Mental Health85-1

MENTAL HEALTH
NURSING
FILE
SIGNATURE OF EXTERNAL EXAMINER
SIGNATURE OF INTERNAL EXAMINER
SIGNATURE OF PRINCIPAL
MENTAL HEALTH NURSING
SUBMITTED TO: SUBMITTED BY:

MRS. DEEKSHA MS. JYOTI BATRA
ASSISTANT PROFESSOR M.SC. NURSING 1ST YEAR
MENTAL HEALTH NURSING MENTAL HEALTH NURSING
Sr. Content Teacher Sign.
No.
1 ASSIGNMENT
PHOBIA
NATIONAL MENTAL HEALTH ACT, 2017
NATIONAL MENTAL HEALTH PROGRAME
BEHAVIOUR THERAPY
ROLE OF A NURSE IN
PSYCHOPHARMACOLOGICAL THERAPY
2 NURSING CARE PLAN
SCHIZOPHRENIA
SCHIZO-AFFECTIVE MANIA
BIPOLAR AFFECTIVE DISORDER
PERSONALITY DISORDER
Delirium
3 CASE STUDY
OBSESSIVE COMPULSIVE DISORDER
POST- SCHIZOPHRENIA DEPRESSION
4 CASE PRESENTATION
SUBSTANCE ABUSE
5 MENTAL STATUS EXAMINATION
6 MINI MENTAL STATUS EXAMINATION
7 HISTORY TAKING
PARANOID SCHIZOPHERNIA
ANXIETY DISORDER
SUBSTANCE ABUSE
8 PROCESS RECORDING
BIPOLAR DISORDER
MAJOR DEPRESSION
9 ECT REPORT
RECURRENT DEPRESSION
SCHIZOPHRENIA
10 DRUG BOOK
11 HEALTH TALK
STRESS MANAGEMENT
EATING DISORDERS
12 CLASS PRESENTATION
MANIA
CRISIS INTERVENTION
CASE STUDY
ON
OBSESSIVE
COMPULSIVE DISORDER

Patient’s Profile
Identification data
Client name : ABC
Age : 32 Years
Sex : Female
Ward : OPD
Education : 10th standard
Occupation : House wife
Marital status : Married
Religion : Hindu
Date of admission : 07.04.2023
Address : Agroha
Final diagnosis : Obsessive-Compulsive Disorder
Informant : Husband
Information : Reliable
Presenting Chief Complaints

According to Patient
Mujhe asa lgta h ki thakavt horhi h or hr time gussa aane lgta h,or dr lgne lgta h ,bar
bar hath dhoti rhti hu .kai bar mujhe ase lgta h ki mai agr bar bar hota dhoti hu ,us
vjay se mere hatho ku tvcha khrab hogyi h ,mujhe khud se hi kai bar gin aane lgti h ,
bar bar mai sfai pr jor dalti hu ptani mujhe ase ku lgta h ki hr trf gndgi h isliye bar bar
saf krti hu.
According to Informant
Repeated hand-washing
Damage to skin from excessive washing
Overemphasis on cleanliness and neatness
History of Present Illness

Mrs. Manjula is a house wife. Her age is 32 years. She was apparently normal before eight
month. Since eight month she is over conscious about cleanliness. Repeatedly she is washing
house, hands and taking bath 3-4 times a day. She is feeling anxious whenever someone
comes in her house. After going the visitor she used to wash floor and taking bath. She got
contact dermatitis because of repeated hand wash with soap. She is not accepting that she is
washing unnecessarily. She was admitted in hospital with the diagnosis of obsessive-
compulsive disorder on 07/04/2023 for further evaluation and treatment.
Past Psychiatric History
Not significant
Past Medical History
She did not have any major medical illness history.
Past surgical History
There is no significant surgical history.
Personal History
Perinatal history
She was delivered at hospital that was full term vaginal delivery. There were no significant
birth complications to the child as well as the mother.
Childhood history
She has achieved all milestones at time. Immunization schedule was adequately followed.
Educational history
Education was started at the age of 4 years. She was good in academic performance and had
good relationships with teachers and peers. Never dropout from school, she completed her
graduation.
Play history
She used to play with same sex peer group and had good relationship with peers.
Puberty
She has normal development during puberty.
Occupational history
She is a house wife. She is properly caring her family.
Sexual and marital history
She got married at the age of 26 year.
She has good marital relationship with her husband.
Family History
There was a nuclear family. These are 4 family members. There is no family history of
Hypertension/ Diabetes mellitus/ Psychiatric illness/Alcoholism or suicide.
Family tree
Male Male
Female patient
Premorbid personality
Interpersonal relationships : Good relationship with family member.
Use of leisure time : Watching T.V.
Predominant mood : Mood alteration ()
Attitude towards self and other : Self-appraisal of abilities and behaving normally with
others.
Attitude towards work and responsibility : She is interested in doing work and is a
responsible housewife
Religious beliefs and moral attitudes : Having faith on religions and participating in
religious activity.
MENTAL STATUS EXAMINATION
General appearance and behavior

Personality : She is Ectomorphic &Looking same age
Eye-to-eye contact : Maintained
Psychomotor activity : She is a conscious, Normal activity
Rapport : Maintained properly
Posturing : Normal posture
Clothing & Grooming : She was a well groomed & Hygienic
Speech
Student Nurse : Aapka naam kya hai?
Client : Manjula
Initiation : Patient responded when talk
Reaction time : Normal
Rate : Slow
Productivity : Pressured speech
Volume : Decreased
Tone : Normal variation
Relevance : Relevant
Stream : Normal
Coherence : Coherent
Others : No rhyming, punning, echolalia perseveration or neologism.
Inference:
Speech sample:
Mood
Subjective
Student nurse : Aap kaisa feel kar rhi hai?
Patient : : Thodi stressed hu.
Objective : Anxious mood.
Inference
Thought
Student Nurse : Kya aapke dimag me koi vichar bar bar aata hai?
Client : Jab bhi mai kisi cheez ko chhuti hut oh mujhe aisa lgta hai ki hath gande ho gye aur
jab tak hath na dholu bechaini rahti hai.
Stream : Obsession is present. There is no retarded thinking thought block and flight of
ideas.
Content of thought
Student nurse : kya aapko aisa lagta hai ke koi tumhe nukshan pahuchana chahta hai
Client : nahi
Remarks : No delusion.
Perception
Hallucinations
Student Nurse : Aapko koi aawaje sunai deti hain ya koi jo sirf apko dikhta ho?
Client : Nahi
Remarks : No hallucinations present
Sensorium
Consciousness
Student Nurse : Hello,manjula
Client : Hello, sir
Remarks : Patient has obeyed by calling her name
Orientation
Person
Student Nurse : AApke sath ye kaun baithe hain?
Client : Meri Nanad..
Remarks : Oriented to person
Place
Student Nurse : Abhi aap kaha hain?
Client : RML hospital me.
Remarks : Oriented to place
Time
Student Nurse : Aaj kaun sa din hai?
Client : Mangalwar.
Remarks : Oriented to time
Attention
Student Nurse : in numbers ko ulta boliye 2, 4, 6, 8, 10.
Client : 10, 8…4..6..2.
Remarks : Attention aroused with difficulty
Concentration
Student Nurse : Mahino ke naam bataiye ulte side se?
Client : December, November…September, October, June, July …August, March
….January.
Remarks : Concentration sustained with difficulty
Memory
Immediate
Student Nurse : Aap in sabdo ko boliye Table, Pen, Rose, Bus and Tree.
Client : Table, Pen, Rose, Bus and Tree
Remarks : Immediate memory intact.
Recent
Student Nurse : AApne subah naste me kya khaya hai aaj?
Client : Roti aur sabji aur chai.
Remarks : Recent memory intact.
Remote
Student Nurse : Aapka birthday kab aata hai?
Client : 15 feb.
Remarks : Remote memory intact.
Intelligence
Student Nurse : Abhi desh ke pradhanmantri kaun hain?
Client : Modi ji hain.
Student Nurse : India ka president kon hai?
Client : Dhyan nhi hai.
Student Nurse : India ki rajdhani kya hai?
Client : Delhi.
Student Nurse : Lal kila kha hai?
Client : Delhi mein.
Student Nurse : Delhi ka chief minister kon h?
Client : Kejriwal.
Remarks : Normal intelligence as per educational status.
Abstraction
Student Nurse : kutte aur sher ek jaisi kaun si bate hain aur alag kya hai unme ?
Client : Dono Janwar hai Kutte ko palte hain aur sher ko pal nai sakte.
Judgment:
Student Nurse : Agar yah ape abhi aag lag jaye to aap kya karengi”?
Client : bhag jaungi yaha se or fire bigrade ko phone krungi.
Remarks : Judgment is intact
Vital Signs:
S. No. Vital Sign Normal Value Patient’s Value
1. Temperature 98.60 F 97.40 F
2. Pulse 72-90 Beats/M. 78 Beats/M.
3. Respiration 14-20 Breath/M. 18 Breath/M.
4. Blood Pressure 120/80mmHg 130/80mmHg

Medication chart:
Alprazolam – 1mg B.D.
Fluoxetin – 20mg B.D.
Haloperidol – 10mg B.D.
Buspiron – 5mg B.D
Tra D
Pharma Fre
de Grou o Ro Contra-
S. N. cological que Action Indication Side-effects Nsg. Responsibility
Na p se ute Indications
Name ncy
me s
Anxit Alprazola Short 1 Oral BD It act on BDZ Generalized Hypersensitivi Nausea, Check the physician’s
m acting mg receptors I and anxiety ty, acute vomiting, order.
Benzo II which is disorder, Panic narrow angle weakness, Medication given must
diazep linked with disorder, glaucoma, epigestric pain, be charted on the
1.
ines GABA receptor Insomnia, pregnancy, dry mouth, patient’s case sheet.
and enhancing Acute mania. lactation body pain Check the five rights for
GABA drug administration
transmission. Always address the
Fluda Fluoxetin SSRI 20 Oral BD It inhibit the re- Depressive Severe renal Dry mouth, patient by name and
c mg uptake of episode, failure, constipation, make certain
2. serotonin at dysthymia, hypersensitivi sedation. identification
post synaptic enuresis, panic ty Do not leave the patient
space. attack. until the drug is
Halop Haloperid Butyro 10 Oral BD It blocks the Schizophrenia, Closed angle Sedation, swallowed
idol ol pheno mg D2, D3 and D4 drug induced glaucoma, hypotension, Do not allow the patient
nes receptor in psychosis, Coma Extra pyramidal to carry drugs
3. mesolimbic Mania, ADHD, resulting CNS symptoms. Do not force oral
Other therapeutic therapies:
Yoga therapy,
Individual psychotherapy,
Progressive muscle relaxation
Aversion therapy
OBSESSIVE COMPULSIVE DISORDER
Introduction
OCD is psychiatric disorder characterized by subject’s obsessive, distressing,
intrusive thoughts and related compulsions /task/ rituals attempt to neutralize the obsessions.
Obsessions & compulsions are source of distress, time consuming and causes impairment in
individual’s ability socially, occupational and school functioning.
Definition
Recurrent thought or ideas (Obsessions) that an individual is unable to putout of his or her
mind and action that an individual is unable to refrain from performing (compulsions).
Obsessions & compulsions are severe enough to interfere with social and occupational
functioning.
Etiology
Biological theories
Neurotransmitter’s
Serotonin
Noradrenaline
Genetics
Electrophysiological studies
Electroencephalography
Evoked potentials
Brain imaging
Cranial CT & MRI Scans
Behavioral theories
Psychodynamic theories
Neurotransmitter’s
Serotonin – recent clinical and laboratory studies have suggested that changes in brain
serotonin (5-HT) function may be contribute to anxiety types behavior among the anxiety
disorder , perhaps the most compelling evidence implicating 5-HT exists for OCD.
Noradrenaline – OPD patients were found to have higher plasma free 3-methoxy- 4 – hydroxyl,
phenylglycal and plasma nor epinephrine levels. The maximum number of binding sites (Bmax)
triturated clonidine was significant greater in OCD patient than in normal. this pattern of alpha 2
adenorececeptor status is different than the patterns in major depression and panic anxiety there
was a blunted growth hormones, cortisol & ACTH response to clonidine in OCD.
Genetics
Several investigators from the time of griesinger (1868) have found evidence to suggested a
familial origin, in monozygotic twins, 1 st degree relatives of OCD clients the diseases is
common.
C. Electrophysiological studies
Electroencephalography – many of the earlier reports suggested EEG abnormalities in OCD.
Temporal lobe spikes & increased theta wave have been reported in sleep EEG of OCD
subject.
Evoked potentials – obsession patient are characterized by reduced amplitude and decreased
latencies of lobe EP component. The role of the frontal lobes in such cognitive function is
implicit and such a dysfunction.
D. Brain imaging
Cranial CT & MRI Scan – the first reported abnormally in cranial CT in OCD
was an increased in the ventricular brain ratio but this was not replicated subsequent studies
have shown similar results with the care date nuclear. Earlier report found non- specific
abnormalities on MRI of the brain in OCD.
2. Behavioral theories
Interplay b/w classical operant conditioning paradigms. The external aversive
stimuli interact with the organism with privies learning, such stimuli have acquired specific
significant. This result in the stimuli gaining more strength resulting in sensitization. Ritual
acts produce relief and thus through negative reinforcement increase the possibility of
repetition of the phenomena.
Mower’s 2 stages theory – Role of exposure & response prevention.
3. Psychodynamic theories
According to Freud, the anal erotic phase of psychosexual development was
responsible for the evolution of anankastic traits to defend against unacceptable anal
impulses.
Ego psychological theory
The conflict was thought to arise due to inadequate mastery of the oedipal
conflict, resulted in regression to the anal sadistic stag to avoid anxiety to which the subject
was already predisposed due to difficulties in the anal period of development. it stimulates
anal and aggressive impulsive against which defense mechanism are used .e.g. Isolation.
Undoing, reaction formation, orderliness, magical thinking, rigidity, regression.
Autoimmune response to group A streptococcal infection
NURSING PROCESS
S.NO. NEED PROBLEM
1. Reduce anxiety level. Anxiety
2. Participate in self care activities. Self care deficit.
Control obsessional thought, reduce
3. anxiety, social isolation, poor diet, obsessional thought, reduce anxiety,
insomnia, unrestful sleep. ineffective health maintenance.
Fear Decrease avoidance behavior.
4. Improve coping. Ineffective coping.
5.
Book Pictures In Patient
Types 1. Predominantly obsessional Mixed obsessional thought & act.
thought or rumination. Thought, ideas, mental images.
These may be ideas, thought, Washing hand &cleanliness of floor.
mental image, impulses which are
very much distressing to the
individual.eg A woman getting
idea to kill her child whom she
loves.
2.Predominantly compulsive act /
obsessional rituals e.g. washing,
checking, counting etc the
underlying overt behavior is fear,
the ritual act is a symbolic
attempt to overt the danger or
fear. Obsessional thought are ideas images or impulses that enter
3.Mixed obsessional thought & the individual’s mind again and again in stereotyped form.
Clinical act. Repeated hand washing.
Features Majority of OCD individual will

have both thought & acts.
Obsessional thought are ideas Some OCD suffers even fear that the bath soap.
images or impulses that enter the
NURSING DIAGNOSIS
1. Anxiety as related to earlier life conflicts secondary to obsessive-compulsive disorder (OCD) as evidenced by a decline in social and role
performance, repeated behaviors, and recurrent thoughts.
2. Social Isolation is related to past experiences of difficulty in interaction with others secondary to Obsessive Compulsive Disorder as
evidenced by lack of confidence in public, inability to make eye contact, lack of communication, obsession with one’s own ideas; repetitious
meaningless behavior.
3. Ineffective Coping related to situational crises secondary to obsessive-compulsive disorder as evidenced by obsessive conduct or
ritualistic habits, failing to do something for basic necessities, failure to respond adequately to responsibilities, and poor problem-solving
abilities
4. Self-Care Deficit related to excessive ritualistic habits secondary to Obsessive Compulsive Disorder (OCD) as evideced by the refusal to
practice self-hygiene, unclean clothes, uncombed hair, a bad body odor, lack of enthusiasm for choosing appropriate attire, and incontinence
Deficient Knowledge related to unawareness of potential side effects and unfamiliarity with the drugs being utilized secondary to the new
diagnosis of obsessive-compulsive disorder (OCD) as evidenced by verbally expressing a lack of knowledge or expertise or requesting
information, conveys a false impression of one’s health, performs desired or recommended health behavior incorrectly.
Nursing
Nsg. Diagnosis Goals Intervention Implementation Evaluation
assessment
Subjective Exhaustion related To reduce Identify stressor / root cause for Identified stressor / root cause for Reduce anxiety
data- to anxiety anxiety and anxiety. anxiety. and perform
Hallucinatio And obsessional perform Administer the drugs as per doctor’s Administered the drugs as per productive
n thought. productive prescription. doctor’s prescription. Acts by client
Delusions of Acts by client Observe action ,side of effects of Observed action ,side of effects of responded to
the responded to drugs. drugs. relaxation
persecution relaxation Record and report the observations Recorded and report the techniques with a
Confusion techniques made. observations made. decreased anxiety
Thought with a provide psychotherapy , behavior provided psychotherapy , behavior level
blocking decreased therapy based on symptom therapy based on symptom
Objective anxiety level. Encourage the client’s participation Encouraged the client’s participation
data- in relaxation exercises. in relaxation exercises.
Withdrawal Teach the client to use relaxation Taught the client to use relaxation
behavior techniques techniques
Hostility Help the client see mild anxiety Helped the client see mild anxiety
Inability to
trust others
Inadequate
speech
SUMMARY
Mrs. ABC is a 32 year female patient diagnosed with OCD. She is responding properly and
maintaining eye contact. She is conscious regarding health but over conscious about hygiene
her immediate and remote memory of infect. She is oriented to time, place and person.
Mrs. Manjula is a house wife. She was apparently normal before 8 month. she is over
conscious about cleanliness repeatedly .she is washing house , hand and taking bath 3-4 time
a day. She is feeling anxious when even some come in her house after going the visitor. She
used to wash floor and taking bath. She got contact dermatitis because of repeated hand wash
with soap. She is not accepting that she was washing unnecessary. She was admitted in
hospital with the diagnosis of OCD on 07-04-23 for further evaluation and treatment. I have
taken this case for my case study.
HEALTH EDUCATION
Psychoeducation:
Explain to the patient and family that schizophrenia is a chronic disorder with symptoms that
affect the person’s thought processes, mood, emotions and social functions through-out the
person’s lifetime.
Teach the patient and family about the importance of medication compliance and the
therapeutic/ non- therapeutic effects of antipsychotic medication
Instruct the patient and family to recognize impending symptoms exacerbation and to notify
physician when the patient poses a threat or danger to self or others and requires
hospitalization
Teach the patient and family to identify psychosocial or family stressors that may exacerbate
symptoms of the disorder and methods to prevent them.
BIBLIOGRAPHY
Townsend.M, (2007), “Psychiatric Mental Health Nursing”, Jaypee brothers, New Delhi,
India.
Doenges M.E. et al., (1995), “Psychiatric Care Plans Guidelines for Planning and
Documenting Client Care”, 2nd ed. F. A. Davis Company, Philadelphia, PA.
Ahuja.N, (2006), “A Short Text Book of Psychiatry”, Jaypee brothers, New Delhi, India.
Sreevani.R, (2008), “A Guide to Mental Health and Psychiatric Nursing”, Jaypee Brothers,
New Delhi, India.
CASE STUDY
ON
POST- SCHIZOPHRENIC DEPRESSION

