mg atropine IM or SC 30minutes before ECT, or
IVjust before ECT.
b. Intra-procedure care
💗Place the patient comfortably on the ECT table in supine position.
🔴Stay with the patient
🔴 Assist in administering the anesthetic agent and muscle relaxant
Since the muscle relaxant paralyzes all muscles including respiratory
muscles, patent airway should be ensured and ventilatory support
should be started.
🔴Mouth gag should be inserted to prevent possible tongue bite.
🔴The place(s) of electrode placement should be cleaned with normal
saline or 25 percent bicarbonate solution, or a conducting gel applied.
🔴Monitor voltage, intensity and duration of electrical stimulus given.
🔴Monitor seizure activity using cuff method.
🔴 100 percent oxygen should be provided.
🔴 During seizure monitor vital signs, ECG, oxygen saturation, EEG, etc.
🔴Record the findings and medicines given in the patient's chart.
c. Post-procedure care
💗 Monitor vital signs.
🔴Continue oxygenation till spontaneous respiration starts.
🔴Assess for post-ictal confusion and restlessness.
🔴 Take safety precautions to prevent injury (
🔴If there is severe post critctal confusion and restlessness, IVdiazepam
may be administered.

55
🔴Reorient the patient after recovery and stay with him until fully
oriented.

• Document any findings as relevant in the patient's record.

14.Describe occupational therapy

Occupational therapy is the application of goal oriented, purposeful
activity in the assessment and treatment of individuals with
psychological, physical or developmental disabilities.
Goal
The main goal isto enable the patient to achieve a healthy balance of
occupations through the development of skills that will allow him to
function at a level satisfactory to himself and others.
Settings
Occupational therapy is provided to children, adolescents, adults and
elderly patients. These programs are offered in psychiatric hospitals,
nursing homes, rehabilitation centers, special schools, community
group homes, community mental health centers, day care centers,
halfway homes and deaddiction centers.
Advantages
🔴Helps to develop socialskills and provide an outlet forself-expression. ·
🔴Strengthens ego defenses.
🔴Develops a more realistic view of the self in relation to others.
Points to be Kept in Mind
🔴The client should be involved as much as possible in selecting the
activity.
🔴• Select an activity that interests or has the potential to interest him.
🔴The activity should utilize the client's strengths and abilities.
🔴The activity should be of short duration.
🔴 Ifpossible,the selected activity should provide some new experience
for the client.
Processof Intervention

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It consists of six stages:
🔴Initial evaluation of what patient can do and cannot do
🔴 Development of immediate and long-term goals by the patient and
therapist together.

🔴. Development of therapy plan with planned intervention.

🔴Implementation of the plan and monitoring the progress.
🔴. Review meetings with patient and allthe staff involved in treatment.
🔴Setting further goals when immediate goals have been achieved;
modifying the treatment
Types of Activities
🔴Diversional activities: For example, organized games.
🔴Therapeutic activities: These activities are used to attain a specific
care plan or goal.
Suggested OccupationalActivities for PsychiatricDisorders
💗Anxiety disorder Simple concrete tasks
🔴Depressive disorder Simple concrete tasks
💗Manic disorder Non-competitive activities
🔴Schizophrenia (paranoid)Non-competitive,
🔴Schizophrenia (catatonic) Simple concrete tasks
Antisocial personality Activities that enhance selfesteem and are
expressive and creative, but not too complicated.
🔴Substance abuse Group activities in which clientbuses his talents
🔴Childhood and adolescent disorders:
Children :Playing, story telling, painting, poetry,music, etc.
Adolescents: Creative activities
💗Mental retardation Repetitive work assignments.

15.Describe recreational therapy

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Recreation is a form of activity therapy used in most psychiatric
settings. It is a planned therapeutic activity that enables people with
limitations to engage in recreational experiences.
Aims
🔴To encourage social interaction.
🔴To decrease withdrawal tendencies.
🔴Toprovide outlet forfeelings.
🔴 To promote socially acceptable behavior.

🔴 To develop skills, talents and abilities.

🔴To increase physical confidence and a feeling of selfworth.
Points to be Kept in Mind
💗Provide a non-threatening and non-demanding environment.
🔴 Provide activities that are relaxing and without rigid guidelines and
time-frames.
🔴Provide activities that are enjoyable and selfsatisfying.
Typesof RecreationalActivities
💗Motor forms: These can be further divided into 🔴🔴fundamental
🔴accessory;
🔴Sensory forms: These can be either visual, ,or auditory
🔴Intellectual forms: These include reading, debating and so on.
Suggested RecreationalActivities for PsychiatricDisorders
💗Anxiety disorders Aerobic activities
🔴Depressive disorder Non-competitive sports
🔴Manic disorder One-to-one basis
Schizophrenia (paranoid) Concentrative activities.
🔴Schizophrenia (catatonic) Social activities
🔴Dementia Concrete, repetitious crafts
Childhood and adolescent disorders
🔴child on a one-to-one basis

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🔴Adolescents fare better in groups;
🔴Mental retardation Activities should be according to the client's level
of functioning

16.Describe play therapy

Play is a natural mode of growth and development in children.Through
play a child learnsto express his emotions and it serves as a tool in the
development ofthe child.
Curative Functions
💗 It releases tension and pent-up emotions.
🔴 It allows compensation for loss and failures.

🔴It improves emotional growth through his relationship with other

children.
🔴It provides an opportunity to the child to act out his fantasies and
conflicts, to get rid of aggression and to learn positive qualities from
other children.
Diagnostic Functions
💗Play therapy gives the therapist a chance to explore family
relationships of the child and discover what difficulties are contributing
to the child's problems.
🔴 Play therapy allows to study hidden aspects of the child's personality.
🔴It is possible to obtain a good idea of the intelligence level ofthe child.
🔴 Through play inter-sibling relationships can be adequately studied
Types of Play Therapy
🔴Individual vs Group play therapy
In individual therapy the child is allowed to play by himself and the
therapist's attention is focused on this one child alone.
In group play therapy other children are involved.
🔴Free play vs Controlled play therapy
In free play the child is given freedom in deciding with what toys he
wants to play.
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In controlled play therapy, the child is introduced into a scene where
the situation or setting is already established.
🔴Structured vs Unstructured play therapy Structured play therapy
involves organizing the situation in such a way so as to obtain more
information.
In unstructured play therapy no situation is set and no plans are
followed.
🔴Directive vs Non-directive play therapy
In directive play therapy, the therapist totally sets the
directions,whereas in non-directive play therapy, the child receives no
directions
Play therapy is generally conducted in a playroom. The playroom
should be suitably stocked with adequate play material, depending
upon the problems ofthe child.

UNIT IV & V- SHORT ANSWERS

THERAPEUTIC COMMUNICATION & TREATMENT
MODALITIES
1.Differentiate Transference & counter
transference
Transference Counter transference
🔴Discomfort being 🔴Tension,reconflict,danger
observed can be observed
🔴Feeling contained(mother 🔴Feeling to being in love

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and infant)
Mother wanting 🔴Wanting to focus on
mothering.keeping the mother rather than dyand
infant as the focus is
problematic
🔴Feeling acknowledge 🔴feeling criticized , not
doing anything for dyad

2.Explain the types of communications

Communication takes place on two levels:
🔴verbal
🔴non-verbal.
Verbal communication occurs through words,
spoken or written.
Non-verbal communication
occurs through gestures or behaviors that do not
involve the spoken or written words. The types
of non-verbal commuunication include vocal eyes, gestures, physical
appearanice, space, posture, touch and facial expression.

3.DifferentiateEmpathy and sympathy

Empathy Sympathy

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62
4.Define Process Recording and list down the
purposes
it is the recording of the conversation during the interaction or the
interview between the nurse and the patient in the psychiatric setup
with the nurse's inference .
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Purpose
🔴assists the nurse or student to plan, structure and evaluate the
interaction on a conscious
🔴assists her to gain competency in interpreting and synthesizing raw
data under supervision;
🔴helps to consciously apply theory to practice;
🔴 helps her to develop an increased awareness of her habitual, verbal
and non-verbal communication
🔴helps the nurse to learn to identify thoughts and feelings in relation to
self and others;
🔴helps to increase observational skills,
🔴 helps to increase the ability to identify problems and gain skills in
solving them;

5.Define Akathesia
Akathisia is a subjective feeling or muscular discomfort that can cause
patients to be agitated, restless and feel generally dysphoric. Akathisia
can be treated with propranolol, benzodiazepines and clonidine.