HISTORY TAKING
IDENTIFICATION DATA:-
Name of the patient -ABC
Age /Sex -21/F
Father/Spouse –Rishi Ram
C.R No. -71091
Education -12th pass
Occupation -Labour
Income -900
Marital status –Unmarried
Religion -Hindu
Address –Dalamwala-Jind
D.O.A -06/05/23
Ward/Unit No –Psychiatric ward/unit-2
Informant – Sister in law
Information -Reliable
Presenting Chief Complaints:-

As per patient:-
Did not respond
As per informant:-
Soti nahi hai
Ajeeb ajeeb baate karti hai x10days
Apne aap se baate karti hai
TDI -2Years
History of Present Illness:-
Mode of onset -Acute
Course –Continuous
Intensity -Increasing
Precipitating factors –Not known
Maffi 20years female, unmarried, 10th pass labor residing in Hindu nuclear family of LSES of rural background of Jind.
27July 2019 Patient was asympatomatic but when she get to know that one girl from her village married against wishes of her parents. As per her
cousin brother ye sochti bhut jyada h.. One day when all ladies of her house talked about this, she started behaving abnormally , she started self
muttering and said mai aisi vaisi ladki nahi hu, vo kyo bhaag gyi ghar se galti ki usne, nahi karni chahye thi, kaha jaa rhi h tu mat jaa. She
became irritable and started roaming in her house. When someone try to stop her she do this excessively. This behavior was continued for
10days. She did not engage in household work that time. Her self care was decreased, she took bath with the help of her sister in law. Her sleep
was decreased to only 2hours . her appetite was also decreased . she ate only when someone asked from her.
on 30july 2019After 2days of initiation of symptoms, she developed fever then she was taken to shanti hospital Jind. According to her cousin
brother doctor said her B.P low so IV fluids givn with multivitamin. Patient was admitted for 3days. During her hospital stay, her self muttering
continued and she used abusive language for doctor and nurse. So sedation given to the patient. No documented record of sedation is available.
Then she was discharged from hospital. And patient was sympatomatic till 2years.
28july2022According to her cousin brother, one day shee suddenly stop talking to anyone and not oriented to time, place and person. She took
treatment from PGIMS on OPD basis.
Then She was taken to local baba on 1/8/22 baba did some pooja and rotated cloth over her head. Then She was taken to come. After that She
did not open her eyes and did not ask for food. Her sister in law fed her 2days(tea and biscuits) her sleep got decreased in night. Now she use to
sleep for 10-12hrs/day.
On 3/5/23 she started talking after silent behavior. This time her symptoms of self-muttering increased to next level, become aggressive,
laughing and started shouting. She was taken to PGIMS Rohtak in emergency where tab. Olanzapine 10mg 1HS and tab. Cloze 0.5mg 1HS was
given for 3days. According to her cousin she improved then before. Her self-muttering decreased slightly but improvement in sleep pattern. But
next day she again started self-muttering excessively. Sometimes she started crying without any reason for 1-2hours. According to her cousin her
symptoms aggravated, again her sleep got decreased inspite of taking medication. Now she came in OPD, at MAMC, Agroha.
Treatment History:-
Two years back patient took treatment from PGIMS Rohtak on OPD basis.
She took treatment was

28/05/23
Tab. Olanzapine 10mg 1HS c
Tab. Cloze 0.5mg 1HS X15days
Patient get relieved in 3-4days.

ECT -No
Psychotherapy -No
Past Psychiatric and Medical History

Psychiatric:- No history of psychiatric illness in past
Medical:-No history of seizure
No history of head injury, consciousness or chronic fever
No history of DM/HTN/CAD/HIV positivity
Family History
Client belongs to Hindu nuclear family of lower socio economic status
No family history of psychiatric illness.
50yrs/M 34yrs/F
Illiterate Died in 2012
Unemployed due to cancer
Father Mother
Cancer
Died 21yrs/F Died
1996 12th pass 2014
Student
Self
VII. Personal History
Perinatal history
Antenatal period –Normal
Intranatal period –Normal
Birth –At full term
Birth cry –Immediate
Birth defects –No
Postnatal complications -No
Childhood history
Primary caregiver -Mother
Development milestone- Normal
Behavior and emotional problems- No
Illness during childhood- No
Educational history
Age at beginning of formal education –5years
Emotional problems during adolescence -No

Puberty
Age at appearance of secondary sexual characteristics -12Years
Anxiety related to puberty changes-Not Significant
Age at menarche -13Yrs
Regularity of cycles, duration of flow -Normal
Occupational History- Unemployed
Marital History
Unmarried
Interpersonal relationship –Extrovert and good
Family and social relationships -Good
Attitude to Self – Confident and respect everyone
Attitude towards work and responsibility –Responsible, and do all the work assigned to her
Religious belief-She has faith in god
Habits –Watching T.V and taking to neighbors
Eating pattern -Regular
Elimination -Regular
Sleep -Regular
Use of drugs, tobacco, alcohol –No
Date of Examination-3/6/23
A. GENERAL APPEARANCE AND BEHAVIOUR:- Patient was sitting on her bed. Looking one’s age, No physical deformity. When
student went to her she accepted greeting.
Facial expression:-pleasant
Level of grooming:-normal
Level of consciousness:-fully conscious
Level of cleanliness:-adequate
Mode of entry:-came willingly
BEHAVIOR:-Abnormal
Cooperativeness:-normal
Eye to eye contact:-maintained
Psychomotor activity:-Increased
Rapport:-spontaneous
Gesturing:-normal
Posturing:-normal
B. SPEECH:-
Initiation:- speaks when spoken
Reaction time:-Delayed
Rate:- slow
Volume:- normal
Tone:-monotonous
Stream:- blocking
Pitch:-low
Impression:-poverty of speech
C. MOOD AND EFFECT:-
Subjective
Student-aapka mann kesa hai?
Client-mann udas rahta hai
Student-mann kyo udaas rahta h?

Client-mai kisi layak nhi hu.
Impression-Irritable and depressed, idea of hopelessness
Objective
Sad and irritable
Impression:-depressed, Inappropriate mood and affect, non- reactive
D. THOUGHT:-
Stream(flow of thought)-Retarded thinking(poverty of thought)
Form-
Student- Kya aapne khana kha liya?
Client- Nhi abhi nhi khaya.
Content(idea)
Student:-Aapke mann me kya khyal aate hai? Kya aapka marne ka dil karta hai?
Client:- Mai kisi layak nahi hu marne ka dil karta hai. Ab kuch ni ho skta, meri shaddi nhi ho rahi hai. Mere ghar vale ish bat se presan hai aur
muje kuch nahi karna hai bss. Kisi se baat krne ka dil nhi krta Muje nhi jinna or muje kisi se koi matlab nhi h.
Impression:- Helplessness, Hopelessness and suicidal ideation, autistic thinking

Delusion:-
Student:- Kya aapko lgta hai ki koi aapko maarna ya nuksaan phuchana chahta hai?
Client:- nahi.
Impression:- No Delusional thinking
Thought alienation phenomenon:-
Student:-Aap khali baithkar kya sochti ho?
Client:-mute
Impression:-thought blocking
Obsession:-
Student:-Kya aapko kabhi kisi kaam ko bar bar karne ka mann karta hai?
Client:-Nahi
Impression:-no obsession
Phobia:-
Student:-kya aapko kisi cheej se dar lagta hai?
Client:-nahi mujhe nahi lagta

Impression:-no irrational fear
Student:-aapke ghar me kon kon hai?
Client:- mai, bhai, bhabhi or papa or bachhw bhi hai
Student:-aapke padosi kese hai? Kya aap unse baate karti ho?
Client:-thik hai but mera kisi se baat karne ka dil nahi karta akela rahna hi acha lgta hai
Impression:-decreased social relations
IMPRESSION:-
Helplessness, hopelessness, suicidal ideation

Thought blocking
No obsession and fear of irrational things
Decreased social relations
Autistic thinking
E. PERCEPTION:-
Illusion
Student:-mere hath me kya hai?
Client:-pen or copy hai

Impression:-no illusion
Hallucination
Student:-kya aapko aisa kuch sunayi deta hai jo kisi or ko nahi sunta?
Client:- ha, ek aawaj sunai deti hai ki mai tuje nhi chodungi aur mere pass aa ja.
Student:-kya aapko aisa kuch dikhayi deta hai jo kisi or ko nahi dikhta?
Client:- muje har jagah ek ldki dikhti hai.
Impression:- No illusion, visual and auditory hallucination
F. COGNITIVE FUNCTION(Neuropsychiatric assessment):-
Consciousness:-
Student:-hum yha par kitne log hai?
client:-do
Impression:-patient is fully conscious
Orientation;-
Time
Student:-abhi kya time hua hai

Client:-shyam ho gyi hai
Place
Student:-aap is time kaha par h?
Client:-Hospital, Medical Rohtak
Person
Student:-sath me kon hai, mai kon hu?
Client-sath me bhabhi or aap ho.
Impression:- patient was oriented to time, place and person.
Attention
Student:- mai aapko kuch digit dungi unko repeat krna hai? 11,13,15.17
Client:- 11,13,15,17
Concentration
Student:- 22, 27, 29,31,33
Client:-33,31,29,27,22
Impression:- good upto 4 digits

Memory
Immediate
student:-hospital, fan, bed inko recall karo?
Client:-hospital, fan, bed
Recall-3/3
Recent
student:-subah khane me kya khaya?
Client:-roti, karele ki sabji or lassi.
Remote
student:-aapka birthday kb hai?
Client:-24july 1998
Impression:-intact memory
Intelligence
Student:-days in week
Client:-7
Student:-name of PM
Client:-Modi
Student:- Independence day
Client:- 15august
Student:- Ram ko vanwash kitne saal ka hua?
Client:- 14years
Impression:-adequate knowledge
Abstraction
Similarities
Student:-Pen-pencil
Client:-likhte hai
Student:- Apple-mango
Client:- phal hai dono
Dissimilarities
Student:-aankh and kaan?

Client:-aankho se dekhte hai kaan se sunte hai
Proverb
student:-9.2.11?
Client:-bhaag jana
Student:-haath peele karna?
Client:-shaadi karna.
Impresson:-intact and abstract thiking.
Judgment
Personal
Student:-ghar jake kya krogi?
Client:-ghar ka kaam karungi
Social
Student:-aas paas k logo se baat kroge?
Client:- nahi
Test
Student:-agar hospital me aag lag jaye to kya karogi?
Client:- No response by client
Impression:- No proper judgement
G. INSIGHT:-
Student:-kya takleef hai aapko?
Client:-dimak ki takleef hai
Student:- kya aapko lg raha hai aap thik ho jaoge
Client:- ha abhi thik hu
Impression:-insight present
DIAGNOSTIC FORMULATION:-
Patient Maalti 21yrs old female, studied till 12 th , unmarried resident belong to hindu nuclear family of LSES of rural background of district jind
has been admitted with continuous illness of 10days with acute onset characterized by self muttering , irrelevant talk, decreased sleep, deceased
self care, wander behavior, visual hallucination with similar episode in past 2years and recovery in 1week of past episode.
Provisional Diagnosis:-Post schizophrenic depression(F20.4)

PHYSICAL EXAMINATION:-
General appearance- Fair, afebrile, good body built
Temp. – 98.4 F
B.P.- 120/80 mm of Hg
Pulse- 84/min
Respiratory rate- 18/min
CVS- S1S2 normal, no murmur sound heard
Respiratory system- B/L chest clear
No added sound present
Abdomen- soft and non-tender
No organomegaly present
Neuromuscular system- good muscle tone and strength
Lymph node- no enlarge lymph node

POST- SCHIZOPHRENIC DEPRESSION
Definition-
Post-schizophrenia depression describes a depressive episode that arises in the after-month of schizophrenic illness. Some schizophrenic
symptoms may still be present but no longer dominate the clinical picture. These persisting schizophrenic symptoms may be “ positive” or “
negative” though the latter are more common.
This depressive disorder is associated with an increased risk of suicide.
How is it diagnosed?
Post- schizophrenia depression is diagnosed when:-
The individual has had a schizophrenia illness meeting the general criteria for schizophrenia within the past 12 months.
Some schizophrenia symptoms are still present
The depressive symptoms are prominent and distressing, fulfilling at least the criteria for a depressive episode, and have been present for at least
2 weeks.
Symptoms-
Mood swings ranging both ends of the emotional spectrum

Feeling of hopelessness and apathy are common
Mild depression and other schizophrenia symptoms
Depressive symptoms
Psychopathology-
Careful clinical and psychological analyses due to psychopathology are defined four types of depression. From which two types of depression-
agitated and asthenic prevailed in active phase of schizophrenia and remained two hypochondriac and apathy mainly occur during stabilization.
Cognitive symptoms and specified psychopathological and neurodynamical input in alteration of personality structure.
Thought blocking becomes prominent.
Clinical manifestation of post schizophrenia depression-

Book picture Patient’s picture
Autistic thinking (preoccupations totally

removing a person from reality)
Thought blocking
Poverty of speech
Sleep disturbances
Hostility or aggressive behavior
Delusion of persecution and hallucination is

auditory
x
Decreased functioning in work, social relations

and self- care
Suicide can occur due to the presence of

associated depression, command hallucinations
Disturbances of consciousness, orientation,

X
attention, memory and intelligence
X
Organic cause
INVESTIGATIONS AND DIAGNOSIS:-
KFT- LFT
Blood urea- 17 mg/dl SGOT- 39U/L
S. creatinine – 1.0 mg/dl SGPT- 22U/L
S. uric acid- 5.8 mg/dl S. Protein- 7.2 mg/dl
S. sugar- 123 mg/dl
TREATMENT BOOK PICTURE PATIENT PICTURE
Conventional antipsychotics Tab. Aripiprazole 20mg OD
Chlorpromazine- 300-1500mg/day Tab. Chlorpromazine 100mg 1HS
Fluphenazine decanoate- 25-50mg IM every 1-3 weeks
Haloperidol – 5-100mg/day PO
Trifluoperazine- 15-60mg/day PO
Atypical antipsychotic
Clozapine- 25-450mg/day PO
Resperidone – 2-10mg/day PO
Olanzapine -10-20mg/day PO
NURSING MANAGEMENT FOR POST- SCHIZOPHRENIC DEPRESSION-
Nursing assessment-
A nursing assessment includes information regarding any previous incidence of mental illness or psychotic episodes-
Observe behavior pattern, posturing is normal, maintaining eye to eye contact, and accept greetings
Hygiene was also adequate
Thought disturbances is experiencing
Patient reaction time is delayed, volume is high
Patient had auditory hallucination and delusion of persecution
Patient performed self- care activities that is sleep pattern is abnormal
Patient had withdrawal behavior
Nursing Care Plan
Nursing diagnosis-
Disturbed thought process related to inability to trust, panic anxiety, possible hereditary or delusional thinking
Potential for violence, self- directed or at others related to command hallucinations evidenced by physical violence,
destruction of objects in the environment and self -distructive behavior
Self- care deficit related to withdrawal, regression , panic anxiety, cognitive impairment, inability to trust
Social isolation related to inability to trust, panic anxiety, delusional thinking , evidenced by withdrawal, sad, dull affect,
expression of feelings of rejection of aloneness imposed by othe
Nursing Nursing Goal Planning Implementation Evaluation
assessmen diagnosis
t
Subjective Potential for <Not injure others or <To maintain low level < Maintained low level of < Patient able to interact with
data- violence, self- destroy property or of stimulation ( low stimulation others appropriately and
directed or at self lighting, low noise, few anxiety, anger is reduced and
Hallucinati < Observe patient’s
others related to people etc.) in the patient feel comfortable
on <Verbalize feelings behavior frequently
command patient’s environment
of anger or
Delusions hallucinations < Remove all dangerous
frustration < To observe patient’s
of the evidenced by objects from the patient’s
behavior frequently
persecutio physical <Express decrease environment
n violence, feeling of agitation < To remove all
< Alert for signs of
destruction of fear or anxiety dangerous objects from
Confusion increasing fear, anxiety or
objects in the the patient’s
agitation
Thought environment and environment
blocking self -distructive < Apply mechanical
<To be alert for signs of
behavior restraints safely. Check
Objective increasing fear, anxiety
extremities for color, temp.
data- or agitation
and pulse distal to the
Withdrawa <To prevent harm to the restraints for every 15
l behavior patient or others minutes
Hostility <To apply restraints < Help the patient identity

HEALTH EDUCATION
Psychoeducation:-
For schizophrenia
Explain to the patient and family that schizophrenia is a chronic disorder with symptoms that affect the person’s thought processes, mood,
emotions and social functions through-out the person’s lifetime.
Teach the patient and family about the importance of medication compliance and the therapeutic/ non- therapeutic effects of antipsychotic
medication
Instruct the patient and family to recognize impending symptoms exacerbation and to notify physician when the patient poses a threat or danger
to self or others and requires hospitalization
Teach the patient and family to identify psychosocial or family stressors that may exacerbate symptoms of the disorder and methods to prevent
them.
For depression
Teach the family about the depression. Teach about the beginning symptoms of relapse may assist patients to seek treatment early and avoid a
lengthy recurrence
Discuss the importance of support groups and assist in locating resources
Teach the action, side effects and special instructions regarding medication
Discuss methods to manage side effects of medication
Tell the family to offer the patient some household responsibility within the patient level of capability to promote self esteem
Teach the family to recognize the symptoms of suicidal ideation and how to conduct a suicide assessment
Emphasize that antidepressants can cause constipation which may be prevented with a good bowel regimen adding fiber to the diet and drinking
water
Avoid making life changes while the patient is experiencing recovery from depression
Help the patient and family identify community resources such as suicide hotlines
CASE- PRESENTATION
ON
SUBSTANCE ABUSE

IDENTIFICATION DATA
Name XYZ
Age 60years
Sex Male
Bed no. 5
O.P.D no. 15/467942
Ward Psychiatry ward
Education 8th standard
Occupation labrour
Marrital status Married
Religion Muslim
Language Hindi
Diagnosis Schizophrenia
Identification mark Mole at right hand
Date of identification 4/5/2023
Date of assessment 8/5/2023
Informant Patient
Present chief complaints :
a) Psychological:
According to patient : Afim khana
Nind kam aana
Gussa karna
b) Social: He like to interact with other, he is introvert
c) Interpersonal: He has good interpersonal relationship
d) Occupational: Patient lives in house only no occupation history
e) Biological: Restlessness, insomnia
History of present illness
Duration 1 year
Mode of onset Acute
Course Episodic
Intensity Increasing
Precipitating factor No
Description of present illness:
Patient was apparently well 30year back now he gives history of consumption of opium husk from the last 30 year. Initially he started taking
opium husk with his friends. Patient works as a farmer and while working in a field patient feel lethargic and weakness sometime patient feel
pain all over the body and then one of his friend offer him opium husk then patient took opium husk with his own will and patient took one
spoon of opium husk and after ate that patient feel better and energetic and with the period of half an hour to one hour patient got relief from
body pain. After that patient starts taking opium husk daily. Patient took one spoon of opium husk per day for the next one year and after one
year patient feels weak again and body ache at afternoon time then patient increased his opium husk intake habits to get the desire effect and
patient starts to take opium husk twice a day morning or afternoon time.
And then after 3month patient start to take opium husk thrice a day. If the patient do not consume opium husk in a day patient had strong desire
or compulsion to take substance when he not consumed opium husk then he complaints of dysphonic mood, nausea, vomiting, muscle ache,
sweating, Insomnia and now Patient is taking treatment in psychiatric ward
Treatment History
Name of the Chemical Action Dosage Route
drug Name
Tab Clox Clonazepam Antipsychotic 0.5mg Oral
Tab tramacon Tramadol Opioid 100mg Oral
SR Analgesic
No. Of previous episodes with onset and course: 30 years
Complete and incomplete remission: Incomplete

Duration : 30 years
Treatment details and its side effects:
Precipitating factors: No
Past Medical history: Patient has not significant medical history
Past surgical history: Patient has not any significant of surgical history.
Family history:-
Family tree
Male Male
Female
Male patient
Name of the family Relation with Age/Sex Education Occupation Marital status Mental Health status
member patient
Wazid Father 85/M Illiterate Farmer Married Healthy

Abdul Himslf 62/M 7th pass Farmer Married Opioid dependence
Bano Wife 60/F Illiterate Housewife Married Healthy
Babo Son 35/M 10th paas Farmer Married Healthy
Sara Daughter 28/F 5th pass House wife Single Healthy
Sahid Son 22/M B.A pass Clerk Single Healthy
Rihana Daughter 19/F !2th paas Student Single Healthy
Personal History
Prenatal History
Antenatal period No any significant of Prenatal history
Intranatal period
Birth
Birth defect
Postnatal Complication
Childhood history
Primary care giver
Feeding
Age of weaning
Developement Milestones No any significant of Prenatal history
Behaviour and emotional Problems
Illness during childhood
Educational history
Age at beginning of formal education 5year

Acedemic performance Normal
Extra curricular achievements No
Relationship with peers and teachers Good
School phobia No
Reason of termination of study low socio economic status of father
Play history
Game played local indoor games

Relationship with playmates Good relationship with play mates
Emotion problem during adolescence No
Occupation History; Patient is Farmer
Sexual and marital history Married
Interpersonal Relationship Introvert

Family and social relationship Good
Attitude to work and responsibility Patient is responsible to work
Religious, Belief and moral attitude patient is religious
Habits
Eating pattern patient takes 3Meals in a day

Elimination Bowel and bladder habits are normal
Sleeping pattern Patient takes 5-6 hours during night and 1 hour of sleep during a day
General Appearance and Behaviour
Appearance: Looks normal

Facial expression: - Anxious
Level of grooming: - Normal
Level of cleanliness: - Adequate
Level of consciousness- Fully consciousness
Mode of entry: - Come willingly
Behaviour: - Normal
Co-cooperativeness: - Cooperative
Eye to eye contact: - Maintained
Psychomotor activity: - Normal
Rapport: - Spontaneous
Gesturing: - Normal
Posturing: - Normal
Other movement: - Normal
Hallucinatory behaviour: No
Speech: -
Initiation: - Minimal
Reaction time: - Time taken to answer to question
Rate: - Normal
Productivity: - Normal
Volume: - low
Tone: - low pitch
Relevance: - Fully relevant
Stream - Normal
Coherence: - coherent
Others: - preservation
Nurse :- Aap apne bare me kuch btaye.

Patient:- Mera naam deepa hai, mai bimar hu
Inference- Patients speaks in Hindi. She have normal volume, tone, and rate of speech.
Mood and affect: -
Subjective
Nurse: - Aapka man kaisa hai?
Patient: - Mere man achha hai.
Objective
Patient affect is appropriate his mood.
Inference: - Patient is in normal mood.

Mood: - Normal
Affect: - Normal
Inference: - Affect is appropriate to mood.
Thought: -
Stream: Normal, Autistic thinking, thought block, Poverty of speech, Pressure of thought all are absent.
Form: Normal, Circumstantiality, tangantiality, neologism, verbigeration, flight of idea all are absent.
Content:
1. Delusion:-
Nurse: - Kya apko lgta hai ki aapki wife ka kisis se chakkar hai?
Patient: - Ha mujhe aisa lagta hai.
Inference: - Delusion of infidelity is abesent.
Nurse: - Kya apko lgta hai koi apko wash mei krna chahta hai?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Delusion of control is absent.
Nurse: - kya apko lgta hai aap koi mahan insan hai?
Patient: - nahi mujhe aisa nahi lagta or lgega bhi kyu.
Inference: - Delusion of grandiosity is absent.
Nurse: - kya apko lgta hai jab 2 log baat kar rahe hote hai to wo apke bare mei hi bat krte hai?
Inference: - Delusion of reference is absent.
2. Hypochondria:-
Nurse: - Kya apko lgta hai apko koi khtarnak bimari hai? Apne kayi hasptalo sei dwai li hai?
Patient: - na, mujhe nahi lgta hai or mane phle bhi dwai nahi li hai.
Inference: - Hypochondria delusion is absent
Ideas: -
Nurse: - kya apke man mei aisa khyal ata hai ki apki zindgi khtm hone wali hai?
Patient: - Nahi mujhe aisa nahi lagta lekin mujhe apni patni pe gussa ata hai to mujhe marne ka khayal ata hai.
Inference: - Suicidal ideas are present.
3) Obsessional Compulsive Phenomena: -
Nurse: - Kya apko lgta hai ki apke hath gande hai or aap unhe bar bar dhote hai?
Patient: - Nahi aisa nahi hai.
Inference: - No Obsessional/Compulsive phenomena present.
4) Phobia: -
Nurse: - Kya apko kisi cheej sei dar lgta hai?

Patient: - Nahi, Mujhe kisi cheej sei dar nahi lgta.
Inference: - Phobia is not present.
Perception: -
1) Illusions:-
Nurse: - kya apko rassi ko dekh ke aisa to nahi lagta hai ki ye saanp hai?
Patient: - Nahi mujhe aisa nahi lagta.
Inference: - Illusion is not present.
2) Hallucination: -
Auditory Hallucination:-
Nurse: - Kya jab aap akele bathe hote to apko kisi kism ki awaje to nahi suniee deti?
Patient: - Haa, mujhe awaje sunai deti hai aisa lagta hai meri patni or sadu apas me bate karte ho.
Inference: - Auditory Hallucination is present.
b) Visual Hallucination: -
Nurse: - Kya apko aisa kuch dikhayi deta hai jo kisi ko dikhayi nahi deta?
Patient: - Ha mujhe mere sadu dikhaiee dete hai.
Inference: - Visual Hallucination is present.
c) Olfactory hallucination: -
Nurse: - kya apko aisi koi badbu aati hai jaise kuch jal raha hai?
Patient: - Nahi aisa kuch nahi hai.
Inference: - Olfactory hallucination is absent.
d) Gastatory Hallucination: -
Nurse: - Kya apko aisa lgta hai ki kisi cheej ko khane per kdwa swad ata hai?
Patient: - Nahi aisa kuch nahi hota.
Inference: - Gastatory hallucination is absent.
e) Tactile Hallucination: -
Nurse: - Kya apko aisa lgta hai ki apke body pei kuch chalra hai mtlb jaise kuch reing raha hai?
Patient: - Nahi mujhe aisa kuch nahi lgta.
Inference: - Tactile hallucination is absent.
3) Dejavu-Jamaisvu: -
Nurse: - Kya aapko aisa lgta hai kisi jgah aap pehli bar gaye ho lekin apko lge ki aap yha phle bhi aa chuke ho?
Inference: - Dejavu is absent.
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye ho
Patient:- Nahi mujhe aisa nai lgta
Infrence:-Jamaisvu is absent
4) Depersonalization: -
Nurse: - Kya apko aisa lagta hai ki apme ya apki body mei kch change hua hai?
Inference: - Depersonalization is absent.
Cognitive function (Neuropsychiatric assessment)
Consciousness:-
Nurse- aap hospital kyun aye ho?
Patient- mujhe dimagi bimar hu isliye ilaz karane ayi hun.
Inference-Patient is fully conscious.
Attention: -
Nurse: - Aap mujhe 20 tak ginti sunao?

Patient: - Haa mujhe aati 1,2,3,4,5.......
Nurse:- kya aapko 10 se 1 tak ulti ginti aati hai?
Patient:- Haa mujhe atti hai 10,9,8,7,6...........
Inference: - Patient attention is normally aroused.
Concentration: -
Nurse: -100 me se 7 panch bar ghtaoo

Patient: - 93,86,79…. hote hai
Inference: - Patient concentration is normally sustained.
Orientation: -
Time: -
Nurse: - Abhi kya time hua hai?
Patient: - 2:50 pm huei hai.
Inference: - Patient is oriented to time.
Place: -
Nurse: - Yei Kaun si jagah hai?
Patient: - hospital
Inference: - Patient is oriented to place.
Person: -
Nurse: - Kya apko pta hai apke sath kaun hai?
Patient: - Haa meri maa h.
Inference: - Patient is oriented to person.
Memory: -
a) Immediate memory:-
Nurse - Mai apko ek no. duga apko wo no. mujhe dobara btana hai 9835664?
Patient: - 9835664
Inference: - Immediate memory is intact
b) Recent memory: -
Nurse: - Kal rat ko kya khaya tha aapne?

Patient: - yaad nai h
Inference: - Recent memory is poor.
c) Remote Memory: -
Nurse: - Aapka janam tithi kab hoti hai?
Patient: - august me 5 ko
Inference: - Remote memory is intact.
Intelligent: -
General fund of information

Nurse: - Diwali kab aati hai?
Patient: - November main.
Inference: - Patient intelligence is adequate.
Arithmatic ability
Nurse:- Mai apko 100 rs dekr agar 20rs le lu to btao ki apke pas kitne bachenge
Patient:- Mere paas 80rs bachenge
Infrence :-Intellegence is present
Abstractions: -
a) Proverbs
Nurse: - 9 or 2 11 hona ka kya matlab hai?
Patient: - Bhag jana
Inference: - Patient understanding regarding the proverb is good.
b) Similarities & dissimilarities

Nurse: - Pen or copy mei kya farak hai?
Patient: - pen se copy main likhte hai.
Inference: -Abstract thinking is Present
Judgement: -
Nurse:- Aap yaha se jane ke baad kya kroge?
Patient:- Mai ghr walo ki dekhbaal krungi.
Infrence:-Personal judgement is intact.
Nurse: - Agar aapke samne koi accident ho jaye to aap kya kroge?
Patient: - Logo ko mdad kei liye bulaugi.
Inference: - Social Judgement is intact.
Nurse: Agar apke ghr me aag lag jaye aap kya kroge?
Patient: sab milke aag nhujaynge.
Infrence: Test judgement is Present.
Insight: -
Nurse: - Aap yha kiske sath aye ho?
Patient: - Apni maa k sath
Nurse:- aapke yaha ane ka kya karan hai?
Patient:- mai yaha doctr banne aayi hu.
Nurse: - Kya aapko lgta hai aapko koi bimari hai?
Patient: - Nahi mujhe nahi lagta mai bimar hu.