6.Define Token economy

The program involves giving token rards fer appropriate or desired
target behaviors performed by the patient. The token can later be
echanged tor other rewards. For example, i inpatient hospital Wards,
patients receive a reward for performing a desired behavior, such
agtokens which they may iuse to purchase luxuiy itemns or certain
privileges.

64
7. Describe 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 s association. Punishment is presented
immediately after a specific behavioral response and the response is
eventually inhibited. Unpleasant response is produced by electric
stinmuus, drugs, Social disapproval or even fantasy

8.Enlist the symptoms of Dystonia

Early symptoms may include a
🔴foot cramp ,
🔴worsening in handwriting after writing several lines.
In other instances,
🔴the neck may turn or pull involuntarily, especially when the person is
tired or under stress.
🔴 Sometimes both eyes might blink rapidly and uncontrollably; other
times, spasms will cause the eyes to close.
🔴Symptoms may also include tremor or difficulties speaking. In some
cases, dystonia can affect only one specific action, while allowing
others to occur unimpeded

9. Explain Psychodrama
Psychodrama is a specialized type of group therapy that enploys a
dramatic approach in which patients become actors in life-situation
ScenariOS. The goal is to resolve interpersonal conflicts in a less
threatening atmosphere than the real-life situation would present.

10.Define tardive dyskinesia

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It is a delayed adverse effectof antipsychotics. It consists of
abnormal,irregular choreoathetoid movements of the muscles of the
head, limbs and trunk. It is characterized by chewing, sucking,
grimacing and perioral movements.

11.Define EPS and list down the symptoms of

EPS
These are serious neurologic symptoms and majof Side eftects of
antipsychotic drugs. Blockade of D2 réceptors in the midbrain region of
the brain Stem is responsible for the development of EP'S.
Conventional antipsychotic drugs cause a greater incidence of EPS than
do atypical antipsychotic drugs.

Symptoms
🔴dystonia (continuous spasms and muscle contractions)
🔴 akathisia (may manifest as motor restlessness),
🔴parkinsonism (characteristic symptoms such as rigidity),
🔴 bradykinesia (slowness of movement)
🔴, tremor
🔴 tardive dyskinesia (irregular, jerky movements).

12.Explain the Components of therapeutic

relationship
🔴Rapport :Rapport is a relationship or communication especially when
useful and harmonious.
🔴Empathy:It is the ability to put oneself in another person's
circumstances and feelings. The nurse need not necessarily have to
experience it
🔴Warmth:Warmth isthe ability to help the client feel cared for and
comfortable
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🔴Genuineness Genuineness involves being one's own self.This implies
that the nurse is aware of her thoughts, feelings, values and their
relevance in the immediate interaction with a clien

13.Enumerate the Types of relationship

🔴Social relationships.:A social relationship can be defined as a
relationship that is primarily initiated with the purpose of friendship,
socialization, enjoyment or accomplishing a task
🔴Intimate relationships:An intimate relationship occurs between two
individuals who have an emotional commitment to each other.
🔴Therapeutic relationships:The therapeutic relationship between nurse
and client differs from both a social and an intimate relationship. The
focus of the relationship is on the client's ideas, experiences and
feelings.

14.List down the various techniques of

therapeutic communication
🔴Listening
🔴Broad opening
🔴Restating
🔴Clarificatio
🔴Reflection
🔴Humor
🔴Informing
🔴Focusing
🔴communication
🔴Theme identification
🔴Silence

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15.Explain lithium toxicity
Lithium is an element with atomic number 3 and atomic weight 7.It was
discovered by FJCade in1949,and is a most effective and commonly
used drug in the treatment ofmania
Indications
🔴Acute mania
🔴Prophylaxis for bipolar and unipolar mood disorder.
🔴Schizoaffective disorder
🔴Cyclothymia
🔴 Impulsivity and aggression
🔴Other disorders:
🔴premenstrual dysphoric disorder
🔴 bulimia nervosa
🔴borderline personality disorder
🔴episodes ofbinge drinking
🔴 trichotillomania
🔴cluster headaches

16.Enlist the steps of Systematic

desensitization
It consists of three main steps:
🔴 Relaxation training
🔴Hierarchy construction
🔴Desensitization of the stimulus
🔴. Relaxalion training:
Some of the methods to induce realxation are
🔴Jacobson's progressive muscle relaxation

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🔴Hypnosis
🔴Meditation or yoga
🔴Mental imagery
🔴 Biofeedback
🔴. Hierarchy construction: Here the patient is asked to list all the
conditions which provoke anxiety.Then he is asked to list them in a
descending order of anxiety provocation.
🔴. Desensitization of the stimulus: This can either be done in reality or
through imagination.

17.Explain assertive skill training

Assertive training is a behavior theraps technique in which the patient
is given training tö bring about change in emotional and other
behavioral pattern by being assertive Patient is al encouraged not to be
afraid of showing an appropriate response, negative or positive, to an
idea or suggestion. Assertive behavior training is given by the therapist,
first by role play an then by practice in a real life situation. Attention is
focused on more effective interpersonal skills.Social skills training helps
to improve social manners like encouraging eye contact, speaking
appropriately, observing simple etiquette, and relating to people.

18.Explain time out

Timeout method includes removing the patient from the reward or the
reward from the patient for a particular period of time following a
problem behavior. This is often used in the treatment of childhood
disorders. For example, the child is not allowed to go out of the ward
to play if he fails to the given work.

19.Explain the types of family therapy

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Individual Family Therapy
In individual family therapy each family member has a single therapist.
Conjoint Family Therapy
The most common type of family therapy is the single-family group, or
conjoint family therapy.
Couples Therapy
Couples are often seen by the therapist together. The couple may be
experiencing difficulties in their marriage,
Multiple Family Group Therapy
In multiple family group therapy, four or five families meet weekly to
confront and deal with problems or issues theyhave in common.
Multiple Impact Therapy
In multiple impact therapy, several therapists come together with the
families in a communicativ setting.
Nework Therapy
Network therapy is conducted in people's homes

20.Differentiate restitution and response cost

Restitution (Over-correction): Restitution means restoring the
disturbed situation to a state that is much better than what it was
before the occurrence of the problem behavior For example, if a
patient passes urine in the ward he would be required to not only clean
the dirty area but also mop the entire/larger area of the floor in the
ward.
Response cost: This procedure is used with individuals wvho are on
token programs for teaching adaptive behavior. When undesir- able
behavior occurs, a fixed number of tokens or points are deducted from
what the individual has already earned

70
21.define therapeutic community
Stuart and Sundeen defined therapeutic community as "a therapy in
which patient's social environment would be used to provide a
therapeutic experienceforthe patient by involving him as an active
participant in his own care and the daily problems of his community."

22.List down the indications of ECT

💗Major depression: With suicidal risk; with stupor; with poor intake of
food and fluids; melancholia with psychotic features with unsatisfactory
response to drugs
🔴 Severe catatonia (functional): With stupor; with poor intake of food
and fluids; when drugs are contraindicated or have serious side-effects.
🔴. Severe psychosis (schizophrenia or mania): With risk ofsuicide,
homicide or danger of physical assault; with depressive features; with
unsatisfactory response to drug therapy
💗 Organic mental disorders
💗organic mood disorders.
💗organic psychosis
💗. Other indications: ECT is preferred to antidepressant therapy in
some cases, such as for clients with cardiac disease; for pregnant
women, in whom antidepressants place the fetus at risk for congenital
defects.

23.List down the contraindications of ECT

Contraindications
A )Absolute:
💗Raised ICP (intracranial pressure)
B. Relative:
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🔴cerebralaneurysm
🔴cerebral hemorrhage
🔴brain tumor
🔴 acute myocardial infarction
🔴congestive heart failure

🔴 pneumonia or aortic aneurysm

🔴 retinal detachment

24.Explain the types of ECT

💗1.Direct ECT: In this, ECTis given in the absence of anesthesia and
muscular relaxation. This is not a commonly used method now.
2. Modified ECT: Here ECT is modified by druginduced muscular
relaxation and general anesthesia.
Frequency and Total Numberof ECT
Frequency: Three times per week or as indicated.
Total number: 6to 10; upto 25 may be preferred as indicated.

Application of Electrodes
Bilateral ECT: Each electrode is placed 2.5-4 cm(1-1V:zinch) above the
midpoint,
UnilateralECT: Electrodes are placed only on one side of head, usually
non-dominant side

25.List down the side effects of ECT

🔴Memory impairment.
🔴 Drowsiness, confusion and restlessness.
🔴Poor concentration, anxiety.