Nurse:- kya aap dawaie rozana lete ho?
Patient:-kabi kabi
Inference: - Insight is absent grade 1st
Nurses notes
Day-1
S.no Date Time Medication Injection Activity done
01. ……..
4.5.2023 9am Clonazepam tab Assessment was done
02.
…….. History taking was done
10am Tramadol
03. Medication administred

B-complex ……..
1pm Mental status examination
04. done
Day-2
5.5.2023
9am Clonazepam ………. Patient was asking about fresh complaints
01
………. Health education was given to the patient and her family members
02.
10am Tramadol regarding medication and importence of follow up.
………
03.
12am B-complex
Day-3
1 6.5.2023 9am Clonazepam ……… Vital sign done
2 10am Trmadol ……… Health education is given to the

patient regarding dietry pattern
Conclusion:-
Myself Jyoti Batra, student of M.Sc. Nursing 1st year. I am posted in Psychiatry ward. My patient Mr abdul with diagnosis Schizophrenia
assigned to me. I learned about this disorder and various psychiatric illnesses and their management and how to deal with mentally ill patient. I
learnt all these things under the supervision of Miss Renuka mam . I learnt about pharmacology of substance abuse patient and also about
psychotherapies like , behaviour therapy etc. It was a great learning experience for me and I will apply this knowledge in my future
Health education
Educate the patient relative do not force the patient about any activity
Educate the Family member to provide psychological support.
Encorage the patient to ventilate the feeling to a close one
Encorage the family members that do not judge the patient for any activity
Educate the family members to provide balance diet to the patient
Advise the family member about the importance of treatment
Advise the Patient to consult the doctor if any side effect occur
Educate the patient and family members about the side effect of medicine
Educate the family members to follow up the treatment
BIBLIOGRAPHY
Neerja KP: Essentials of mental health and psychiatric nursing vol. 1 Jaypee publisher
Sreevani R. A Guide To Mental Health And Psychiatric Nursing.2nd Edition. Jaypee Publisher
CASE PRESENTATION
ON

HISTORY TAKING
IDENTIFICATION DATA:-
Name of the patient -abc
Age /Sex -20/M
Father/Spouse –Malkha
C.R No. -76302
Education -10th pass
Occupation -Labour
Income -9000/
Marital status –Unmarried
Religion -Hindu
D.O.A -20//06/23 at 13:35pm
Ward/Unit No –Psychiatric ward/unit-2
Informant –Self and his mother
Relation with patient-mother
Information -Relevant
Presenting Chief Complaints:-
As per patient:-
Mai thik hu mujhe kuch nhi hua
As per informant:-
Sota nahi hai
Ladai jhagda karta hai x15days
Gussa karta hai]
TDI -1Years
History of Present Illness:-
Duration -1 Years
Mode of onset -Acute
Course –Episodic
Intensity -Increasing
Precipitating factors –Not known

Deepak 20years male, unmarried, 10th pass labor residing in Hindu nuclear family of LSES of rural background. 1/6/23 Patient was apparently
maintaining well on medication till 20 days back when family member noticed that patient has difficulty in initiating as well as maintenance of
sleep. Patient sleep decreased from 6-7hrs to 3-4hrs.when patient was not maintaining sleep he walk in room without any purpose. 2days later
when patient returned from his work as laborers, he didn’t eat food and threw away the plate patient tried to break household items also. Patients
cousin brother came to stop him but patient shouted on him and asked him to stay away from this.
5/6/23 patient went out of the house without telling anyone. On being called on his phone he told that he went to Mandi and would return later
no need to call him. Next day he returned in the morning, slept for 2-3hrs. but after waking up he started to shout at his father or other family
member. For last few days patient broke items like utensils, cycle, and chair. Patient also stopped taking his ATT medication 15days back.
Family members also noticed that patient has decreased need of sleep and remained energetic whole day. Patient went several times out of the
house and came back. Next day on being asked where he went patient would not reply and instead shout on them. He would also say that people
in the neighborhood are talking ill about him. His level of self-care declined. Patient appetite also decreased. Family member also noticed that
patient had started change the place of god photographs kept in the house without any reason.one day neighbor reported to his family member
that he started shouting loudly in public in front of everyone that ‘mai bhole baba hu dhup batti karo’.when patient was asked to come along with
family members to the hospital he threatened than he would harm himself by keeping his hand in the fan. He slapped his family members several
times, and abused the driver and was forcefully brought to the psychiatry OPD on 20/6/23 and got admitted in 13/II.
Treatment History:-
Patient got admitted in Hindu Rao Hospital for one day with diagnoses of Abdominal Koch’s
No treatment record is available with them.

She took treatment was
16/10/20
Tab. Sertraline 50mg 1HS c
Tab. Sodium valproate 500mg-x-700mg x20days
20/12/18
Tab. Sertraline 50mg 1HS
Tab. Sodium valproate 500mg-x-700mg x20day
26/7/21
Tab. Sodium valproate 500mg 1-x-1 x20days
Tab. Diazepam 5mg 2HS
10/5/23
Tab. Sodium valproate 500mg 1-x-1 x20days
Tab. Diazepam 5mg 2HS
As there was no relief of symptoms,
Patient again took treatment
ECT -No
Psychotherapy -No
History of any cannabis abused in last 2 years.
No history of DM/HTN/CAD/HIV positivity
Family History
Client belongs to Hindu nuclear family of lower socio economic status
50yrs/M 40yrs/F
Illiterate Illiterate
Unemployed Labour in factory
Father Mother
Alcholic
25yrs/F 18yrs/Male 20yrs/Male
10th pass 12th 10th Class
Housewife Labour in textiles Labour
Sister Brother Self

VII. Personal History
Perinatal history
Antenatal period –Normal
Intranatal period –Normal
Birth cry –Immediate
Birth defects –No
Postnatal complications -No
Childhood history
Development milestone- Normal
Behavior and emotional problems- No
Illness during childhood- No
Educational history
Age at beginning of formal education –5years
Emotional problems during adolescence -No
Puberty
Occupational History- Labor in paper making factory x2years
Marital History
Unmarried
Interpersonal relationship –Extrovert and good
Family and social relationships -Good
Attitude towards work and responsibility –Responsible, and do all the work assigned to her
Habits –Watching T.V
Sleep –Regular
Use of drugs, tobacco, alcohol –Yes(Cannabis)
Date of Examination-10/6/23
A. GENERAL APPEARANCE AND BEHAVIOR:- Patient was sitting on her bed. Looking one’s age, No physical deformity. When student
went to her she accepted greeting.
Facial expression:-Anxious
Level of grooming:-Shabbily dressed
Level of consciousness:-fully conscious
Level of cleanliness:-inadequate
Mode of entry:-came willingly.
BEHAVIOR:-
Cooperativeness:-less than so
Eye to eye contact:-made but not maintained
Psychomotor activity:-Increased
Rapport:-Not established
Gesturing:-normal
Posturing:-normal
B. SPEECH:-
Initiation:- Spontaneous
Reaction time:-Delayed
Rate:- Rapid
Volume:- increased
Tone:-High pitch
Stream:-normal
Client:- Mera naam Deepak hai, mai company me kaam karta hu
Impression- Patients speaks in Hindi. She has normal volume, tone, and rate of speech.
C. MOOD AND EFFECT:-
Subjective
Student-aapka mann kesa hai?
Client-thik hai, gussa bhut jaldi aata hai

Student-kya aap udaas h?
Client-abhi thik hu
Impression-labile
Objective
irritable
Impression:-irritable, Inappropriate mood and affect
D. THOUGHT:-
Stream(flow of thought)
Normal
Form(formal thought disorder)
Student:-kya aap bahar ghumne jate ho?
Client:-kabhi kabhi hospital k bahar ghumta hu.
Impression-Normal
Content(idea)
Student:-aapke mann me kya khyal aate hai? Kya aapka marne ka dil karta hai?
Client:-nahi, lekin kaam chhut gya hai. Mahine se kaam pe nahi gya. Kaam to karna pdega dikkat par kmaane khane k liye chahye
Impression:-No suicidal ideation
Student:-kya aapko lgta hai ki koi aapko maarna ya nuksaan phuchana chahta hai?
Client:-nahi mujhe kon maarega
Impression:-no delusional thinking
Student:-aap khali baithkar kya sochte ho?
Client:-mute
Impression:-thought blocking
Student:-kya aapko kabhi kisi kaam ko bar bar karne ka mann karta hai?
Client:-nahi
Impression:-no obsession
Student:-kya aapko kisi cheej se dar lagta hai?
Client:-darta hu apne se andhere se. raat ko ghr aane me dar lgta hai. Andhera hota hai to mandi bhaag jata hu.
Impression:-no irrational fear
Student:-aapke ghar me kon kon hai?

Client:-chhota bhai, mummy, papa or badi behan ki shadi ho gyi.
Student:-aapke padosi kese hai? Kya aap unse baate karte ho?
Client:-Nahi
Impression:-decreased social relations
E. PERCEPTION:-
Illusion
Student:-mere hath me kya hai?
Client:-pen or copy hai
Impression:-no illusion
Hallucination
Student:-kya aapko aisa kuch sunayi deta hai jo kisi or ko nahi sunta?
Client:-nahi
Student:-kya aapko aisa kuch dikhayi deta hai jo kisi or ko nahi dikhta?
Client:-nahi
Impression:-no visual and auditory hallucination

F. COGNITIVE FUNCTION(Neuropsychiatric assessment):-
Consciousness:-
Student:-hum yha par kitne log hai?
client:-char
Impression:-patient is fully conscious
Orientation;-
a)Time
Student:-abhi kya time hua hai
Client:-shyam ho gyi hai.
b)Place
Student:-aap is time kaha par h?
Client:-Hospital, Medical Rohtak
c)Person
Student:-sath me kon hai, mai kon hu?
Client-sath me bhai hai, aap nurse ho

Impression:- patient was oriented to time, place and person.
Attention
Student:- mai aapko kuch digit dungi unko repeat krna hai?
Student:- 11,15,17,19
Client:-11,15,17,19
Student:-22,24,26,28
Client:-28,26,24,22
Impression:- attention normally aroused
Concentration
Student:-40-3
Client:-37
Student:- 100-7
Client:-93
Client:- complete in 20sec.
Impression:-concentration sustained
Memory
a)Immediate
student:-hospital, fan, bed inko recall karo?
Client:-hospital, fan, bed
Recall-3/3
b)Recent
student:-subah khane me kya khaya?
Client:-roti, bhindi sabji.
c)Remote
student:-aapke school ka kya name tha
Client:-Global school
Impression:-intact memory
Intelligence
Student:-days in week
Client:-7
Student:-name of PM
Client:-Modi
Student:- Independence day
Client:- 15august
Student:- Ram ko vanwash kitne saal ka hua?
Client:- 14years
Impression:-adequate knowledge
Abstraction
Similarities
Student:-Pen-pencil
Client:-likhte hai
Student:- Apple-mango
Client:- phal hai dono
Dissimilarities
Student:-aankh and kaan?

Client:-aankho se dekhte hai kaan se sunte hai
Proverb
student:-9.2.11?
Client:-bhaag jana
Student:-haath peele karna?
Client:-shaadi karna.
Impresson:-intact abstract thinking.
Judgment
Personal
Student:-Ghar jake kya kroge?
Client:- kaam par jaunga ek mahina ho gya kaam par gye.
Social
Student:-aas paas k logo se baat kroge?
Client:-haa
Test
Student:-agar hospital me aag lag jaye to kya karogi?
Client:-bhaag jaunga yha se.
Impression:-intact personal, social and test judgement.
G. INSIGHT:-
Student:-Hospital aane ki kya vagah hai?
Client:-yaha acha lag rha hai
Student:-Kisi ilaaj ki jrurat hai
Client:-Nahi
Impression:-insight 1/5
DIAGNOSTIC FORMULATION:-Patient Deepak 20Y/M, unmarried labor by occupation, residing in Hindu nuclear family of LSES of rural
background of Delhi has been admitted with episodic illness of 1year with current episode characterized by decreased need of sleep, over
activity, over talkativeness, abusive and aggressive behavior, poor self-care, decreased appetite for last 15days with past history suggestive of
Manic episode1year back which required admission. History of Koch Abdomen in March 2019. Family history of alcohol abuse in father
dependence pattern with substance history suggestive of Cannabis used for last 2years with amount or pattern not known, with well adjust PMP.
On MSE general appearance shabbily dresses, argumentative, aggressiveness. Rapport not established, psychomotor activity increased, reaction
time decreased, affect irritable, social judgment impaired, insight 1/5
Diagnosis-Bipolar affective disorder with mania

PHYSICAL EXAMINATION
General condition-Fair, afebrile, good body built
B.P -110/70mmHg
Temperature -98.6 F
Pulse -70/min
Respiratory rate -12b/min
Per abdomen –Soft, non-tender
No organanomegaly present
Respiratory system –B/L Chest clear
Central nervous system –Normal gait
Superficial and deep reflexes are present
No autonomic abnormality present
Cardiovascular system –S1S2 Normal
No murmur sound hear
Lymph node –No enlarge lymph node

CASE PRESENTATION
BIPOLAR AFFEECTIVE DISORDER:-
It is also known as manic depression. This is characterized by recurrent episode of mania and depression in the same patient at different times.
Typically the patient experiences extreme highs mania or depression alternating with extreme lows, interspersed between the highs and lows are
periods of normal mood.
Onset-onset usually occur between ages of 20 and 30. Symptoms sometimes appear in the late childhood or early adolescence.
Etiology –precise cause unknown
Genetic, biochemical, and psychosocial factor may play a role
May be triggered by stressful events, antidepressant use
Sleep deprivation and hypothyroidism
SIGN AND SYMPTOMS:-

Manic phase Depressive phase
Expensive grandiose or hyperirritable mood Low self esteem
Increased psychomotor activity such as Overwhelming inertia

agitation, pacing or hand wringing
Excessive social extroversion

Feeling of hopelessness, apathy or self-re-
approach
Rapid speech with frequent topic changes Difficulty concentrating or thinking clearly
without disorientation or intellectual
impairment
Decreased need for sleep and food
Psychomotor agitation
Impulsivity
Anhendonia
Impaired judgment
Suicidal ideation
DIAGNOSIS:-
Based on sign and symptoms
ICD 10 criteria
PSYCHOPATHOLOGY
Depressive or hypersomnia
Insomnia or hypersomnia
Feeling of inadequacy
Social withdrawal
Loss of libido or interest in pleasurable activity
Lethargy
Suicidal ideation
Manic phase
Elevated, expansive/ irritable mood

Flight of ideas, thought racing in mood
Rapid shift from one topic to another
Pressure of speech, speech is forceful strong and difficult to interrupt
Delusion of grandeur
Delusion of persecution
Distractibility
CLINICAL MANIFESTATION OF BIPOLAR AFFECTIVE DISORDER WITH MANIA
Book picture Patients picture
Hypomanic phase
Insomnia
Hyperactive and physical restlessness
Grandiosity or inflated self-esteem
Increased productivity and creativity
Depressive phase
Insomnia or hypersomnia
Feelings of inadequacy
Decreased productivity
X
Social withdrawal
Loss of libido or interest in pleasurable

activities
Lethargy
Suicidal ideation
x
INVESTIGATION AND DIGNOSIS
Book picture Patient picture
MSE
Psychiatric history
Clinical observation
Investigation
ICD 10 diagnostic criteria
KFT
Blood urea- 17mg/dl
S.Creatinine- 1.0mg/dl
S.Uric acid- 7mg/dl
LFT
SGOT -39U/L
SGPT-22U/L
S. Alkaline phosphate- 39 to 117U/L
S. protein- 7.2g/dl
B. sugar- 123mg/dl
Treatment book picture Patient picture
1.Anticonvulsant agents- carbamazepine, 1. Tab. Olanzapine- 10mg/HS

divalproex sodium
2. Tab. Clonazepam- 2mg/HS
2.SSRI- paroxetine
3.Tab. Na Valporate- 500 mg 1x1
3. Antinmanic- lithium carbonate, li. Citrate
4. Psychotherapy of family members
4.Individual therapy, family therapy
5. Motivational therapy
5.ECT if drug therapy failure
Nursing Management for Bipolar Affective Disorder-
NURSING ASSESSMENT-
During period of mania-
-Bizzare and eccentric appearance
-Difficulty concentration, flight of ideas, delusion of grandeur and impaired judgment
-Decreased sleep, motor agitation, rapid jumbled speech, euphoria, hostility
-Dry mouth, tremors, tachycardia, and labored respiration
During period of depression-
-Anorexia, weight loss, constipation
-Altered sleep patterns
-Difficulty thinks logically
-Confusion and indecisiveness
-Guilt, helplessness, sadness and crying
-Amenorrhea
-Lack of motivation, low self-esteem, poor self-hygiene

-Irritability, pessimism, impotence and lack of interest in sex
-Inability of experience pleasure

NURSING DIAGNOSIS
-Disturbed thought process
-Impaired social interaction
-Risk for injury
-Disturbed sleep pattern

NURSING CARE PLAN
Nursing Nursing Goal Planning Implementation Evaluation
assessment diagnosis
Subjective Data High risk for <Control < To demonstrate a stable <Demonstrate a stable Risk of inury is
related to thought mood and practice self-care mood and practice self- reduced
In mania-
extreme processes activites care activites
< Feeling of joy hyperactivity
< During manic phase- < Decrease
<Rapid mood Demonstrate environmental stimui, to
< To decrease environmental
swings a stable promote relaxation and
stimui, to promote relaxation
mood and enable to sleep
< Sleep and enable to sleep
practice self-
disturbance < Monitor drug level,
care < To monitor drug level,
especially lithium
In depression- activities especially lithium
< Change the client’s
>Suicidal idea <To change the client’s
energy in one direction
> Worthlessness,
< Change the client’s
hopelessness < To prevent overstimulation
< Impairment of During depression
<Ensure the client spend
cognition
Phase- with him and focus on
Objective Data strengths and
< To ensure a safe
accomplishments and
In mania environment to client
minimize failure
Nursing Nursing Goal Planning Implementati Evaluation
assessment diagnosis on
Subjective Data Risk suicidal Short term < To ask about <Patient is Risk for suicide is
behavior ”Have any thought asked about decease to some
< Anhedonia Patient will
related to about harming have any extent
not harm self
<Worthlessness, depression yourself” in any thought about
hopelessness way harming
yourself in
<Suicidal ideas Long term < Make a short
any way.
term verbal or
<Impairment of Patient well
written contract < Created a
cognition recognize
that the patient will safe
self, worth,
< Somatic not harm. environment
dignity,
symptoms that is free
power and <To create a safe
from sharp
self-esteem environment
objects, belts,
Objective data <To avoid the glass, items,
patient to leave alcohol,
<Alterations of
alone. supervise
activity
closely during
To observe any
<Poor personal meal and
sudden change in
hygiene medication
mood
<Altered social
HEALTH EDUCATION
For depression
Teach the family about the depression. Teach about the beginning symptoms of relapse may assist patients to seek treatment early and avoid a
lengthy recurrence
Discuss the importance of support groups and assist in locating resources
Teach the action, side effects and special instructions regarding medication
Discuss methods to manage side effects of medication
Tell the family to offer the patient some household responsibility within the patient level of capability to promote self esteem
Teach the family to recognize the symptoms of suicidal ideation and how to conduct a suicide assessment
Emphasize that antidepressants can cause constipation which may be prevented with a good bowel regimen adding fiber to the diet and drinking
water
Avoid making life changes while the patient is experiencing recovery from depression
Help the patient and family identify community resources such as suicide hotlines.
For mania
Teach about the bipolar illness and ways to manage the disorder
Teach about medication management
For patient who is taking lithium, teach about the need for adequate salt and fluid intake
Teach the patient and family about signs of toxicity and the need to seek medical attention immediately
Teach about the behavioral signs of relapse and how to seek treatment in early stages
Educate the patient and family about risk taking behavior and how to avoid
CLASS PRESENTATION
ON
MANIA
Name of the subject : Mental health Nursing

Topic selected : Mania Disorder
Group : B.Sc. Nursing III Year
Place/venue : M. A. college of nursing
uration/time : 45 Minute
Method of teaching : Lecture Cum Discussion Method
Teaching aid : White Board
Date : 11/5/2023
General Objective:-
On completion of teaching the student will acquire depth knowledge regarding mania disorder.
Specific object:-
At the end of the teaching activity the student will be able to define mania.
At the end of the teaching the student will be able to enlist the etiological factor.
At the end of the teaching will be explained about symptom of mania.
Duration Specific Concepts Teaching Learning Av- Evaluation
Objective Activity Activity Aids
2 min Introduc Introduction:- Explain by Listening Green What
e Topic Mania is a flight of ideas, Increase pressure of speech, Lecture cum Board do
2 min and elevated mood, energy and increase activity. Discussion you
Define Mean
Note:- according ICD it include F30-F39 (in mood disorder)
mania. of mania ?
Definition:- MANIA
Mania can be described by ‘hyperactive’ ‘over-excited’
Sudden generate thought And Ideas. It is psychosis disorder.
Aetiology:-
⮚ Stressful life event. E.g. (death of family member by

Explain
aetiology, separation) bereavement.
types ⮚ Heredity.
⮚ Neurological condition. (brain tumour, trauma)
⮚ Drug induces: - e.g. steroid. (hyper thyroilism)
⮚ Co- morbid illness adversely effect e.g.

alcoholism.
Duration Specific Concepts Teaching Learning Av-aids Evaluation
Objective Activity Activity
10 min Explain by Listening Green-
Explain Types Of Mania Lecture cum board
about Discussion
types
Mild Mania or Hypomanio

Acute Mania
Delirious Mania Of Severe
Clinical manifestation:- Mild mania

or Hypomania:-
It is mild form of mania
1. The individual ‘simple feel grate’.
2. Pt show moderated flightiness or over
activity.
3. Energy is moderated.
4. Thinking is speeded up.
5. Sudden oscillation of mood
(change)
6. Create talents, mast productive.
7. Poor judgement.
8. Disturbance in sleep patterns.
9. Some time more talkative than usual.
Duration Specific Concepts Teaching Learning Av-aids Evaluation
Objective Activity Activity
10. Attention deficit. Explain by Listening Green-
11. Rapid eye movement. Lecture cum board
Discussion
(ii) acute mania:-
1. Feel great.
2. It show more flightiness of ideas
or over excited.
3. More energy.
4. Thinking is speeded more up.
5. Without stopping more change
sudden mood.
6. Poor judgement.
7. Create more talent.
8. Vary high risk activity e.g.
(foolish business investment)
9. Hypersensitivity.
10. Sleeplessness (only 3-4 HR)
Euphoria: - is a mental and emotional
CLASS PRESENTATION
ON
CRISIS INTERVENTION

Name of the subject : Mental health Nursing
Topic selected : Crisis intervention
Group : B.Sc. Nursing III Year
Place/venue : M. A. college of nursing
uration/time : 45 Minute
Method of teaching : Lecture Cum Discussion Method
Teaching aid : White Board
Date : 12/5/2023
General Objective:
At the end of the class the students will acquire in-depth knowledge on crisis intervention and to develop a positive attitude towards
handling the crisis in day to day clinical practice and also develops a competent skill in applying this knowledge in taking care of clients both in
wellness and sick.
Specific Objectives:
At the end of class the student will be able to
1. define crisis and crisis intervention.

2. mention the types of the crisis.
3. list the signs of crisis
4. enumerate the universal principles of crisis.
5. state the aims of crisis intervention.
6. mention the goals of crisis intervention.
7. list the purposes of crisis intervention.
8. discuss the techniques of crisis intervention.
9. describe the phases of crisis intervention.
10. discuss the general approaches of crisis intervention.
Time Specific Sub Topics Teaching Students A.V. Evaluation
Objectives Learning Activity Aids
Activity
2 min The students will Introduction Teacher Students
be able to Crisis intervention is emergency first aid for mental health introduces the listen
introduce the (Ehly, 1986).The Chinese language contains two characters topic.
topic. which, taken together, connote the concept of crisis. The
first character, wei, indicates a critical or dangerous
situation, while the second one, ji, means an opportunity
for change. Thus, these characters together indicate that
crisis is a point in time that allows the opportunity to
change.
4 min Define crisis and Definition Teacher defines Students Chart What is crisis
crisis intervention. Crisis - Crisis can be defined as one's perception or crisis and crisis listen and and crisis
experiencing of an event or situation as an intolerable intervention taking intervention?
difficulty that exceeds the person's current resources notes
and coping mechanisms. Crisis can occur on a personal
or societal level.
Crisis Intervention - Crisis intervention is an immediate
and short-term psychological care aimed at assisting
individuals in a crisis situation in order to restore
equilibrium to their biopsychosocial functioning and to
minimize the potential of long-term psychological trauma.
5 min Mention the types Types of crisis Teacher Students Charts What are the
of the crisis. There are 3 types of crisis – discuses types listen and types of
1) Maturational Or Developmental Crisis – it may of crisis. clear crisis?
occur at any transitional period in normal growth doubts
and development. The transitional period where
individuals move into successive stage often
generate disequilibrium. Individuals are required to
make cognitive and behavioral changes that
accompany development, precipitate factors are
normal stress of development.
2) Situational Crisis – it is a response to a sudden and

unavoidable traumatic event that largely affects a
person’s identity and roles.
3) Adventitious Crisis or Social Crisis – social crisis
is accidental, uncommon and unanticipated and
result in multiple losses and radical environmental
changes. An adventitious crisis occurs outside the
person precipitate by an unexpected event.
2 min List the signs of Signs of Crisis- Teacher Students Handouts. What are the
crisis explains signs listen and signs of
● Counselors are encouraged to be aware of the
and symptoms clear crisis?
typical responses of those who have experienced a
of crisis. doubts.
crisis or are currently struggling with a trauma.
● On the cognitive level, they may blame themselves
or others for the trauma.
● Often, the person appears disoriented, becomes
hypersensitive or confused, has poor concentration,

uncertain, and poor troubleshooting capabilities.
Physical responses to trauma include increased
heart rate, tremors, dizziness, weakness, chills,
headaches, vomiting, shock, fainting, sweating, and
fatigue.
● Among the common emotional responses of people
who experience crisis in their lives include apathy,

depression, irritability, anxiety, panic, helplessness,
hopelessness, anger, fear, guilt, and denial.
When assessing behavior, some typical responses
to crisis are difficulty eating and/or sleeping,
conflicts with others, withdrawal and lack of
interest in social activities.
3 min Enumerate the Universal Principles – Teacher explain Students Handouts List out the
universal the universal listen universal
There are four basic principles outlined for
principles of crisis principles of principles of
intervention for individuals dealing with personal and
intervention. crisis crisis
societal crisis:
intervention. intervention?
● Prompt intervention – Since victims are initially at

high risk for maladaptive coping or immobilization.
Providing intervention as quickly as possible is
imperative. Resource mobilization should be
immediately enacted in order to provide victims with
the tools they need to return to some sort of order and
normalcy, in addition to enable independent
functioning.
● Facilitate comprehension – processing the situation

or trauma is necessary in order for the sufferer to
understand what the traumatic event was all about.
This is done in order to help the victim gain a better
understanding of what has occurred and allowing him
or her to express feelings about the experience.
● Problem-solving – The counselor should assist the

victim(s) in resolving the issue within the context of
their situation and feelings. This is necessary for
developing self-efficacyand self-reliance.
● Return to normalcy – counselor must help the victim

get back to being able to function independently by
actively facilitating problem solving, assisting him/her
in developing appropriate strategies for addressing
those concerns, and in helping putting those strategies
into action. This is done in hopes of enabling the
victim to become self-reliant.
1 min State the aims of Aims of Crisis Intervention – Teacher Students Handouts What are the
crisis intervention. discusses aims listen and aims of crisis
● To provide a correct cognitive perception of the
of crisis asking intervention?
situation.
intervention. doubts
● To assist the individual in managing the intense and
over whelming feelings associated with the crisis.

1 min Mention the goals Goals of Crisis Intervention – Teacher Student Handouts What are the
of crisis discuses goals listen goals of
● To decrease emotional stress and protect the crisis
intervention. of crisis crisis
victim from additional stress.
● To assist the victim in organizing and mobilizing
resources or support system to meet unique needs

and reach a solution for the particular situation that
precipitate the crisis.
1 min List the purposes Purposes of Crisis Intervention – Teacher Student Pamphlet Enumerate
of crisis discusses the listen the purposes
● To reduce the intensity of an individual’s
intervention. purposes of of crisis
emotional, mental, physical and behavioral reaction
crisis intervention?
to a crisis.
intervention.
● To help the individuals return to their level of
functioning before the crisis.

6 min Discuss the Techniques of Crisis Intervention- Teacher Student Slides What are the
techniques of crisis describes the listen and techniques
● Catharsis – the release of feelings that take place
intervention. techniques used taking used for
as the patient talks about emotionally charged
in crisis notes crisis
areas.
● Clarification – encouraging the patient to express
more clearly the relationship between certain

events.
● Suggestions – influencing a person to accept an
idea or belief, particularly the belief that the nurse

can help and that person will in time feel better.
● Reinforcement of Behavior – giving the patient
positive response to adaptive behavior.
● Support of Defense – encouraging the use of
healthy, adaptive defences and discouraging those

that are unhealthy or maladaptive.
● Rising Self Esteem – helping the patient regain
feelings of self worth.
● Exploring of Solution – examining alternative
ways of solving the immediate problem

10 min Describe the Phases of Crisis Intervention – Teacher Student Slides What are the
phases of crisis 1) Immediate crisis intervention – explains all the listen and phases of
intervention. It involves establishing a rapport with the phases of crisis asking crisis
victim, gather information for short term intervention doubts intervention?
assessment and service delivery and averting a
potential state of crisis. Immediate crisis
intervention also include caring for the medical,
physical, mental health and personal need of the
victim about local resources or services.
2) Second Phase –
It involves an assessment of needs to
determine the service and resources required by the
victim in order to provide emotional support to the
victim. The purpose of this phase is to determine
how the crisis affects the victim’s life, so that a
plan for recovery can be developed, allowing the
victims to begin towards the future.
3) Third Phase-
Recovery intervention helps victims re-
stabilize their lives and becomes healthy again. It
also involves helping the victim prevent further
victimization from the criminal justice system or
other agencies, the victim may come into contact
15 min Discuss the General Approaches - Teacher Students Slide What are the
general approaches explains general listen general
A general approach of crisis intervention integrates
of crisis approaches of approaches
numerous assessment tools and triage
intervention. crisis of crisis
procedures. Roberts' 7-Stage Crisis Intervention
intervention. management
Model, SAFER-R Model and Lerner and Shelton's 10-
?
step acute stress & trauma management
protocol creates one comprehensive model for responding
to crisis that can be utilized in crisis situations.
The ACT (Assessment Crisis Intervention Trauma

Treatment) model of crisis intervention developed by
Roberts as a response to the September 11, 2001 tragedy
outlines a three-stage framework. This tool is a guide and
not to be followed rigidly.
The first step is the assessment stage; this is done

by determining the needs of victims, other involved
persons, survivors, their families, and grieving family
members of possible victim(s) and making appropriate
referrals when needed.
These are the three types of assessments that

need to be conducted:
1. Triage assessment - an immediate assessment to
determine lethality and determine appropriate
referral to one of the following: emergency
inpatient hospitalization, outpatient treatment
facility or private therapist, or if no referral is
needed;
2. Crisis assessment - consists of gathering
information regarding the individual's crisis state,
environment, and interpersonal relationships to be
used in working towards resolving the current
crisis. This step helps facilitate development of an
effective and appropriate treatment plan.
3. Biosocial and cultural assessment - systematic
assessment tools are used to ascertain the client's
current levels of stress, situation, present problem,
and severe crisis episode.
The goal of the crisis intervention stage of Roberts'

ACT model is to resolve the client's present
problems, stress, psychological trauma, and emotional
conflicts. This is to be done with a minimum number of
contacts, as crisis intervention is intended to be time-
limited and goal-directed.
1. Intake and Assessing the person who is in

Crisis/Suffering from the aftereffects of Crisis
Stage one of the seven step approach focuses on assessing

lethality. The clinician is to plan and conduct a thorough
biopsychosocial and lethality/imminent danger assessment;
this should be done promptly at the time of arrival. Once
lethality is determined one should establish rapport with
the victim(s) whom the clinician will be working with.
2. Exploring the Crisis Situation of the person
The next phase is to identify major problem(s), including

what in their life has led to the crisis at hand. During this
stage it is important that the client is given the control and
power to discuss their story in his or her own words.
3. Understanding the Coping Style employed by the

person
While he or she is describing the situation, the intervention

specialist should develop a conceptualization of the client's
"modal coping style", which will most likely need
adjusting as more information unfolds. This is referred to
as stage three.
4. Confronting Feelings, Exploring Emotions and

Challenging the Maladaptive Coping Style
As a transition is made to stage four, feelings will become

prevalent at this time, so dealing with those feelings will be
an important aspect of the intervention. While managing
the feelings, the counselor must allow the client(s) to
express his or her story, and explore feelings and emotions
through active listening and validation. Eventually, the
counselor will have to work carefully to respond to the
client using challenging responses in order to help him or
her work past maladaptive beliefs and thoughts, and to
think about other options.
5. Exploring Solutions and Educating the client in best

practices of Coping
At step five, the victim and counselor should begin to

collaboratively generate and explore alternatives for
coping. Although this situation will be unlike any other
experience before, the counselor should assist the
individual in looking at what has worked in the past for
other situations; this is typically the most difficult to
achieve in crisis counseling.
6. Developing a concrete treatment plan/structure of

activities and Reassuring the clients newly gained
healthy perspective
Once a list has been generated, a shift can be made to step

six: development of a treatment plan that serves to
empower the client. The goal at this stage it to make the
treatment plan as concrete as possible which could be
followed by the client and implemented as an attempt to
make meaning out of the crisis event. Having meaning of
the situation is also an important part of this stage because
it allows for gaining mastery.
7. Follow-Up
Step seven is for the intervention specialist to arrange for

follow-up contact with the client to evaluate his or her post
crisis condition in order to make certain resolution towards
progressing. The follow-up plan may include "booster"
sessions to explore treatment gains and potential problems.
SAFER-R Model
The SAFER-R Model is a much used model of

intervention[12] with Roberts 7 Stage Crisis Intervention
Model. The model approaches crisis intervention as an
instrument to help the client to achieve his or her baseline
level of functioning from the state of crisis. This
intervention model for responding to individuals in crisis
consists of 5+1 stages.
They are:
1. Stabilize
2. Acknowledge
3. Facilitate understanding
4. Encourage adaptive coping
5. Restore functioning or,
6. Refer
Lerner and Shelton's 10 step acute stress & trauma

management protocol[14]
A comprehensive view of how to treat the trauma consists

of ten stages outlined by Lerner and Shelton (2001). These
10 steps relate similar to the crisis intervention steps.
● The first step is to assess for danger/safety for self and

others, this means for the victim, counselor, and others
who may have been affected by the trauma.
● Then consider the physical and perceptual mechanisms

of injury.
● Once injury is assessed the victim's level of

responsiveness should be evaluated.
● If any medical needs are there, it should be addressed.
● The individual who witnessed or is experiencing a

crisis, should be observed to identify his or her signs of
traumatic stress.
● After the assessment of the situation is completed the

counselor should introduce his or her self, state their
title and role, and connect with the individual by
building rapport.
● A good rapport building allows for a more fluid

approach in grounding the individual, this can be done
by allowing the client/person to tell their story.
● The interventionist provides support through active and

empathetic listening,
● Normalize, validate, and educate the individuals

emotions, stress and adaptive coping styles.
● Finally, the intervention specialist is to bring the

person to the present, describe future events, and
provide referrals as needed.
After the crisis situation has been assessed and crisis

interventions have been applied, the aim is at eliminating
stress symptoms, thus treating the traumatic experience.
Summary:
So far we have discussed about definition, types, signs,

universal principles, aims, goals, purposes, technique,
phases, general approaches of crisis intervention.
Conclusion:
From this class students gain adequate knowledge

regarding crisis and its intervention.
Bibliography:
Teacher reference
● Mary C. Townsend’s, “Psychiatric Mental Health Nursing”, sixth edition, F. A. Davis publication
Student reference:
● R. Sreevani’s, “A Guide To Mental Health and Psychiatric Nursing”, 3rd edition Jaypee Brothers Publication
NURSING CARE PLAN
ON
SCHIZOPHRENIA

IDENTIFICATION DATA
Name Mr xyz
Age 65years
Sex Male
Bed no. 5
O.P.D no. 15/467942
Occupation labrour
Religion Muslim
Language Hindi
Diagnosis Mental and Behaviour disorder due to the use of opioids
Informant Patient
Present chief complaints:
a) Psychological:
According to patient: Afim khana
Nind kam aana
Gussa karna

Duration 1 year
Mode of onset Acute
Course Episodic
Treatment History
drug Name
SR Analgesic

Duration : 35 years
Family history:-
Family tree
Male Male Male patient
Female
Personal History
Prenatal History
Intranatal period
Birth
Birth defect
Childhood history
Primary care giver

Feeding
Age of weaning
Educational history

School phobia No
Play history


Habits
Sleeping pattern Patient takes 5-6 hours during night and 1 hour of sleep during a da

Behaviour: - Normal
Gesturing: - Normal
Posturing: - Normal
Speech: -
Rate: - Normal
Volume: - low
Tone: - low pitch
Stream - Normal
Nurse: - Aap apne bare me kuch btaye.