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🔴Headache, weakness/fatigue, backache, muscle aches.
🔴 Dryness of mouth, palpitations, nausea, vomiting.
🔴 Unsteady gait.
🔴Tongue bite and incontinence.

UNIT VI, VII & XII- short answers SCHIZOPHRENIA,

MOOD DISORDERS & ORGANIC BRAIN DISORDERS
1.Explain the characteristic features of
catatonic stupor
🔴Mutism: Absence ofspeech.
🔴Rigidity: Stiff ,immobile posture that cannot be easily moved.
🔴Negativism: A motiveless resistance to all commands .
🔴 Posturing:
🔴 Stupor: Does not react to his surroundings and appears to be
unaware of them.
🔴Echolalia:unsolicited repetition of utterances made by others.
🔴Echopraxia: Repetition or mimicking of actions observed.
🔴Waxy flexibility:Parts of body can be placed in positions

2.List down the negative symptoms of

schizophrenia
🔴Affective flattening or blunting
🔴Avolition apathy (lack of initiative)
🔴Attentional impairment
🔴Anhedonia (inability to experience pleasure)
🔴Alogia (lack of speech output)

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3.List down the symptoms of paranoid
schizophrenia
🔴Delusions of persecution:
🔴Delusions of jealousy:
🔴Delusions of grandiosity
🔴Hallucinatory voices that threaten or command the patient, or
auditory hallucinations

without verbal form, such as whistling, humming and laughing

🔴Other features include disturbance of affect volition, speech and
motor behavior

4.Explain the characteristic features of

catatonic excitement
🔴 Increase in psychomotor activity :ranging from restlessness, agitation,
excitement, aggressiveness to at times violent behavior.
🔴Increase in speech production.
🔴Loosening of associations and frank incoherence. 🔴Sometimes
excitement becomes very severe accompaniedby rigidity,hyperthermia
and dehydration and can result in death. It is then known as acute
lethal catatonia or pernicious catatonia.
5.Enlist 4 A’s of Bleuler
🔴Affective disturbance: Inability to show appropriate emotional
responses
🔴Autistic thinking: It is a thought process in which the individual is
unable to relate to others or to the environment.

74
🔴Ambivalence: It refers to contradictory or. opposing emotions,
attitudes, ideas or desires for the same person, thing or situation
simultaneous opposite feelings.
💗Associative looseness: Inability to think logically..

6.Explain the characteristic features of

hebephrenic schizophrenia
🔴marked thought disorder,
🔴 incoherence,
🔴severe loosening of associations
🔴extreme social impairment.
🔴Delusions and hallucinations are fragmentary and changeable.
🔴Other oddities of behavior include senseless giggling, mirror-gazing,
grimacing, mannerisms and so on. The course is chronic and
progressively downhill without significant remissions.

7.Explain the four stages of elevated mood

Elevated mood in mania has four stages depending on the severity of
manic episodes:
💗 Euphoria (StageI):Increased sense ofpsychological well-being and
happiness not in keeping with ongoing events.
🔴Elation (StageII):Moderate elevation ofmood with increased
psychomotor activity.
🔴 Exaltation(StageIII):Intense elevation of mood with delusions of
grandeur.
🔴 Ecstasy (Stage IV):Severe elevation ofmood, intense sense of rapture

8.Differentiate cyclothymia and dysthymia

75
9.List down the classification of BPAD
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10.Classify depression

77
11Explain depressive cognitions
🔴Hopelessness :a feeling of 'no hope in future' due to pessimism
💗helplessness :the patient feels that no help is not possible
🔴 worthlessness :a feeling of inadequacy and inferiority
unreasonable :guilt and self-and blame over trivial matters in the past.

12.List down the symptoms of hypomania

Hypomania is a lesser degree of mania.
🔴There is a persistent mild elevation of mood increased sense of
psychological well being 🔴happiness not in keeping with ongoing
events

78
🔴.In some cases irritability,conceit,and boorish behavior may take the
place of the more usual euphoric sociability.
🔴Concentration and attention may be impaired,
13.Classify antidepressants with examples
💗. Selective Serotonin Reuptake Inhibitors
(SSRIS): example Citalopram,Fluoxetine,Sertraline
💗. Tricyclic Antidepressants (TCAS): example Amitriptyline
,Clomipramine,Imipramine, Doxepin
💗 Monoamine oxidase inhibitors (MAOIS) examples Isocarboxazid ,
Phenelzine
💗Other Newer Antidepressant drugs
Bupropion, Maprotiline

14.List the psychological therapies for

depression
💗Cognitive therapy:It aims at correcting the depressive negative
cognitions like hopelessness, worthlessness, helplessness
🔴Supportive psychotherapy: such as reassurance, ventilation,
occupational therapy, relaxation and other activity therapies.
🔴 Group therapy: Group therapy is useful for mild cases of depression.
💗Family therapy
💗Behavior therapy: It includes social skills training, problem solving
techniques, assertiveness training, self-control therapy, activity
scheduling and decision making techniques.

15.Enlist the somatic symptoms of depression

Somatic symptoms of depression, according to ICDlO
🔴Significant decrease in appetite or weight.
🔴Early morning awakening, at least 2 or more hours before the usual
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time of waking up.
🔴Diurnal variation, with depression being worst in the morning.
🔴 Pervasive lack ofinterest and lack ofreactivity to pleasurable stimuli.
🔴 Psychomotor agitation or retardation

16.Differentiate delirium and dementia

80
17.Define Alzheimer’s disease
A progressive disease that destroys memory and other important
mental functions.
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Brain cell connections and the cells themselves degenerate and die,
eventually destroying memory and other important mental functions.

18.Explain the stages of dementia

Stages of Dementia
Stage I: Early stage (2 to 4 years)
🔴Forgetfulness
🔴Declining interest in environment
🔴Hesitancy in initiating actions
🔴Poor performance at work
Stage II: Middle stage (2 to 12 years)
💗Progressive memory loss
🔴 Hesitates in response to questions
🔴Has difficulty in following simple instructions
🔴Irritable, anxious
🔴Wandering
🔴Neglects personal hygiene
🔴Social isolation
Stage III: Final stage (up to a year).
💗Marked loss ofweight
🔴Unable to communicate
🔴Does not recognize family
🔴Incontinence of urine and feces
🔴Loses the ability to stand and walk
🔴Death is usually caused by aspiration pneumonia

19.Define vascular dementia

VASCULAR DEMENTIA
(MULTI-INFARCT DEMENTIA)

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Vascular dementia is a condition characterized by an irreversible
alteration in brain function that results from damage or destruction of
brain issue such as blood clots thatblock smatl vessels in the brain,
Etiology
• Small focal deficits- typically caused by a series of small strokes
Contributing factors
Advanced age
Cerebral emboli or thrombosis
Diabetes
Heart disease
High blood cholesterol level
Hypertension

Unit– VIII& IX SHORT ESSAYS:

1.Describe the Clinical features of Obsessive
Compulsive Disorder.
Clinical Picture
💗Obsessional thoughts These are words, ideas and beliefs that intrude
forcibly into the patient's mind. They are usually unpleasant and
shocking to the patient
🔴Obsessional images These are vividly imagined scenes, often of a
violent or disgusting kind involving abnormal sexual practices.
🔴Obsessional ruminations These involve internal debates in which
arguments for and against even the simplest everyday actions are
reviewed endlessly.
🔴Obsessional doubts These may concern actions that may not have

83
been completed adequately. The obsession often implies some danger
such as forgetting to turn off the stove or not locking a door.
🔴Obsessional impulses These are urges to perform acts usually of a
violent or embarrassing kind,
such as injuring a child, shouting in church etc.
🔴Obsessional rituals These may include both mental activities such as
counting repeatedly in a special way or repeating a certain form of
words, and repeated but senseless behaviors such as washing hands 20
or more times a day.
🔴repeated hand washing may be preceded by thoughts of
contamination.
🔴These patients usually believe that the contamination is spread from
object to object or person to person even by slight contact and may
literally rub the skin offtheir hands by excessive hand washing
💗Obsessive slowness: Severe obsessive ideas or extensive compulsive
rituals characterize obsessional slowness in the relative absence of
manifested anxiety.This leads to marked slowness in daily activities

2.List the signs and symptoms of Post

traumatic stress disorder and Explain the
nursing intervention
The main symptoms
🔴 persistent anxiety
🔴 irritability,
🔴insomnia
🔴, intense intrasive imagery (flashbacks)
🔴recurring distressing dream
🔴 inability to feel emotion
🔴 diminished interest in activities.