Mood and affect: -
Subjective
Objective

Mood: - Normal
Affect: - Normal
Thought: -
Content:
1. Delusion:-
2. Hypochondria:-
Inference: - Hypochondria delusion is absent.
Ideas: -
4) Phobia: -

Perception: -
1) Illusions:-
2) Hallucination: -
Consciousness:-
Attention: -

Concentration: -
Orientation: -
Time: -
Place: -
Patient: - hospital
Person: -
Memory: -
Patient: - 9835664
b) Recent memory: -

c) Remote Memory: -

Intelligent: -
Arithmatic ability
Abstractions: -
a) Proverbs

Judgement: -

Insight: -


Patient:-kabi kabi
NURSING CARE PLAN

ASSESSMENT DIAGNOSIS GOAL IMPLEMENTATION RATIONALE EVALUATION
Appears upset, : Limited or no Patient will attend Assess if the Many of the positive Patient attends one
agitated, or anxious interaction with one structured medication has reached symptoms of structured every group
when others come others. group activity therapeutic levels. schizophrenia activity.
too close in contact within 5-7 days. (hallucinations,
or try to engage delusions, racing •Client initiates
him/her in an Identify with clients he thoughts) will subside conversation
activity experiences when he/ with medications,
Dysfunctional she feels anxious which will facilitate Client spends time
interaction with around others interactions. with others
others/peers •Increase anxiety can
Inappropriate Keep client in an intensify •Verbalized decreased
emotional response environment as free of agitation, discomfort in social
Observed use of stimuli (loud noises, aggressiveness, and situations
unsuccessful social crowding) as possible. suspiciousness.
interactions Client might respond to
behaviors Avoid touching the noises and crowding
client with agitation, anxiety,
and increased inability
to concentrate on
outside events.
•Touching by an
unknown person
Health education
Encourage the patient to ventilate the feeling to a close one
Encourage the family members that do not judge the patient for any activity
BIBLIOGRAPHY
Neerja KP: Essentials of mental health and psychiatric nursing vol. 1 Jaypee publisher
Sreevani R. A Guide To Mental Health And Psychiatric Nursing.2nd Edition. Jaypee Publisher
NURSING CARE PLAN

ON
SCHIZOAFFECTIVE MANIA
HISTORY COLLECTION:
IDENTIFICATION DATA-
Name : Mrs. abc
Age : 48 years
Sex : Female
Marital Status : Married
IP No. : 352617
Date of Admission : 15/07/2023
Religion : Hindu
Occupation : Housewife
Education : 5th
Socio-economic status : Middle class
Address : Agroha
Informant : Husband
CHIEF COMPLAINTS-
According to the patient:
Nind nhi aati
Dimag ghum rha hai
Sir bhari ho rkha hai
According to Informant:
Gali galoch krti hai
Soti nhi hai
Nachna gaana krti hai
Akele me badbdati hai
Dwaiya nhi khati
PRESENT PSYCHIATRIC HISTORY-
The onset is chronic within year. The duration is about 37 year. It is periodical type. There is ↑sing and ↓sing intensity. There are no
precipitating factors. But she is having irritability, sleep disturbance, suspeciousness, muttering to self, overalertness, aggressiveness, increased
activity. Her hygiene is maintained by the family
PAST PSYCHIATRIC HISTORY-
Mrs Kamla was suffering from schizoaffective Manic type disease since last 37 years.
The first episode was in 2001 when she was 21 years old. there was decreased need for sleep, irritability, increased psychomotor activity, over
religiosity, muttering to self and even to third person, delusion of persecution was there.
The second episode was in 2015 when she got similar symptoms and admitted in RML hospital.
The third episode was in July 2017.
4th episode was in August 2018.
5th episode was in December 2019.
Sixth episode was in February 2022.
Past Medical History

She did not have any major medical illness history.
Past surgical History
There is no significant surgical history.
FAMILY HISTORY-
DEATH -
In Mrs kavita’s family her younger brother and her older sister was suffering from depression. so there was psychiatric history present in the family. Mrs kamla’s
husband was suffering from congenital heart disease that's why he had undergone pacemaker implantation in 2016. there was no other significant history in the
family.
PERSONAL HISTORY-
Prenatal History:
During prenatal period, there is no any evidence of radiation exposure but the child had history of pneumonia. The mother was carried out all the
antenatal checkups. There was no complication to mother and child during the period.
Natal History:
The mother had normal vaginal delivery no complication during delivery. Breathe and cried at birth milestones were normal.
Behaviour during childhood:
The mother was provided breast milk to the child up to 3 years and weaning was also practiced. There was no neurotic symptoms and habit and
excretory disorders.
Illness during childhood:

History of pneumonia during childhood and no evidence of any neurotic disorders.
Schooling:
Mrs. Kamla was average in school.
Occupational History:
She was a housewife.
Sexual history:
She was admitted puberty at the age of 15 yrs.
Interpersonal relationships : Good relationship with family member.

Use of leisure time : Watching T.V.
Predominant mood : Mood alteration
Attitude to self and other : Self-appraisal of abilities and behaving normally with others.
Attitude to work and responsibility : She is interested in doing work and a responsible housewife
Religious beliefs and moral attitudes: Having faith on religious and participating in religious activity.
PHYSICAL EXAMINATION:
Vital Signs-
Temperature: 98.2’ F
Pulse: 84 beats/min.
Respiration: 20 breaths/min.
Blood Pressure: 110/80 mm of Hg.
General Appearance-
Body Built: Normal
Level of consciousness: Conscious
Look: Dull
Behaviour: Normal.
Integumentary System-
Skin Texture: Rough
Any skin disorder: No
Intactness of skin: Nil
Sensory Organs-
Function of Senses :. Normal.
Visual acquity : Clear.
Clarity of Speech : clear
Comprehensive Conversation : normal.
Respiratory System-
Breathing pattern : Regular.
Any breathing difficulty : no difficulty
Cardiovascular System-
Palpitation : Normal.
Rate and rhythm of heart beat : Normal.
Gastrointestinal System-
GI motility : Normal
Bowel Sounds : Present.
Musculoskeletal System-
Motor activity : Increased
Gait : Poisture
Neurological System-
Symmetry of organs :Symmetrical
Level of Consciousness : conscious
Sensory Fuctions : normal
Renal System-
Complaints of flank pain : No
Reproductive System-
Regularity of menstruation .
MENTAL STATUS EXAMINATIION:

1) General Appearance and Behaviour-
Facial Expresion : Anxious
Posture : Normal
Mannerism : Absent
Eye to Eye contact : Partial.
Rapport :Built
Consciousness : conscious
Behaviour : friendly
Dressing and Grooming : Appropriate
Physical Feature : look younger than hes age.
2) Psychomotor Activity-
↑Sed activity.
3)Speech-
Coherence : coherent.
Relevance: relevant
Volume : Loud
Tone : High pitched.
Murmur : present
Reaction Time : Normal.
4) Thought-
Form of Thought : Disirretibility.
Stream of Thought : no flight of ideas.
Content of Thought:
a) Delusion : Delusion of presecution and grandiosity present in past.
b) Obsession : Absent.
c) Phobia : Absent.
d) Preoccupation : Absent.
5) Mood and Affect-
Pleasurable affect : Elation.
Unpleasurable affect : No
Other Affects : No.
6) Disorders of perception-
Hallucination : Auditory.
Others : Nil
7) Cognitive Functions-
a) Attention and Concentration:
Nurse :”What are the days in a week ? “.
Patient : Sunday, Monday…….
Remark :She has normal concentration.
b) Memory:
1) Immediate memory
Nurse : “What you had in your breakfast today ?”.
Patient :”No answer”.
Remark : Patient memory is impaired.
2) Recent Memory
Nurse :”what is your child’s name?”.
Patient :”Anil, rekha, pushpa”.
Remark : My patient is having good recent memory.
3) Remote Memory
Nurse :”What is your date of birth ?”.
Patient : ”04/02/1961”.
Remark : My patient is having good remote memory.
c) Orientation:
Time :
Nurse :”What is the time now ?”.
Patient : “It is 11:00 am”.
Place:
Nurse : “Where are you now ?”.
Patient : “I am in mental hospital”.
Person :
Nurse :” Who is the person standing beside of you ?”.
Patient :” This is my daughter”.
Remark : My patient is oriented to time , person, and place.
d) Abstraction:
Nurse : “What is the difference between Bulb and Tube light?
Patient :”I don’t know”.
Remark : My patient’s abstraction is very poor.
e) Intelligence and General Observation:
Nurse :”Who is the prime minister of India?”.
Patient :”Mr. Modi”.
Remark : My has good intelligence.
f) Judgment:
Nurse :”If you want to cross the road, during crossing vehicle comes, what you’ll do?”.
Patient :”No answer”.
Remark : She has poor judgment power.
g) Insight:
Nurse : “Why did you admit here?”.
Patient : My patient said that “I reached along with family members”.
Remark : She has poor insight.
h) General Observation:
Sleep
1) Insomnia : Persistent.
2) Hypersomnia : Absent.
3) Non –organic sleep : Absent.
4)Early morning awakening : Present.
5) Episodic Disturbances : Absent.
NURSING ASSESSMENT:
After the complete assessment of the daughter it became clear that the patient is having altered thought process loosening of association, flight of
ideas.
Assessment NsgΔSis Goal Planning Rationale Implementation Evaluation
Subjective Data : Alteration in Patient’s thought To find Assess The present The patient thought
The patient says thought process process will out the present the content of status of the patient process has improved
someone might harm related to improve. status. thought. was found out. to some extent.
me. inability to trust, To Convey positive
Objective Data : panic anxiety as provide positive acceptance of reinforcement was
Delusional thought evidenced by reinforcement. patient need or provided.
unable to concentrate. delusional the take belief.
thinking inability To Discharge Aggravated of the
to concentrate. Avoid long discussion. condition was avoided.
aggravation of
the condition. Extend of the diseases
To find Discharge was found out.
out the extend of Long discussion
diseases. about the
irritation,
thinking and
talks.
Assessment NsgΔSis Goal Intervention Rationale Implementation Evaluation
Subjective Data : Disturbed sleep Patient will Assess the sleep To get the Assessed the sleep The patient’s
The patient says “I pattern, get adequate pattern of the patient. baseline data. pattern of the patient. sleep pattern is
did not get proper insomnia sleep. Observe and obtain To plan further. Observed and obtained improved up to
sleep. related to feedback from client feedback from client some extent.
agitation, regarding usual regarding usual
Objective Data : anxiety, disease bedtime,rituals and bedtime,rituals and
Patient sleep pattern condition number of hours of number of hours of
is disturbed, she did evidenced by sleep. sleep.
not get adequate patient Recommend limiting To support Recommend edlimiting
sleep. verbalization of caffeine and sleep. of caffeine and
and facial chocolate prior to chocolate prior to sleep.
expression sleep. Provided calm
Provide calm environment to patient.
environment to patient. To provide
adequate sleep.
.
Assessment NsgΔSis Goal Intervention Rationale Implementation Evaluation
Subjective Data : Sensory Patient’s Observe To Observed Client has come
The patient says “ perceptual will come the patient for the sign Prevent aggressive the patient for signs to the reality up
I am hearing some related to across the of hallucination. response. of hallucination. to some extent.
fearful sounds panic anxiety reality. Establish Established
every time”. withdrawal in good the therapeutic To make good therapeutic
to self nurse patient trust in nurse. nurse patient
Objective Data : evidenced by relationship. relationship.
Based on MSE sad dull affect. Develop To Developed
report it is clear positive attitude in give positive positive attitude in
that the patient is patient reinforcement. patient.
having auditory Allow the To Allowed
hallucination. patient to move freely bring the patient to the patient move freely
and talk effectively. realty. and talk effectively.
Make the To Made the
patient to understand make them able to patient to understand
between reality and his differenciate between between reality and
behaviour. reality and behaviour. his behaviour.
BIBLIOGRAPHY:
AHUJA NIRAJ: ”A SHORT TEXTBOOK OF PSYCHIATRY”5TH EDITION; JAYPEE
PUBLISHERS; NEW DELHI 2006; PAGE NO:227-35.
KAPOOR BIMLA;”PSYCHIATRIC NURSING”; VOLUME-III; 1 ST EDITION; KUMAR
PUBLISHING HOUSE; 2005; NEW DELHI; PAGE NO:72-74.
NURSING CARE PLAN
ON
BIPOLAR AFFECTIVE
DISORDER

HISTORY OF THE PATIENT
DEMOGRAPHIC DATA:
Name : Aniket
Age : 21 years
Sex : Male
Ward : Male Ward
Education : 12th class
Occupation : Student
Religion : Hindu
Community : Urban
Socio Economic Status : Low-middle class
Marital status : Unmarried
Language : Hindi
Nationality : Indian
Address : Fatehabad (Haryana)
Diagnosis : Biplar affective disorder (BAPD)
Informant:
 Primary Source: Patient
 Secondary Source: Informant and Medical Record
Information: Appropriate
Reliable
Adequate
Informant:
Reliability of Information: Reliable
Relationship with Patient: Brother
Duration of relationship: From Birth
CHIEF COMPLAINTS:
According to Patient: patient is not able to explain the exact problem
According to informant:
• Not doing work properly
• Not maintaining hygiene
According to Medical Record:
 Spontaneous verbalizing
 Feeling of sedation
 Altered consciousness
 Loss interest in maintaining hygiene
 Circumstentiality
 Irrelevant talk
 Suspicious
 Escape from nearest ones From 3 years
 Insomnia
 Big talks
HISTORY OF PRESENT ILLNESS:

Nature of onset : Acute
Onset : Insidious
Duration : 2 and half year
Intensity : Increased
Course : Continuous
Precipitating factors : Un fulfillment of educational expectations (Adm. in B.
Tech)
History of current episode: patient was apparently well 2 and half year back, his interpersonal
relationship and biological functions were fixed at that time. Then his family members got to know from
the school that patient leaves the house in the working for school but does not go to school and roams here
and there with bad elements of village. In following few days they noticed that past (new expensive
mobile, phones, scooty, car, television) and he also started saying bizarre things like SDM and other
proves him and he wants to be a superstar and a famous actor. Sleep got decreased. He went to Mumbai
several times without his family members. He was very irritable and 3-4 persons are not able to control at
that place. He didn’t ready to take medicine because he think that he is absolutely fine.
Other disturbance related to:

 Sleep: Disturbed sleep
 Appetite: Decreased appetite
 History of substance abuse: Present tobacco-smoking.
Effects of problem on activities such as:

 Personal Hygiene:
• Hair was not combed properly.
• Neatly dressed up.
• Nails were big.
• Not interested in activities of daily living (ADL)
 Domestic Activities: Patient was not interested in daily domestic activities.
 Social Activities: Not much interested.
PAST HISTORY:
Psychiatric History: patient was apparently well 2 and half year back, his interpersonal relationship and
biological functions were fixed at that time. Then his family members got to know from the school that
patient leaves the house in the working for school but does not go to school and roams here and there with
bad elements of village. In following few days they noticed that past (new expensive mobile, phones,
scooty, car, television) and he also started saying bizarre things like SDM and other proves him and he
wants to be a superstar and a famous actor. Sleep got decreased. He went to Mumbai several times without
his family members. He was very irritable and 3-4 persons are not able to control at that place. He didn’t
ready to take medicine because he think that he is absolutely fine.
Medical History:
Patient has no history of Jaundice, Pneumonia, Asthma, TB, Head injuries, Seizures.
Surgical History:
The patient has no past surgical history.
FAMILY HISTORY:
Family Genogram:
Family Genogram:
Members of family: There are nine members in the family.