84
The symptoms may develop after a period of latency, within 6 months
after the stress or may be delayed

Nursing Intervention
🔴Monitor physician's ongoing assessments, laboratory reports and
other data to rule out organic pathology.
🔴 Identify primary and secondary gains.
🔴 Do not focus on the disability; encourage patient to perform self-care
activities as independently as possible.
🔴Do not allow the patient to use the disability as a manipulative tool to
avoid participation in the therapeutic activities.
🔴Withdraw attention if the patient continues to focus on physical
limitations.
🔴Encourage patient to verbalize fears and anxieties.
🔴 Positive reinforcement for identification or demonstration of
alternative adaptive coping strategies.
🔴Identify specific conflicts that remain unresolved and assist patient to
identify possible solutions.
🔴 Assist the patient to set realistic goals for the future.
🔴Help the patient to identify areas of life situation that are not within
his ability to control.
🔴Encourage verbalization of feelings related to this inability

3.Explain the types of Dissociative disorder.

☘Dissociative Amnesia
💗Dissociative Fugue
💗Dissociative Stupor
💗Ganser's Syndrome
💗Multiple Personality Disorder (Dissociative Identity Disorder)
💗Trance and Possession Disorders
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💗Dissociative Motor Disorders
💗Dissociative Convulsions (hysterical fits or pseudo-seizures)
💗Dissociative Sensory Loss and Anesthesia
💗Dissociative Amnesia Most often, dissociative amnesia follows a
traumatic or stressful life situation.
🔴 There is sudden inability to recall important personal information
particularly concerning the stressful life event.
🔴The amnesia may be localized, generalized, selective or continuing in
nature.
🔴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 ofsevere stress.
🔴The course is typically a few hours to days and sometimes months.
🔴Dissociative Stupor In this, patients are motionless and mute and do
not respond to stimulation, but they are aware of their surroundings. It
is a rare condition.
🔴Ganser's Syndrome Canser's syndrome is a rare condition with four
features: giving '
🔴approximate answers' to questions designed to test intellectual
functions,
🔴psychogenic physical symptoms
🔴, hallucinations
🔴 apparent clouding of consciousness.
💗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.

86
🔴Transition from one personality to another is sudden, and the
behavior usually contrasts strikingly with the patient's normal state.
🔴Trance and Possession Disorders
This disorder is very common in India. It is characterized by a
temporary loss of both the sense of personal identity and full
awareness of the person's surroundings.
💗Dissociative Motor Disorders
It is characterized by motor disturbances like paralysis or abnormal
movements. Paralysis may be a monoplegia, paraplegia or quadriplegia.
🔴Dissociative Convulsions (hysterical fits or pseudo-seizures)
It is characterized by convulsive movements and partial loss of
consciousness.
🔴Dissociative Sensory Loss and Anesthesia
It is characterized by sensory disturbances like hemianesthesia,
blindness, deafness and glove and stocking anesthesia

4.Explain treatment modalities and Nursing

management of a patient with generalized
Anxiety disorder(GAD).

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5.Define Hypocondriasis. List down the signs
and symptoms of Hypocondriasis

6.Describe phobia , its types and management

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A phobia is an unreasonable fear of a specific object,activity or situation
Types of Phobia
💗 Simple phobia
🔴 Social phobia
🔴Agoraphobia
🔴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 ofthe sight ofblood
🔴Claustrophobia-fear of closed spaces
🔴Gamophobia-fear ofmarriage
🔴Insectophobia-fear ofinsects
🔴AIDSphobia-fear ofAIDS
Social phobia Social phobia is an irrational fear of performing activities
in the presence of other people or interacting with others.
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.
🔴Asthe agoraphobia increasesin severity, there is a gradual restriction
in normal day-to-day activities. Treatment
Pharmacotherapy
🔴Benzodiazepines (e.g. alprazolam, clonazepam, lorazepam, diazepam)
🔴 Antidepressants (e.g.imipramine, sertraline, phenelzine)
Behavior therapy
💗Flooding
🔴Systematic desensitization

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🔴Exposure and response prevention
🔴 Relaxation techniques
Cognitive therapy
This therapy is used to break the anxiety patterns in phobic disorders.
Psychotherapy Supportive psychotherapy is a helpful adjunct to
behavior therapy and drug treatment

7.Explain the clinical features and

management of OCD
Clinical featurea q 1 ans is there
Pharmacotherapy
🔴Antidepressants (e.g.fluvoxamine, sertraline, etc.)
🔴 Anxiolytics (e.g.benzodiazepines)
Behavior Therapy
💗Exposure and response prevention
🔴Thought stoppage
🔴Desensitization
🔴Aversive conditioning
🔴Exposure and response prevention This is vivo exposure procedure
combined with response prevention techniques.
🔴Thought stoppage Thought stopping is a technique to help an
individual to learn to stop thinking unwanted thoughts.
🔴Other Therapies
Supportive psychotherapy.
ECT-for patients refractory to other forms of treatment.

8.Explain dissociative disorders in detail

Conversion disorder is characterized by the presence ofone ormore
symptoms suggesting the presence of a neurological disorder that
cannot be explained by any known neurological or medical disorder.
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Features
🔴The patient does not produce the symptoms intentionally.
🔴The patient shows less distress or shows lack of concern about the
symptoms, called as belle indifference.
Etiology of Conversion Disorders
Psychodynamic Theory
Conversion symptoms allow a for hidden wish but sufficiently
disguised so that the individual does not have to face the unacceptable
wish. The symptoms are symbolically related to the conflict.
Behavior Theory
According to this theory the symptoms are learnt from the surrounding
environment.Conversion disorder is more common in people with
hystrionic personality traits.

Types
☘Dissociative Amnesia
💗Dissociative Fugue
💗Dissociative Stupor
💗Ganser's Syndrome
💗Multiple Personality Disorder (Dissociative Identity Disorder)
💗Trance and Possession Disorders
💗Dissociative Motor Disorders
💗Dissociative Convulsions (hysterical fits or pseudo-seizures)
💗Dissociative Sensory Loss and Anesthesia
Treatment
🔴Free association

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🔴Hypnosis
🔴Abreaction therapy
🔴Supportive psychotherapy
🔴Behavior therapy (aversion therapy, operant conditioning, etc.)
🔴Drug therapy: Drugs have a very limited role. A few patients have
anxiety and may need short-term treatment with benzodiazepines
Nursing Intervention
💗Monitor physician's on going assessments, laboratory reports and
other data to rule out organic pathology.
🔴Identify primary and secondary gains.
🔴Do not focus on the disability; encourage patient to perform self-care
activities as independently as possible.
🔴 Do not allow the patient to use the disability as a manipulative tool
to avoid participation in the therapeutic activities.
🔴Withdraw attention if the patient continues to focus on physical
limitations.
🔴Encourage patient to verbalize fears and anxieties.
🔴 Positive reinforcement
🔴Identify specific conflicts
Assist the patient to set realistic goals for the future.
🔴Help the patient to identify areas of life situation that are not within
his ability to control. Encourage verbalization of feelings related to this
inability.

9.Explain conversion disorders

Same ans 8 th

10.Explain psychosomatic disorders.

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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.

Psychosomatic disorders is divided into

1.Somatization disorder
2.Hypochondriasis
3.Somatoform autonomic dysfunction
4.Persistent somatoform pain disorder
1 .Somatization Disorder
Somatization disorder is characterized by chronic multiple somatic
symptoms in the absence of physical disorder. The symptoms are
vague, presented in a dramatic manner and involve multiple organ
systems.
2.Hypochondrias is
Hypochondriasis is defined as a persistent preoccupation with a fear or
belief of having a serious disease despite repeated medical
reassurance.
3.Somatoform Autonomic Dysfunction
In this disorder, the symptoms are predominantly under autonomic
control, as if they were due to a physical disorder. Some of them
include palpitations, hiccoughs, hyperventilation, irritable bowel,
dysuria, etc.
4.Persistent Somatoform Pain Disorder
The main feature in this disorder is severe,persistent pain without any
physical basis. It may be of sufficient severity so as to cause social or
occupational impairment. Preoccupation with the pain is common.
Treatment
Drug therapy
💗 Antidepressants
🔴 Benzodiazepines

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Psychological treatment.
💗Supportive psychotherapy
🔴 Relaxation therapy

11. DESCRIBE the etiological factors in

substance use disorders.
12 Describe the etiological factors in
Substance use disorders
Biological Factors
💗Genetic vulnerability: family history of substance use disorder, e.g.
twin studies suggest
that genetic mechanisms might account for alcohol consumption.
🔴Biochemical factors: for example, role of dopamine and
norepinephrine have been implicated in cocaine, ethanol and opioid
dependence. Abnormalities in alcohol dehydrogenase or in the
neurotransmitter mechanism are thought to play a role in alcohol
dependence.
🔴 Withdrawal and reinforcing effects of drugs (they serve as
maintaining factors).
🔴Co-morbid medical disorder (e.g. to control chronic pain) .
Psychological Factors
💗General rebelliousness
🔴Sense ofinferiority
🔴 Poor impulse control
🔴Low self-esteem
🔴Inability to cope with the pressures of living and society (poor stress
management skills)
🔴Loneliness, unmet needs
🔴 Desire to escape from reality
🔴Desire to experiment, a sense of adventure
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🔴Pleasure-seeking
🔴 Machoism
🔴 Sexual immaturity
Social Factors
💗Religious reasons
🔴Peer pressure
🔴 Urbanization
🔴 Extended periods of education
🔴Unemployment
🔴Overcrowding
🔴Poor social support
🔴 Effects of television and other mass media
🔴Occupation: substance use is more common in chefs,barmen,
executives,salesmen, actors, entertainers, army personnel, journalists,
medical personnel, etc
Easy Availability of Drugs
💗Taking drugs prescribed by doctors (e.g. benzodiazepine dependence).
🔴 Taking drugs that can be bought legally without (e.g.nicotine,
opioids).
🔴Taking drugs that can be obtained from illicit sources (e.g.street
drugs).
🔴Psychiatric disorders Substance use disorders are more common in
depression, anxiety disorders (particularly social phobias), personality
disorder (especially antisocial personality) and occasionally in organic
brain disease and schizophrenia

13.List down the Psychiatric disorders due to

Alcohol dependence syndrome. Explain
withdrawal syndrome
PSYCHIATRIC DISORDERS DUE TO
ALCOHOL DEPENDENCE
💗Acute intoxication
🔴 Withdrawal syndrome
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🔴. Alcohol induced amnestic disorders
🔴Alcohol induced psychiatric disorders
Withdrawal syndrome: In persons who have been drinking heavily over
a prolonged period of time, any rapid decrease in the amount of
alcohol in the body is likely to produce withdrawal symptoms. These
are:
🔴Simple withdrawal syndrome
💗Delirium tremens
💗Simple withdrawal syndrome: It is characterized by mild tremors,
nausea, vomiting, weakness, irritability, insomnia and anxiety.

💗Delirium tremens: It occurs usually within 2-4 days of complete or

significant abstinence from heavy alcohol drinking.
The course is short, with recovery occurring within 3-7 days. It is
characterized by:
🔴A dramatic and rapidly changing picture of disordered mental activity,
with clouding of consciousness and disorientation in time and place
🔴 Poor attention span
🔴Vivid hallucinations which are usually visual; tactile hallucinations can
also occur
🔴 Severe psychomotor agitation, shouting and evident fear
🔴 Grossly tremulous hands which sometimes pick up imaginary objects;
truncal ataxia
🔴 Autonomic disturbances such as sweating, fever, tachycardia, raised
blood pressure, pupillary dilatation
🔴Dehydration with electrolyte imbalances
🔴 Reversal ofsleep-wake pattern or insomnia
🔴Blood tests reveal leukocytosis and impaired liver function
🔴Death may occur due to cardiovascular collapse, infection,
hyperthermia or selfinflicted injury

14.Explain Alcohol deterrent therapy

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Deterrent agents are those which are given to desensitize the individual
to the effects of alcohol and maintain abstinence. The most commonly
used drug is disulfiram (tetraethyl thiuram disulfide) or antabuse.
Disulfiram: Disulfiram is used to ensure abstinence in the treatment of
alcohol dependence. Its main effect is to produce a rapid and violently
unpleasant reaction in a person who ingests even a small amount of
alcohol while taking disulfiram.
Mechanism of action Disulfiram is an aldehyde dehydrogenase
inhibitor that interferes with the metabolism of alcohol and produces a
marked increase in blood acetaldehyde levels.
🔴 The accumulation of acetaldehyde produces a wide array of
unpleasant reactions called the disulfiram-ethanol reaction (DER),
characterized by nausea, throbbing headache, vomiting, hypotension,
flushing, sweating, thirst, dyspnea, tachycardia, chestpain,
vertigo,blurred vision and a sense of impending doom associated with
severe anxiety.
🔴There action occurs almost immediately after the ingestion of even
one alcoholic drink and may last up to 30minutes.
Therapeutic indications
The primary indication for disulfiram use is as an aversive conditioning
Side-effects the absence of alcohol consumption include fatigue,
dermatitis, impotence, optic neuritis, mental changes, acute
polyneuropathy and hepatic damage.
🔴With alcohol consumption. In extreme cases convulsions, respiratory
depression, cardiovascular collapse, myocardial infarction and death.
Contraindications
🔴Pulmonary and cardiovascular disease.
🔴nephritis, brain damage, hypothyroidism, diabetes,hepatic disease,
seizures, poly-drug dependence or an abnormal electroencephalogram.
Nurse's responsibility
💗 An informed consent
🔴 Ensure that at least 12hours have elapsed since the last ingestion of
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alcohol before administering the drug.
🔴 Patient must be instructed that ingestion of even the smallest
amount of alcohol brings on a disulfiram-ethanol reaction
🔴Thepatient should also be warned against ingestion of any alcohol-
containing preparations such as cough syrups, drops of any kind, and
alcohol-containing foods
🔴Caution patient against taking CNS depressants or any OTC(over-the-
counter) medications during disulfiram therapy.
🔴 Instruct patient to avoid driving or other activities requiring alertness
until response to drug is known.
🔴 Patients should be warned that the disulfiram-alcohol reaction may
continue for as long as 1 to 2 weeks after the last dose of disulfiram.
🔴Patients should carry identification cards describing disulfiram-alcohol
reaction
🔴Emphasize the importance of follow-up

15.Explain Alcohol induced Psychiatric

disorders. Explain the Nursing management of
a patient with Alcohol abuse.
. Alcohol- induced psychiatric disorders
💗 Alcohol-induced dementia: It is a long term complication of alcohol
abuse, characterized by global decrease in cognitive functioning.
🔴Alcohol-induced mood disorders: Excess drinking may induce
persistent depression or anxiety
🔴Suicidal behavior: Suicidal rates are higher in alcoholics when
compared to non-alcoholics of the same age.
🔴 Alcohol-induced anxiety disorder: Alcohol persons report panic
attacks during acute withdrawal, similarly during the first 4 to 6 weeks
of abstinence.
🔴 Impaired psychosexual function: Erectile dysfunction and delayed

98
ejaculation are common in chronic alcoholics
🔴 Pathological jealousy: Excessive drinkers may develop an overvalued
idea or delusion that the partner is being unfaithful.
🔴 Alcoholic seizures (rum fits): Generalized tonic clonic seizures occur
usually within 12- 48 hours after a heavy bout of drinking
🔴 Alcoholic hallucinosis: This is characterized by the presence of
hallucinations (auditory) during abstinence, following regular alcohol
intake. Recovery occurs within one month.
NURSING MANAGEMENT FOR SUBSTANCE
USE DISORDER
Nursing Assessment
💗. Recognition of alcoholabuse:
🔴 Be suspicious about' at-risk' factors:
🔴If at-risk factors raise suspicion, the next step is to ask tactful but
persistent questions to confirm the diagnosis.
🔴 Certain clinical signs lead to the suspicion that drugs are being
injected:
🔴. Behavioral changes
🔴. Laboratory tests:
Nursing Diagnosis I
Risk for injury related to hallucinosis, acute intoxication evidenced by
confusion, disorientation, inability to identify potentially harmful
situations.
Objective: Client will not harm self.
Intervention:
🔴Place the client in a room near the nurse's station or where the staff
can observe the client closely.
🔴) Monitor the client's sleep pattern
🔴 Decrease environmental stimuli when the client is restless, irritable or
tremulous.
🔴Talk to the client in simple, direct, concrete language.

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Nursing Diagnosis II
Altered health maintenance related to inability to identify, manage or
seek out help to maintain health, evidenced by various physical
symptoms, exhaustion, sleep disturbances, etc.
Objective:The clientwillmaintain optimum health status.