Type of family: Nuclear Family
History of mental illness in family:
Any history of drug abuse in family: The family has no history of substance abuse.
PERSONAL HISTORY:
1. Prenatal history:
 Maternal infections : Absent
 Exposure to radiations : Absent
 Checkups : Done
 Any complications : Absent
2. Natal history:
2. Birth History:
 Order : Fourth child
 Term : Full term normal delivery
 Place : Home
 Type : Normal
 Labour : Normal
 First cry : Normal
 Cyanosis or jaundice : Absent
 Immediate breast feeding : Yes
 Neonatal infections : Absent
3. Milestones: Delayed
4. Early Childhood history (through age 3):

 Feeding habits:
• Breast fed : Yes
• Bottle fed : Yes
• Age of weaning : 7 months
• Eating problems : No
 Toilet training : At 4 years of age
 Behavioral problems:
• Thumb sucking : Present
• Bed wetting : Present
• Temper tantrum : Present
• Tics : Absent
• Head bumping : Absent
• Rocking : Absent
• Night terrors : Absent
• Fears : Present
• Nail biting : Absent
• Stammering : Absent
• Truancy : Absent
 Childhood disorders:
• Febrile convulsions : Absent
• Seizures : Absent
 Personality as a child:
• Shy : Present
• Restless : Present
• Overactive : Absent
• Withdrawn : Present
• Persistent : Absent
• Outgoing : Absent
• Timid : Absent
• Athletic : Absent
• Friendly : Absent
• Patterns of play : Normal
5. Middle Childhood (3-11 years):
 Early school history :No school phobia
 Gender identification : Normal
 Peer relations : Average
 Behavioural problems:
• Phobias : Absent
• Bed wetting : Present
• Fire setting : Absent
• Cruelty to animal : Absent
• Hyperactivity : Absent
6. Late childhood (puberty through adolescent):
Social relationship:
 Attitude towards school and school mates : Positive attitude
 Number and closeness of friends : Very few
 Leader or follower : Actor
 Participation in group or gang activity : No
 Idealized figures : No
 Patterns of aggression : Present
School History:
 Adjustment and relation with classmates : Average
 Adjustment and relation with school teachers : Average
 Favorite studies or interest : Good
 Particular abilities : Non
 Extracurricular activities/ sports/hobbies : Not good
 Scholastic performance : Good
 Relation of problems or symptoms to any school period: No
 School popularity : No
Cognitive and motor development:

 Learning /reading : Normal
 Intellectual skills : Normal
 Motor skills : Normal
Adolescent emotional or physical problems:
 Nightmares/phobias/bed wetting/running away : Absent
 Smoking/alcohol/substance abuse : present
 Delinquency : Absent
 Eating disorders : Absent
 Weight problems : No
 Feeling of inferiority : Present
Adolescent turmoil: Not significant
7. Psychosexual history (childhood through adolescence):
 Onset of puberty: At the age of 14 years
 Attitude towards opposite sex:
• Timid : Absent
• Shy : Present
• Aggressive : Present
• Need to impress : No
• Seductive : No
• Anxiety : Absent
8. Religious background:
 Liberal
9. Home situation in childhood and adolescent:
 Congenial : No
 Broken home : No
 Disturbing : No
10. Parent’s attitude towards the patient : Parent’s attitude towards the patient is positive.
11. Any parental lack before 18 years of age : No
12. Adulthood history:
Social activity:
 Has friends/withdrawn/socializing well : Not Withdrawn
 Social mixing/participation : good
 Relationship with people of same and opposite sex: Average relationship
13. Personality:
 Attitude to others in social, family and sexual relationship: Patient has inability to
trust other, make and sustain relationship but anxious and emotionally cold, etc. patient has
negative attitude towards others.
 Attitudes to self: Patient has a feeling of big.
 Moral and religious attitudes and standards: Patient is religious priorly before 2 and
half year but after this he feeling a boundation of religion and he want to escape from
religious boundation.
 Mood: mood (affect) is not defined because patient is sedative condition.
 Leisure activities and hobbies: Patient was not interested in doing any leisure able
activity.
 Fantasy life: Patient have fantasy life.
 Reaction pattern to stress: Patient does not have ability to tolerate frustrations, losses,
disappointments, and this leads to arousing anger, anxiety or depression.
 Habits:
• Eating : Normal
• Sleeping : Disturbed
• Excretory functions : Normal
PHYSICAL EXAMINATION
VITAL SIGNS:
• Temperature : 98.8 oF
• Pulse : 92 beats/min
• Respiration : 26 breath/min
• Blood Pressure : 130/80 mmHg
GENERAL APPEARANCE:
• Nourishment : Normal
• Body Build : Ectomorphic
• Healthy : Unhealthy
• Activity : Dull
POSTURE:
•Body Curves : Normal body curves.
HEIGHT : 5’8”
WEIGHT : 65kg
SKIN CONDITION:
• Colour : Whitish in clear.
• Texture : Dry texture
• Temperature : Warm in touch.
• Lesions : No lesion present
HEAD & FACE:

• Scalp : Normal
• Face : Normal
EYES:
• Eye Brows : Normal in shape.
• Eye Lashes : Thin lashes present
• Eyelids : NAD, no infection
• Conjunctiva : Normal in white colour
• Sclera : Normal in red colour.
• Pupils : Normal, NAD
• Lens : Normal, NAD
• Vision : NAD
EARS:
• External Ear : Not properly clean
• Tympanic Membrane : NAD
• Hearing : Normal hearing present.
NOSE:
• External Nares : NAD
• Nostrils : Normal septal deviation present.
MOUTH & PHARYNX:
• Lips : Slightly brownish in colour
• Odour of mouth : Foul smelling present.
• Teeth : Coated and stained, dental caries.
• Mucus Membrane : Intact & dry
• Gums : Bleeding present in gums
• Tongue : Dry & coated present
• Throat & Pharynx : NAD
NECK:
• Lymph Nodes : Normal, no palpable lymph nodes
• Thyroid Gland : NAD
CHEST:
• Thorax : Normal, NAD
• Breath Sound : Normal, NAD
ABDOMEN : Non-tender, normal bowel sound present
EXTREMITIES:
• Upper Extremities : Normal movement, no deformity
• Lower Extremities : Unsteady gait, normal movement.
GENITALS & RECTUM : NAD
NEUROLOGICAL TEST:
• Reflexes : Normal reflexes present.
• Test for sensations : Sensation present checked by safety pin.

GENERAL APPEARANCE AND BEHAVIOR:
Facial Expression: Patient’s has spontaneous talk.
Patient was not looking attentive while talking to him.
Patient was telling self made story.
Eye to eye contact: Eye contact was not maintained by the patient.
Posture: The patient was normally relaxed.
The patient had a normal posture.
Dress: The patient was appropriately dressed in kurta and pajama with leather jacket.
Hygiene: The patient was looking little unhygienic.
The hair was not combed.
Finger nails were cut.

Gait: Gait is normal.
Physique and body built: Patient has normally built.
Physical feature: Looks according to his age
Appropriate weight
No physical deformity present

LEVEL OF CONSCIOUSNESS: Patient is conscious.
MOTOR DISTURBANCES
motor retardation. Present
Stereotypy: patient repeat word.
SPEECH/ THOUGHT
Evaluation of Speech:
1. Intensity: The voice of patient was not normally audible, patient was speaking very
slowly, and repetition was needed to hear the patient.
2. Pitch: The voice was changing according to the subject matter.
3. Speed: The patient spoke at a usual rate of speech but very slowly.
4. Spontaneity:Patient responded when questions were put to him and sometimes
remains mute.
5. Manner:Manner of speaking was normal.
6. Reaction time: It was abnormally slow.
DISORDERS IN CONTENT OF THOUGHT:
.
1. Persecutory delusion: Present, as patient has belief that someone is going to harm
him.
DISORDERS OF RATE OF SPEECH:
1. Mutism: Present, as patient didn’t answered for some questions.

Bradylalia: Abnormally slow speech.Present in my patient.
DISORDERS OF PERCEPTION
HALLUCINATION:
May be defined as a sensory experience in the absence of a stimulus or object.
Auditory Hallucination: Present, as patient hears multiple voices of males and females.
Visual Hallucinations: Present, as patient see faces of his friends.
VARIATIONS OF PERCEPTION:
Heightened perception: present in patient
DISTURBANCES IN MOOD AND AFFECT

1. Depression: Present, as patient was sad during talking.
2. Grief or Mourning: Present, as patient was sad for his carrier, he wants to be an
astronaut.
Other Affects:
1. Anxiety: Present, as patient was apprehended.
2. Fear: Present, as patient was fearful.
3. Blunted: Present in my patient.
DISORDERS OF MEMORY
ORIENTATION: Patient was oriented to time, place ,person.
INSIGHT:
Patient’s assessment of his illness.
LEVELS OF INSIGHT: Grade-I insight is present.
CONCENTRATION: Concentration is poor.
ABSTRACT THINKING: Abstract thinking is not present.
JUDGEMENT: Judgment is poor.
INTELLIGENCE: Present.
SLEEP: The patient has persistent insomnia.
Investigations:
NAME RESULT REFERRAL VALUE REMARKS
Random Blood Sugar 102 mg/dL 70-110 mg/dL Normal
KFT:
Urea 20 mg/dL 15-45 mg/dL Normal
S. Creatinine 0.86 mg/dL 0.7-1.3 mg/dL Normal
Uric Acid 4.6 mg/dL 3.5- 7.2 mg/dL Normal
Electrolytes:
Sodium 144 mmol/L 135-158 mmol/L Normal
Potassium 4.6 mmol/L 3.8-5.6 mmol/L Normal
Calcium 1.2 mmol/L 1.1-1.3 mmol/L Normal
Phosphorus 2.8 mg/dL 2.5-5.0 mg/dL Normal
LFT:
S. Bilirubin
Total 0.39 mg/dL 0.2-1.2 mg/dL Normal
Direct 0.10 mg/dL 0.0-0.2 mg/dL Normal
SGOT/AST 21 U/L <40 U/L Normal
SGPT/ALT 18 U/L <38 U/L Normal
Total Protein 6.3 g/dL 6.2-8.5 g/dL Normal
S. Albumin 4.3 g/dL 3.5-5.3 g/dL Normal
GGT 14 U/L 8-78 U/L Normal
Medication:
GENERIC NAME DOSAGE ROUTE FREQUENCY ACTION
Tab. Quantiapine 200 mg P/O BD Antipsychotic
Tab. Trihexiphenyldine 2 mg P/O BD Antiparkinsonian
Tab. Lopez 1 mg P/O HS Anticonvulsant
NURSING CARE PLAN
NURSING DIAGNOSIS
1. Impaired Social Interaction: The state in which an individual participates in an insufficient or excessive quantity or ineffective quality of
social exchange.
2. Disturbed Sensory Perception: Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated,
distorted or impaired response to such stimuli.
3. Disturbed Thought Process: Disruption in cognitive operations and activities.
4. Interrupted Family Process: Change in family relationships and/or functioning.
5. Impaired Verbal Communication: decreased, reduced, delayed, or absent ability to receive, process, transmit or use a system of symbols.
Assessment Diagnosis Goals Intervention Implementation Evaluation
Subjective Impaired Verbal Expected outcomes Identify the duration of the Therapeutic levels of an Patient trying
data Communication: or patient goals for psychotic medication of the antipsychotic aids clear to start verbal
Am not want decreased, reduced, impaired verbal client. thinking and diminishes communication
to talk with delayed, or absent communication derailment or looseness with the family
Keep voice in a low manner and
anyone. ability to receive, nursing diagnosIS ofassociation. or medical
speak slowly as much as
process, transmit or team.
possible. A high-pitched/loud tone of
Objective use a system of
voice can elevate anxiety levels
data symbols. Keep environment calm, quiet
while slow speaking aids
Nurse and as free of stimuli as
understanding.
observe the possible.
client not Keep anxiety from escalating
Use clear or simple words, and
communicate and increasing confusion and
keep directions simple as well.
with anyone. hallucinations/delusi
Focus on and direct client’s
Client might have difficulty
attention to concrete things in
processing even simple
the environment
sentences.
Assess if the medication has
Helps draw focus away from
reached therapeutic levels.
delusions and focus on reality-
Expected outcomes identify with client symptoms he based things.
NURSING CARE PLAN
ON
PERSONALITY DISORDER

IDENTIFICATION DATA
Name Mrs meena Rani
Age 55years
Sex Female
Bed no. 5
O.P.D no. 16/480626
Occupation Homemaker
Religion Hindu
Language Hindi
Diagnosis Personality Disorder
Identification mark Mole at left feet
Informant Patient
a) Psychological:
According to patient:
Nind kam aana
Gussa karna
Akele bethe bolna
b) Social: She like to interact with other, she is introvert

c) Interpersonal: She has good interpersonal relationship

Duration 1 year
Mode of onset Acute
Course Episodic

Patient was apparently well 20year back now he gives history of consumption of anxiety
from the last 6year. Initially he started taking anxiety with his friends. Patient works as a
farmer and while working in a field patient feel lethargic and weakness sometime patient feel
pain all over the body and then one of his friend offer him opium husk then patient took
opium husk with his own will and patient took one spoon of opium husk and after ate that
patient feel better and energetic and with the period of half an hour to one hour patient got
relief from body pain. Patient took one spoon of opium husk per day for the next one year
and after one year patient feels weak again and body ache at afternoon time then patient
increased his opium husk intake habits to get the desire effect and patient starts to take opium
husk twice a day morning or afternoon time.
And then after 3month patient start to take opium husk thrice a day. If the patient do not
consume opium husk in a day patient had strong desire or compulsion to take substance when
he not consumed opium husk then he complaints of dysphonic mood, nausea, vomiting,
muscle ache, sweating, Insomnia and now Patient is taking treatment in psychiatric ward
Treatment History

drug Name
SR Analgesic


Duration : 6 years
Past surgical history: Patient has not any significant of surgical
history.
Family history:-
Family tree
Male
Female
Personal History
Prenatal History
Antenatal period No any significant of prenatal history
Intranatal period
Birth
Birth defect
Childhood history
Primary care giver

Feeding
Age of weaning
Development Milestones No any significant of prenatal history
Educational history

Academic performance Normal
Extracurricular achievements No
School phobia No
Play history

Occupation History; Patient is house wife


Habits

Sleeping pattern Patient takes 5-6 hours during night and 1 hour of
sleep during a day

Behaviour: - Normal
Gesturing: - Normal
Posturing: - Normal
Speech: -
Rate: - Normal
Volume: - low
Tone: - low pitch
Stream - Normal
Nurse: - Aap apne bare me kuch btaye.
Mood and affect: -
Subjective
Objective

Mood: - Normal
Affect: - Normal
Thought: -
Stream: Normal, Autistic thinking, Thought block, Poverty of speech, Pressure of thought
all are absent.
Form: Normal, Circumstantiality, tangantiality, neologism, verbigeration, flight of idea all
are absent.
Content:
1. Delusion:-
Nurse: - kya apko lgta hai jab 2 log baat kar rahe hote hai to wo apke bare mei hi bat krte
hai?
2. Hypochondria:-
Inference: - Hypochondria delusion is absent.
Ideas: -
Patient: - Nahi mujhe aisa nahi lagta lekin mujhe apni patni pe gussa ata hai to mujhe marne
ka khayal ata hai.
4) Phobia: -

Perception: -
1) Illusions:-
2) Hallucination: -
Patient: - Haa, mujhe awaje sunai deti hai aisa lagta hai meri patni or sadu apas me bate karte
ho.
Nurse: - Kya apko aisa lgta hai ki apke body pei kuch chalra hai mtlb jaise kuch reing raha
hai?
Nurse: - Kya aapko aisa lgta hai kisi jgah aap pehli bar gaye ho lekin apko lge ki aap yha
phle bhi aa chuke ho?
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye
ho
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye
ho
Consciousness:-
Attention: -

sPatient: - Haa mujhe aati 1,2,3,4,5.......
Concentration: -

Orientation: -
Time: -
Place: -
Patient: - hospital
Person: -
Memory: -
Patient: - 9835664
b) Recent memory: -