Intervention:(
🔴) Monitor the client's health status.
🔴Administer medications as prescribed by physician.
🔴 Observe the client for any behavioral changes and inform physician
when necessary.
🔴 Maintain fluid and electrolyte balance.
🔴) Ensure that amount of protein in the diet.
Nursing Diagnosis Ill
Ineffective denial related to weak, underdeveloped ego, evidenced by
lack of insight,ratiolization of problems, blaming others, failure to
accept responsibility for his behavior.
Objective: Patient will understand the effect of his behavior on others
and verbalize acceptance of responsibility and desire for change.
Intervention
🔴Develop trust, convey an attitude of acceptance. 🔴Ensure that patient
understands it is not him but his behavior that is unacceptable.
🔴) Identify recent maladaptive behaviors
(🔴) Do not allow patient to rationalize or blame others for behaviors
associated with substance use.
(🔴) Provide positive reinforcement .
Nursing Diagnosis IV
Ineffective individual coping related to impairment of adaptive
behavior and problemsolving abilities, evidenced by use of substances
as coping mechanisms.
Objective: Patient will be able to use adaptive coping mechanisms,
instead of abusing drugs/ alcohol, in response to stress
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Intervention.
🔴Encourage client to explore options available to deal with stress.
🔴Give positive reinforcement for respond to stress with adaptive coping
strategies.
🔴 Teach client and family that alcoholism is a disease that requires long-
term treatment and followup.
🔴Teach the client about the prevention of HIV transmission.

16.Explain the nursing intervention for a

patient with acute drug intoxication
17.Explain about narcotic and psychotropic
substances and its abuse
18Explain the management of Alcohol
Dependence Syndrome
🔴 A full assessment, including an appraisal of current medical,
psychological and social problems.
🔴 Treatment of withdrawal from alcohol
💗Detoxification: Detoxification is the treatment for alcohol withdrawal
symptoms. The drugs of choice are benzodiazepines.

🔴• For vitamin B deficiency a preparation of vitamin B containing 100

mg of thiamine should be administered parenterally, twice daily for 3 to
5 days. This should be followed by oral administration of vitamin Bfor at
least 6months.
🔴 Administration of anticonvulsants as necessary, 🔴maintaining fluid
and electrolyte balance
🔴, strict monitoring of vitals, level of consciousness and orientation.
🔴 Close observation is essential, especially during first five days.
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🔴. Alcohol deterrent therapy: Deterrent agents are those which are
given to desensitize the individual to the effects of alcohol and maintain
abstinence. The most commonly used drug is disulfiram or antabuse.
🔴 Psychological treatment
💗Motivational interviewing: This involves providing feedback to the
patient on the personal risks that alcohol poses, together with a
number of options for change.
🔴Group therapy: Group therapy enables the patients to observe their
own problems mirrored in others and towork out better ways of coping
with them.
🔴Aversive conditioning: This therapy is based on classical conditioning.
In alcoholism the behavior patterns are self-reinforcing and
pleasurable, but are maladaptive for reasons outside the control of the
client.
🔴Cognitive therapy: This involves reduction in alcohol intake by
identifying and modifying maladaptive thinking patterns.
🔴Relapse prevention technique: This technique helps the patient to
identify high-risk relapse factors and develop strategies to deal with
them.
🔴Cue exposure technique: This technique aims through repeated
exposure to desensitize drug abusers to drug effects,and thus improve
their ability to remain abstinent.
Other therapies include assertiveness training,
behaviorcounseling,supportive psychotherapy and individual
psychotherapy.

19.Explain the psychiatric complications of

ADS
Medical and Social Complications of Alcohol
Dependence
102
A Medical
Gastrointestinal system
💗Gastritis, peptic ulcer, reflux esophagitis, carcinoma of stomach and
esophagus
🔴Fatty liver, cirrhosis of liver, hepatitis, liver cell carcinoma
🔴 Acute and chronic pancreatitis
🔴Malabsorption syndrome
Cardiovascular system
💗Alcoholic cardiomyopathy
🔴 High risk for myocardial infarction
Central nervous system
💗Peripheral neuropathy
🔴Epilepsy
🔴Head injury
🔴 Cerebellar degeneration
Miscellaneous
🔴Protein malnutrition
🔴Vitamin deficiency disorder
🔴 Peripheral muscle weakness
🔴Acne
🔴 Sexual dysfunction in males, failure of
🔴ovulation in females
🔴Damage to the fetus
🔴Fetal alcohol syndrome (facial abnormality, low birthweight, low
intelligence), increased still births. Alcohol dependence is responsible
for 3 percent of all cases of mental retardation
B. Social
💗Marital disharmony
🔴 Occupational problems
🔴 Financial problems
🔴Criminality
🔴 Accident

103
20.Explain the management of a patient with
long term alcohol abuse(15th question answer
same)

UNIT VIII & IX SHORT ANSWERS:

- NEUROTIC AND SUBSTANCE USE -
DISORDERS
1.Define panic attacks with its characteristic
features
Panic disorder is characterized by anxiety, which is intermittent and
unrelated to particula circumstances. The central feature is the
occurrence of panic attacks, i.e. sudden attacks of anxiety in which
physical symptoms predominate and are accompanied by fear of a
serious consequence such as a heart attack. The lifetime prevalence of
panic disorder is 1.5 to 2 percent.Itisseen 2to 3timesmore oftenin
females.
Clinical Features
💗 Shortness ofbreath and smothering sensations
🔴Choking, chest discomfort or pain
🔴Palpitations
🔴Sweating, dizziness, unsteady feelings or faintness
🔴 Nausea or abdominal discomfort
🔴Depersonalization or derealization
🔴Numbness or tingling sensations

104
🔴Flushes or chills
🔴Trembling or shaking
🔴 Fear of dying
🔴 Fear of going crazy or doing something uncontrolled

2.Define hypochondriasis
Hypochondrias is hypochondriasis is defined as a persistent
preoccupation with a fear or belief of having a serious disease despite
repeated medical reassurance.

3.What are the types of somatoform disorders

There are 4 types
🔴Somatization disorder
🔴Hypochondriasis
🔴Somatoform autonomic dysfunction
🔴Persistent somatoform pain disorder
Somatization Disorder
Somatization disorder is characterized by chronic multiple somatic
symptoms in the absence of physical disorder.
Hypochondriasis
Hypochondriasis is defined as a persistent preoccupation with a fear or
belief of having a serious disease despite repeated medical
reassurance.
Somatoform Autonomic Dysfunction
In this disorder, the symptoms are predominantly under autonomic
control, as if they were due to a physical disorder.
Persistent Somatoform Pain Disorder
The main feature in this disorder is severe, persistent pain without any
physical basis.

4.list down the types of anxiety disorders.

105
🔴Phobic anxiety disorder
🔴Other anxiety disorders
🔴 Obsessive-compulsive disorder
🔴Reaction to severe stress and adjustmen disorders
🔴Dissociative (conversion) disorders
🔴Somatoform disorder
🔴 Other neurotic disorders

5.Differentiate panic anxiety disorder and

generalized anxiety disorders

generalized panic anxiety

anxiety disorder disorder

🔴Generalized anxiety 🔴Panic disorder is

disorders are those in characterized by anxiety,
which anxiety is unvarying which is intermittent and
and persistent unrelated to particular
circumstances
🔴unlike phobic anxiety 🔴unlike phobic anxiety
disorders where anxiety is disorders where, though
intermittent And occurs anxiety is intermittent, it
only in the presence of a occurs only in particular
particular stimulus situations
🔴The prevalence rate of 🔴The lifetime prevalence of
generalized anxiety panic disorder is 1.5 to 2
disorders is about 2.5-8%. percent.

6.Enlist the Symptoms of Opioid Use Disorders

Acute Intoxication
It is characterized by apathy, bradycardia, hypotension, respiratory
depression, subnormal temperature and pinpoint pupils. Later delayed
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reflexes, thready pulse and coma can occur.
Withdrawal Syndrome
Narcotic withdrawal rarely produces a life-threatening situation.
Common symptoms include watery eyes, running nose, yawning, loss of
appetite, irritability, tremors, sweating, cramps, nausea, diarrhea,
insomnia, raised body temperature, piloerection and anorexia.
Withdrawal symptoms begin within 12hours of the last dose, peak in 24
to 36 hours and disappear in 5 to 6 days.
These injecting drug users have become a high risk group for HIV
infection

7.Explain the procedure of Disulfiram Therapy

Disulfiram is used to ensure abstinence in the treatment of alcohol
dependence. Its main effect is to produce a rapid and violently
unpleasant reaction in a person who ingests even a small amount of
alcohol while taking disulfiram.

8.Define Aversion therapy

: This therapy is based on classical conditioning. In alcoholism the
behavior patterns are self-reinforcing and pleasurable, but are
maladaptive for reasons outside the control of the client. In this
technique the client is exposed to chemicallyinduced vomiting or shock
when he takes alcohol

9.Mention withdrawal symptoms in alcoholic

patients.
Withdrawal syndrome: In persons who have been drinking heavily
over a prolonged period of time, any rapid decrease in the amount of
alcohol n the body is likely to produce withdrawal
symptoms. These are:
🔴 Simple withdrawal syndrome
•🔴Delirium tremens
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Simple withdrawal syndrome: It is characterized by mild tremors,
nausea, vomiting, weakness, irritability, insomnia and anxiety.
Delirium tremens: It occurs usually within 2-4 days of complete or
significant abstinence from heavy alcohol drinking. The course is short,
with recovery occurring within 3-7 days. It is characterized by:
.🔴 A dramatic and rapidly changing picture of disordered mental
activity, with clouding of consciousness and disorientation in time and
place
🔴 Poor attention span
🔴Vivid hallucinations,tactile hallucinations also occur
🔴 Severe psychomotor agitation, shouting and evident fear
🔴 Grossly tremulous
🔴Autonomic disturbances such as sweating, fever, tachycardia, raised
blood pressure,pupillary dilatation
🔴 Dehydration with electrolyte imbalances
🔴 Reversal ofsleep-wake pattern or insomnia
🔴Death

10.Explain the types of phobia

Types of Phobia
🔴 Simple phobia
🔴 Social phobia
🔴Agoraphobia
Simple phobia (Specific phobia) Simple phobia is an irrational fear of a
specific object or stimulus. Simple phobias are common in childhood.
Examples of some specific phobias:
🔴Acrophobia-fear of heights
🔴 Hematophobia-fear ofthe sight ofblood
🔴Claustrophobia-fear of closed spaces
🔴 Gamophobia-fear ofmarriage
🔴Insectophobia-fear ofinsects
🔴AIDSphobia-fear ofAIDS
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Social phobia Social phobia is an irrational fear of performing activities
in the presence of other people or interacting with others.
Agoraphobia It is characterized by an irrational fear of being in places
away from the familiar setting of home, in crowds, or in situations
thatthe patient cannot leave easily.

11.Describe 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 increasesin severity, there is a gradual restriction in
normal day-to-day activities. The activity may become so severely
restricted that the person becomesself-imprisoned at home.
12.Define Obsessive Compulsive Disorder
According to ICD9, obsessive-compulsive disorder is a state in which
"the outstanding symptom is a feeling ofsubjective 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

13.Explain exposure and response prevention

technique in Obsessive Compulsive Disorder
Exposure and response prevention This is vivo exposure procedure
combined with response prevention techniques. For example
compulsive hand washers are encouraged to touch contaminated
objects and then refrain from washing in order to break the negative

109
reinforcement chain (hand washing reducing the anxiety i.e.negative
reinforcement).

14.Explain thought stoppage in Obsessive

Compulsive Disorder
Thought stoppage Thought stopping is a technique to help an individual
to learn to stop thinking unwanted thoughts. Following are the steps in
thought stopping:
🔴 Sit in a comfortable chair, bring to mind the unwanted thought
concentrating on only one thought per procedure.
🔴As soon as the thought forms, give the. command 'Stop!' Follow this
with calm and deliberate relaxation ofmuscles and diversion of thought
to something pleasant.
🔴Repeat the procedure to bring the unwanted thought under control

15.Enlist the symptoms of post-traumatic

stress disorder
🔴 persistent anxiety,
🔴irritability,
🔴Insomnia
🔴 intense intrasive imagery (flashbacks)
🔴recurring distressing dreams,
🔴inability to feel emotion
🔴 diminished interest in activities
🔴agitation
🔴, hostility
🔴 self-destructive behaviour
🔴 social isolation

110
🔴fear,
🔴severe anxiety
🔴 mistrust
🔴Insomnia or nightmares
The symptoms may develop after a period of latency, within within 6
months after the stress or may be delayed.

16. Enlist the types of dissociative disorder

🔴Dissociative Amnesia
🔴Dissociative Fugue
🔴Dissociative Stupor
🔴Ganser's Syndrome
🔴Multiple Personality Disorder (Dissociative Identity Disorder)
🔴Trance and Possession Disorders
🔴Dissociative Motor Disorders
🔴Dissociative Convulsions (hysterical fits or pseudo-seizures)
🔴Dissociative Sensory Loss and Anesthesia

17.Explain 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 ofsevere
stress.Followingrecovery 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.

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18.Define conversion disorder and enlist the
types.
Conversion disorder(dissociative disorder) is characterized by the
presence ofone ormore symptoms suggesting the presence of a
neurological disorder that cannot be explained by any known
neurological or medical disorder.Patients are unaware of the
psychological basis and are thus not able to control their symptoms.

Types
🔴Dissociative Amnesia
🔴Dissociative Fugue
🔴Dissociative Stupor
🔴Ganser's Syndrome
🔴Multiple Personality Disorder (Dissociative Identity Disorder)
🔴Trance and Possession Disorders
🔴Dissociative Motor Disorders
🔴Dissociative Convulsions (hysterical fits or pseudo-seizures)
🔴Dissociative Sensory Loss and Anesthesia

19.Explain dissociative identity disorder

In this disorder, the person is dominated by two mormore
personalitiesofwhich 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.

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20.Enlist the symptoms of Korsakoff’s
syndrome
Korsakoff' s syndrome: The prominent symptom in Korsakoff' s
syndrome is gross memory disturbance.
Other symptoms include:
🔴 Disorientation
🔴Confusion
🔴 Confabulation
🔴Poor attention span and distractibility
🔴Impairment of insight

21.What are the types of somatoform

disorders.
Repeated
22.Enlist the characteristics of Wernicke’s
syndrome
Wernicke's syndrome:It is characterized by prominent cerebellar ataxia,
palsy of the 6th cranial nerve, peripheral neuropathy and mental
confusion

23.List down the commonly used sychotropic

substances.
🔴 Alcohol
🔴Opioids
🔴Cannabis
🔴 Cocaine
🔴Amphetamines and other sympathomimetics
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🔴 Hallucinogens, e.g. LSD,phencyclidine
🔴Sedatives and hypnotics, e.g. barbiturates
🔴 Inhalants, e.g. volatile solvents
🔴Nicotine
🔴Other stimulants, e.g. caffeine

24.Define obsessional thoughts .List the

common types of obsessional thoughts
content
These are words, ideas and beliefs that intrude forcibly into the
patient's mind. They are usually unpleasant and shocking to the patient
and may be obscene or blasphemous
Common obsessional thought contents are
🔴Fear of germs or getting dirty.
🔴Worries about getting hurt or others being hurt.
🔴Need for things to be placed in an exact order.
🔴Belief that certain numbers or colors are “good” or “bad”
🔴Constant awareness of blinking, breathing, or other body sensations.

25.Define Alcoholic Anonymous(AA) group

AA considers alcoholism as a physical, mental and spiritual disease, a
progressive one, which can be arrested but not. 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. crisishe can obtain immediate help by
telephone. Once sobriety is achieved he is expected to help others

26.Define simple phobia with examples.

Simple phobia (Specific phobia) Simple phobia is an irrational fear of a
specific object or stimulus. Simple phobias are common in childhood.
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By early teenage most of these fears are lost, but a few persist till adult
life.
Examples of some specific phobias:
🔴 Acrophobia-fear of heights
🔴 Hematophobia-fear ofthe sight ofblood
🔴• Claustrophobia-fear of closed spaces
🔴 Gamophobia-fear ofmarriage
🔴Insectophobia-fear ofinsects
🔴AIDSphobia-fear ofAIDS

Unit 10 NURSING MANAGEMENT OF PATIENTS

WITH PERSONALITY ,SEXUAL AND EATING
DISORDERS. (SHORT ANSWERS)
1.Define narcistic personality disorder
A disorder in which a person has an inflated sense of self-importance.In
this 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.
Narcissistic personality disorder is found more commonly in men. The
cause is unknown but likely involves a combination of genetic and
environmental factors.

2.List down the features of sociopathic

personality
Antisocial (Dissocia/) Personality Disorder (Sociopath, Psychopath)
💓Failure to sustain relationships
💓Disregard for the feelings of others
💓Impulsive actions
💓 Low tolerance to frustration
💓Tendency to cause violence
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💓Lack of guilt
💓Failure to learn from experience

3.Define gender identity disorder and its types

These disorders are characterised by distur bance in gender identity,
i.e. the sense of one’s masculinity or femininity is disturbed.
Types.there are 4 types
1. Transexualism: Male and femaleit is again divided into 2; primary and
secondary.
2. Gender identity disorder of childhood.
3. Dual-role transvestism.
4. Intersexuality

4.List down the characteristics of bulimia

nervosa
• An irresistible craving for food: There areepisodes 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

5.Define pedophilia
Paedophilia is a persistent or recurrent involve ment of an adult (age
>16 years and at least 5 years older than the child) in sexual activity
with prepubertal children, either heterosexual or homosexual.This may
be associated with sexual sadism. The paedophilic behaviour may be
either limited to incest or may spread to children outside the family.

6.Differentiate sexual sadism and masochism

Sexual sadism Masochism

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 In this disorder, the person is
sexually aroused by physical
and/or psycho logical
humiliation, suffering suffering
or injury of the sexual partner
Most often the person inflicting
the suffering is male,
The methods used range from
restraining by tying, beating,
burning, cutting, stabbing, to
rape and even killing
Here the person (the ‘masochist’) is
sexually aroused by phy sical and/or
psychological humiliation, suffering or
injury Indi icted on self by other
Most often the masochist is a female
though any pattern is
possible.
The methods used are the same as the
ones used in sexual sadism. Only there
is a role reversal

7.differentiate transsexualisum and

tramsvestism
Transsexualism: In this, there is a persistent and significantsense of
discomfort regarding one's anatomic sex and a feeling that it is
inappropriate to one's perceived gender
Transvestism: Sexual arousal occurs by wearing clothes ofthe opposite
sex.In some cultures, transvestism is practiced for religious, traditional,
or ceremonial reasons.

8.Enlist the complication of anorexia nervosa

1.bradycardia
2.hypotension
3.dry skin
4.laungo hair

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5.starvation
6.constipation
7.hepatitis
8.dysphiagia
9.hypoglycemia
10.pneumonis
11. Emphysema
12.death

9.Define voyeurism
This is a persistent or recurrent tendency to observe unsuspecting
persons (usually of the other sex) naked, ,disrobing or engaged in
sexual activity.This is often followed by mastur ba tion to achieve
orgasm without the obser ved person(s) being aware. This is almost
always seen in males

Unit –XI
1.Define Mental retardation. List down the
Etiology of Mental retardation
Mental retardation refers to significantly subaverage general
intellectualfunctioning resulting in or associated with concurrent
impairments in adaptive behavior and manifested during the
developmental period" (American Association on Mental Deficiency,
1983)
Etiology
Genetic Factors
🔴Chromosomal abnormalities
🔴Down's syndrome

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🔴 Fragile Xsyndrome
🔴 Trisomy Xsyndrome
🔴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
🔴Prenatal Factors
Infections
🔴Rubella
🔴 Cytomegalovirus
🔴 Syphilis
🔴 Toxoplasmosis, herpes simplex
🔴Endocrine disorders
🔴Hypothyroidism
🔴Hypoparathyroidism
🔴Diabetes mellitus
🔴Physical damage and disorders
🔴 Injury
🔴Hypoxia
🔴Radiation

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🔴 Hypertension
🔴 Anemia
🔴 Emphysema
🔴Intoxication
🔴 Lead
🔴Certain drugs
🔴 Substance abuse
💗Placental dysfunction
💗 Toxemia of pregnancy
🔴 Placenta previa
🔴Cord prolapse
🔴Nutritional growth retardation
💗

• Birth asphyxia

• Prolonged or difficult birth

• Prematurity (due to complications)

• Kernicterus ,

• Instrumental delivery (resulting in head

injury, intraventricular hemorrhage)

Environmental and Sociocultural Factors
🔴Cultural deprivation
🔴 Low socioeconomic status
🔴Inadequate caretakers
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🔴Child abuse

• 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)

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Unit XIV LEGAL ISSUES IN MENTAL HEALTH
NURSING: (SHORT ANSWERS)
1.Define parole
Parole is the permission given to patients to perform certain rituals
or attend certain family functions.
🔴Relatives are clearly instructed about the purpose for which the
patient is being sent home and when he should be brought back.
2.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 selfor others, leave of absence may
be granted (for a period of maximum 60 days).
3. Enlist the legal responsibility of a mental
health nurse
🔴The nurse should Protect the patient's rights Keep legal records safely
🔴Maintain confidentiality of patient information
🔴Take informed/substitute consent from patient/relatives for any
procedure
🔴Explain based on level of anxiety, span of attention and level of ability
to decide
🔴Both the laws in the state in which they practice
🔴Criminal and civil responsibilities of mentally ill patients
🔴Legal documentation

.4.Types of admission
🔴Admission on VoluntaryBasis

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🔴Admission under Special Circumstances
🔴Admissionunder ReceptionOrder
🔴Admission in Emergencies
🔴Temporary Treatment Order
🔴Admission of Mentally Ill Prisoners
🔴Miscellaneous Admission

5.types of discharge
🔴 Discharge of a Patient Admitted on Voluntary Basis
🔴Discharge of a Patient Admitted under Special Circumstances
🔴Discharge of a Patient Admitted on Reception Order
🔴Discharge of a Patient Admitted by Police
🔴Dischargeof a Mentally Ill Prisoner

6.List down the objectives of Mental health

act
💗To regulate admission into psychiatric hospitals and psychiatric
nursing homes.
🔴To protect society from the presence of mentally ill persons.
🔴To protect citizens from being detained
in psychiatric hospitals nursing homes without sufficient cause
🔴To provide legal aid to mentally illpersons at state expense in certain
cases.
🔴To regulate maintenance charges of
psychiatric hospitals/nursing homes.

7.Explain nursing malpractice

If the malpractice suit has to stand and be decreed in favor ofthe
aggrieved patient, he will have to prove various facetswhich
contributed to the breach. However it is to be noted that the burden of
proof lies with the patient who in this case is the plaintiff. The various
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factors include:
🔴the nurse had a duty to discharge due
standards of care to the patient
🔴the nurse's performance was well
below the expected standards, thus causing a breach
8.Describe informed consent
In the course of normal treatment a series of interactions result
between a patient and a physician.
During such interactions the patient is allowed to fully consider and
comprehend the information about the proposed treatment. Such
consent istermed asinformed consent.It includes the mode of
administering the treatment, prognosis, side- effects and the risks.
9.Describe admission on reception order
On application: Only a relative not other than husband, wife, guardian
or a friend can make out an application for theadmission of a mentally
ill patient. Such an application should be made out to the magistrate in
writing supported by two medical certificates, one of them issued by a
gazetted medical officer.However no person being a minor or one who
has not seen the mentally ill patient in the last 14 days can make such
an application. The patient may now be admitted afterthe magistrate
obtains consentfrom the medical hospital

. 10.Describe admission not on reception order

The Mentally ill patients exhibiting violent behavior, creating obscene
scenes and dangerous to the society can be detained by the police
officer and produced in court within 24 hours of such detention,
supported by two medical certificates,subsequent to which the
magistrate issues a reception order.

11Explain McNaughten’s rule

The M'Naghten rule states that the individual at the time ofthe crime
did not know the nature and quality ofthe act and ifhe did know what
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he was doing,he did not comprehend ittobewrong.These rules are
alsoreferred to asthe 'nature and quality rule' and 'right from wrong'
test.

12. Explain testamentary capacity

As per the Indian Succession Act, testamentary capacity of the mental
ability of a person is a precondition for making a valid will. The testator
must be a major, free from coercion, understanding and displaying
soundness of mind. At times doctors and nurses are called upon to
witness the will of an ailing person. Under such circumstances the
doctor tests the testator for orientation, concentration and memory.

13Enlist basic rights of mentally ill

🔴 The right to wear their own clothes.
🔴 The right to have individual storage space for their private use.
🔴The right to keep and use their own personal thing
🔴The right to spend a sum of their money for their own expenses.
🔴The right to have reasonable access to all communication media like
telephone, letter writing and mailing.
🔴The right to see visitors every day.
🔴The right to hold civil service status.
🔴The right to refuse electroconvulsive therapy.
🔴The right to manage and dispose of property
14.Describe Durham’s rule
Durham test' or 'product rule' states that an accused person is not
criminally responsible if his/her unlawful act is the product of mental
disease or mental defect

15.Describe product rule

Same answer 16

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16.Enlist the civil responsibilities of a mentally
ill person
🔴Management of Properly
🔴Right to vote
🔴Testamentary Capacity
🔴Marriage
🔴Adoption
🔴Witness
🔴Contract
🔴Driving

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