c) Remote Memory: -

Intelligent: -

Arithmatic ability
Abstractions: -
a) Proverbs

Judgement: -

Insight: -

Patient:-kabi kabi
NURSING PLANNING
ASSESSMENT DIAGNOSIS OBJECTIV INTERVENTION RATIONALE IMPLEMENTATION EVALUATION
E OF CARE
Subjective Cues: Risk for Suicide At the end of Render close Suicide may be an Pt was placed in a room At the end of the
“I been thinking related to the 8 supervision; do not impulsive act with near the nurse station 8
about taking ‘a psychiatric leaving them little or no warning. away from exits and hours
little bit disorder as hours undetected. stairwells. for easy nursing
more’ of evidenced by nursing monitoring, intervention the
my medicines history of suicide intervention Provide a Prevents from acting client was able to
lately…. And its attempts and the client safe out or sudden self- Sharp objects, pills and decide that
been going for a reports of chronic environment. destructive impulses. other potentially suicide is
while now ideation of will dangerous objects were not
especially when suicide. be removed & kept away the answer to
things get bad, it able to: Present Expressing thoughts from the pt. Placed in a perceived
think somehow Demonstrat opportunities for & feelings may quiet room to reduce problems
it’ll help e behavior expression of lessen their intensity. stimuli which may
me; that thoughts, & feelings trigger her. as
maybe it'll make prevents in a nonjudgmental she was able to
things better and is suicideas environment. Gives other ways of Pt was encouraged to refrain
my only way out”. evidenced dealing with strong talk about suicidal from
by: Help plan emotions; gaining a thoughts and intentions making suicide
Objective Cues: alternative ways of sense of control over to harm herself while attempts
Impulsivity - Refraining handling their lives; learn to actively listening to her
Medical record from making disappointment, assess a problem & while performing daily and
states pt as suicide anger, and implement problem- activities. adhering to the
made 2 suicide attempts frustration with solving measures no-suicide
attempts by problem- solving in before reacting; Pt was assisted to make contract and to
overdosing on a constructive develop positive plans; identify
prescribed manner & approaches and Identified and listed
medications as a cognitive- positive thinking. situational, and
teenager and 6 behavioral self- interpersonal, or verbalize an
months ago management emotional triggers acceptable
responses to suicidal Establishes Suggested to use self- alternative
thoughts. permission to talk expression (verbalizing) through
about the subject. strong emotions as expressing
method to manage
Have a no-suicide Provides a sense of suicidal feelings /
contract with the security and Advised to keep a stating
client. strengthens self- journal
worth. Advised to call her
hotlines / family feelings
Stay with the pt members. and
more often. thoughts.
A written no-suicide
contract was secured;
stating not to act on GOAL WAS MET
impulse to do self-
harm.
Pt frequently checked;
was accompanied
throughout meals.
During the crisis “Tunnel Pt was talked to;
period vision“ may emphasized that the
employ therapeutic be crisis is temporary;
use of present; unbearable pain can
self and statements be
suggest give survived; help is
perspective & help available; they’re not
offer hope
Subjective Cues: Risk for self- At the end of the
Reported scars mutilation related 8
were from to impulsive hours
cutting during behavior and nursing
her teenage ineffective coping intervention the Assess for A pattern of Pt was interviewed At the end of the
years. strategies & client will presence of self- injurious behavior and she verbalized 8
physically self- be able to: harm urges & will likely engage to have cutting hours
damaging acts as Demonstrate no history of self- in similar self- urges whenever nursing
Objective Cues: evidenced by signs of self-injury injury harm behaviors she’s distressed, intervention the
Visible scars on history of non- / be when stressed. angry or anxious. client was free
arms and legs suicidal self-injury. free from of self- Render close from self-
Impulsivity injury as evidenced supervision where The client is easier Pt was placed in a injury as there was
Medical record by absence of cuts they can be to observe with room near the no signs
states pt as history or observed easily less chance to nurse station for of
of any forms leave the area easy monitoring,
cutting her arms of self- inflicted Closely supervise undetected away from exits any self-
and legs when she injuries use of sharp / other and stairwells. inflicted injury
was a teenager. (e.g., burns, potentially They may use in
scratches, cuts) dangerous objects. these items for The pt was closely
self-destructive monitored and any form
acts. strictly kept out
from sharp /
Have a no-harm potentially (cuts,
contract with the dangerous objects; burns, scratches)
client. Pt is encouraged stayed with her
to take during use of and agreed
responsibility for cutlery during
healthier behavior. meals. upon
keeping a no- harm
Written no-harm contract.
contract was
secured; stating not
to act on impulse
to do self-harm
Use a matter-of- The pt was talked GOAL WAS MET.
fact approach A neutral approach to objectively
when self- prevents blaming, discuss her
mutilation occurs. which increases thoughts &
anxiety, giving feelings before
special self-mutilating
attention that without
encourages acting criticizing / giving
out. sympathy;
withdrawing
attention while she
acts out by
diverting it through
other activities
(e.g.,
asking her to
meditate).
At the end of the
8-
hour nursing
At the
intervention the
client will be Encourage They may Pt was asked to
able to: identification of be feelings directly express
Demonstrate feelings / that feelings directly by end of hours
related to verbalizing it and
self- listening as she
unaware of
trigger self-
self-control as mutilating / self- destructive discusses this feelings and urges.
evidenced by destructive behavior and needs
performing behaviors. to develop more
alternative effective skills to Pt was assisted to make a written list of
activities to avoid self- her strengths and successful *coping
self-mutilating Help the client destructive behavior from the past.
behaviors. identify strengths behavior in the
and successful future.
coping behaviors Self-perception Pt was assisted in making a plan through
that used in the may be one of identifying and list actions that might
past. hopelessness/ modify the intensity of such situations
helplessness, and people whom they can contact to
Work out a plan needing assistance discuss and examine intense feelings
identifying to recognize (rage, self-hate) arises.
alternative to self- strengths.
mutilating The client was taught and encouraged to
behaviors. Plan is periodically engage in other coping behaviors like
reviewed and increasing physical exercise, expressing
evaluated. Offers a feelings verbally or in a journal
chance to deal with /meditation technique.
Encourage the feelings and nursing intervention, the client
client to try to use struggles that arise. demonstrated self-control
new coping as there were no acting out (self-
behaviors/strategie harming) and she
s and stress They may have openly discussed
management skills limited, or no what precipitates for her to
in present and knowledge of have urges
future situations. stress and
management feelings related to her cutting. The client
techniques / may also started writing on a
not have used journal to express frustration and
positive techniques anger sources and ways
Health education
● Educate the patient relative do not force the patient about any activity
● Educate the Family member to provide psychological support.
● Encorage the patient to ventilate the feeling to a close one
● Encorage the family members that do not judge the patient for any activity
● Educate the family members to provide balance diet to the patient
● Advise the family member about the importance of treatment
● Advise the Patient to consult the doctor if any side effect occur
● Educate the patient and family members about the side effect of medicine
Reference/s:
Doegenes, M., Moorhouse, M. F., & Murr, A. (2019). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales (Fifteenth ed.).
F.A. Davis Company. Martin, P. B. (2019, April 11). 3 Suicide Behaviors Nursing Care Plans. Nurseslabs. https://nurseslabs.com/suicide-
behaviors-nursing-care-plans/ Videback, S. (2020). Psychiatric-Mental Health Nursing (8th ed.) [E-book]. Wolters Kluwer.
NCP #2 Reference/s:
Doegenes, M., Moorhouse, M. F., & Murr, A. (2019). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales (Fifteenth ed.).
F.A. Davis Company. Martin, P. B. (2019, October 15). 4 Personality Disorders Nursing Care Plans. Nurseslabs.
https://nurseslabs.com/personality-disorders-nursing-care-plans/ Videback, S. (2020). Psychiatric-Mental Health Nursing (8th ed.) [E-book].
Wolters Kluwer.
NURSING CARE PLAN

ON
DELIRIUM

IDENTIFICATION DATA
Name Mr ABC
Age 60years
Sex Male
Bed no. 5
O.P.D no. 15/467942
Occupation labrour
Religion Muslim
Language Hindi
Informant Patient
a) Psychological:
Nind kam aana
Gussa karna
Duration 1 year
Mode of onset Acute
Course Episodic
Treatment History

drug Name
SR Analgesic

Duration : 30 years
Family history:-
Family tree
Male Male
Female
Male patient
Personal History
Prenatal History
Intranatal period
Birth
Birth defect
Childhood history
Primary care giver

Feeding
Age of weaning
Educational history

School phobia No
Play history


Habits

Sleeping pattern Patient takes 5-6 hours during night and 1 hour of sleep during a day

Behaviour: - Normal
Gesturing: - Normal
Posturing: - Normal
Speech: -
Rate: - Normal
Volume: - low
Tone: - low pitch
Stream - Normal

Mood and affect: -
Subjective
Objective

Mood: - Normal
Affect: - Normal
Thought: -
Content:
1. Delusion:-
2. Hypochondria:-
Inference: - Hypochondria delusion is absent
Ideas: -

4) Phobia: -

Perception: -
1) Illusions:-
2) Hallucination: -
Consciousness:-
Attention: -

Concentration: -

Orientation: -
Time: -
Place: -
Patient: - hospital
Person: -
Memory: -
Patient: - 9835664
b) Recent memory: -

c) Remote Memory: -

Intelligent: -

Arithmatic ability
Abstractions: -
a) Proverbs

Judgement: -
Insight: -

Patient:-kabi kabi
Nursing Diagnosis
Disturbed thought processes related to delusional thinking.

Chronic Confusion related to cognitive impairment.
Impaired verbal communication related to cognitive impairment.
Risk for injury related to suicidal ideations, illusions, and hallucinations.
Impaired memory related to cognitive impairment.
Risk for other-directed violence related to suspiciousness of others.
Assessment Diagnosis Goals Intervention Implementation Evaluation
Subjective Patient will

Cues: demonstrate
Disturbed thought Client will maintain .. Ensure that medications are Promoting comfort and
appropriate
“I been processes related to agitation at a taken as prescribed. relaxation
orientation to
thinking delusional thinking. manageable level so
Some patients may not take Limiting environmental person and
about taking as not to become
Chronic Confusion medications correctly, either stimulation place.
‘a little bit violent.
related to cognitive overdosing or underdosing.
Increasing patient’s sense of Patient will
impairment.
more’ Provide a calm environment. safety cooperate with
Impaired verbal care and
Allow the patient to interact with Reducing confusion and
of my communication assessments.
familiar faces by providing an disorientation
medicines related to cognitive
isolated, quiet, and Patient will
lately…. impairment. Supporting cognitive and
nonstimulating environment. communicate
And its been functional abilities
Risk for injury needs and
going for a Maintain routines and staff
related to suicidal follow
while now assignments.
ideations, illusions, commands.
especially
and hallucinations. Maintaining similar routines,
when things
such as eating and bathing
get bad, Impaired memory
schedules, can enhance
related to cognitive
orientation. If possible, keep the
Health education
Encorage the patient to ventilate the feeling to a close one
Encorage the family members that do not judge the patient for any activity
PROCESS RECORDING
ON
BIPOLAR DISORDER

Student Name: Jyoti Batra

Date & Location:
Client Diagnosis: Bipolar Disorder, suicidal ideation, suicides attempts
History RT Diagnosis; suicide attempts, anhedonia, anergia, poor sleep, inability to function, hopelessness, helplessness, no violent
Onset, Duration & Prior toward others.
Treatment:
Nurse Communication Client Nurse’s Analysis of the (Effectiveness, Technique, Name &
(Verbal & Non Communication Thoughts & Rationale)
Verbal) (Verbal & Non Feelings
Verbal) Related to the
Interaction
1. Hello… Hello… I had the Greeting the patient:
feeling that he It is necessary in order to have an appropriate start for the
(Establishing eye (Looking me directly wanted to talk conversation.
contact while with a facial with someone.
aproaching in a friendly expression that
manner) denotes interest.)
2. My name is Susan, I'm Yes, not problem I felt well Introducing oneself and
Nursing student at……, when he establishing a contract:
and I would like to talk (The client has a flat answered and It should be done when meeting the client for the first time
with you for a moment. emotional but approved in order to have an appropriate start for a therapeutic
Would you like to accepting expression talking with communication.
speak with me? in his face. He is me.
calm and has a
(Leaning forward the soft speech)
patient, with open
posture)
3. Ok, thank you. My name is J.K Thinking Identifying the patient / Giving
and your name is…? about how to recognition:
(He shows relax start the Shows to the client that the nurse wants to recognizes him
( I took a sit next to him posture and open conversation as an individual, as a person.
at his right side) attitude, well and taking him
groomed straight to the
appearance) point without
being too
invasive.
4. How are you today? I’m ok… Trying to Broad opening question:
active initiate the Gives the client the lead in the interaction , and it may
(Leaning forward, (He seems not very conversation. stimulate him to take the initiative.
making eye contact) convinced of that)
5. Would you like to tell The reason why I'm Satisfied that Broad opening question:
me a little about here is because… he understood Gives the client the lead in the interaction , and it may
yourself, what brought you know… I had my question stimulate him to take the initiative.
you here? or what is have several and he was
happening to you if you suicidal attempts in willing to
want to share it with my life, and last open himself
me? week I knew I was to the
going to try it again. conversation.
(Using SOLER I wanted to kill
technique of active myself, but I
listening) recognize the
symptoms and I
came here before I
actually did it.
I came voluntary
here.
6. Tell me little bit Yes, it is what I I wished not Restating:
more… wanted having to The restatement encourages the
You said you wanted to to do. I feel really ask that
sad, is question, it is
kill yourself? something in my really sad. client to continue, and let the client know that he or she
mind, is depression, I knew exactly communicated the idea effectively.
(Active listening ) something that I what he was
cannot control or get talking about,
rid of it, and I cannot because I was
handle it anymore. very closed to
I'm really tired. It a person in my
hurts my mind, is life with the
pain, is an same problem.
uncontrollable pain
that I feel, and I
don't know why I
feel this way.
( His sadness and

powerless is evident
in his face)
7. How were you planning Taking my bottle of Trying to Exploring:
to kill yourself. meds at one time. know more Allows the nurse to gather more information regarding
about the important topics mentioned by the client.
(Active listening ) (The sadness situation.
continue)
8. You say you tried it In November, 2 I was feeling Placing event in time or
before to kill yourself? months ago. I took very sorry for sequence:
When was the previous 90 pills. him. He had Putting events in proper sequence helps both the nurse and
time that you had also It happen to me so much going client to see them in perspective.
tried it? because I have on in his life. The nurse may gain information about recurrent patterns or
Bipolar themes in the client’s behaviors.
(Active listening ) Disorder. I'm also
HIV(+). I had being
suffering from
Bipolar since 1982
and I was diagnosed
with HIV 8 years
ago.
(Very cooperative
and providing
detailed information
about himself)
9. I imagine how hard Yes it is, and I I’m feeling Emphaty:
should be for you to cannot explain sad, and When empathetic, the
have this two diseases. myself why I have thinking how nurse is nonjudgmental, sensitive capable of imagining
this depression and can I help him another person’s experience.
(Active listening ) this pain. to alleviate his
I can not tolerate it pain. I believe
any more. I live with it is too much
my partner and I suffering for
cannot talk with him an individual
about this. having this
two diseases.
(Confused,
frustrated, sad)
10. Can you explain it little He is very I’m realizing Seeking clarification:
it bit more. supportive with me, his support It helps the nurse to avoid making assumptions that
What it’s the reason and I don’t want to system is understanding has occurred when it has not.
why you cannot speak talk with him failing. Is hard
with him? (Active because I don’t want to understand
listening ) to hurt him. It is the refusing of
enough with my seeking help
pain. I in his close
don’t want to pass family and
him my problems. keeping all to
himself.
(Confused and
depressed)
11. But what do you think But the thing is. His depressive Presenting reality:
he What you disease Clarifying misconceptions that
would prefer? Help you would do if you have makes him
if to disoriented
kill yourself? something in my mind, is depression, really sad. client to continue, and let the client
something that I cannot control or get rid I knew exactly what know that he or she communicated
(Active of it, and I cannot handle it anymore. I'm he was talking about, the idea effectively.
listening ) really tired. It hurts my mind, is pain, is because I was very
an uncontrollable pain that I feel, and I closed to a person in
don't know why I feel this way. my life with the same
problem.
( His sadness and powerless is evident in
his face)
7. How were you Taking my bottle of meds at one time. Trying to know more Exploring:
planning to kill about the situation. Allows the nurse to gather more
yourself. (The sadness continue) information regarding important
topics mentioned by the client.
(Active
listening )
8. You say you In November, 2 months ago. I took 90 I was feeling very Placing event in time or
tried it before pills. sorry for him. He had sequence:
to kill yourself? It happen to me because I have Bipolar so much going on in Putting events in proper sequence
When was the Disorder. I'm also HIV(+). I had being his life. helps both the nurse and client to see
previous time suffering from Bipolar since 1982 and I them in perspective.
that you had was diagnosed with HIV 8 years ago. The nurse may gain information
also tried it? about recurrent patterns or themes in
(Very cooperative and providing the client’s behaviors.
(Active detailed information about himself)
listening )
9. I imagine how Yes it is, and I cannot explain myself I’m feeling sad, and Emphaty:
hard should be why I have this depression and this pain. thinking how can I When empathetic, the
for you to have I can not tolerate it any more. I live with help him to alleviate nurse is nonjudgmental, sensitive
this two my partner and I cannot talk with him his pain. I believe it is capable of imagining another
diseases. about this. too much suffering for person’s experience.
an individual having
(Active (Confused, frustrated, sad) this two diseases.
listening )
10. Can you He is very supportive with me, and I I’m realizing his Seeking clarification:
explain it little don’t want to talk with him because I support system is It helps the nurse to avoid making
it bit more. don’t want to hurt him. It is enough with failing. Is hard to assumptions that understanding has
What it’s the my pain. I understand the occurred when it has not.
reason why you don’t want to pass him my problems. refusing of seeking
cannot speak help in his close
with him? (Confused and depressed) family and keeping all
(Active to himself.
listening )
11. But what do But the thing is. What you His depressive disease Presenting reality:
you think he would do if you have to makes him disoriented Clarifying misconceptions that
would prefer?
Help you if
you open to him, or decide between hurt yourself and hurt about the potential client may be expressing. Intents to
see you that you took the person you love? consequences of self- indicate an alternate line of thought
your injury could for the client to consider.
life. (Poor judgement) produce to his
(Active listening significant others.
techniques )
1 It is a difficult answer Yes I know but is something very He is having poor Non therapeutic:
2 but … Don’t you think difficult to explain, the pain inside my judgment about the It could be non therapeutic because
. that hurting yourself brain, the depression, the loneliness has significance of hurting I’m Rejecting and refusing to
and taking your life, is such dimension that is very difficult to other person or consider or showing contempt for
a way of hurt him too? think clear. himself. the client’s ideas or behaviors.
I’m also Probing or
(Small frown) (Frustrated, sad) persistent questioning the client.
1 Do your partner has Yes, he has. We both contracted it but Feeling sorry for both Non therapeutic:
3 HIV too? we never knew how we got it. now. I’m Introducing an unrelated topic
. or changing the subject.
(Non judgmental (The depression seems to be bothering
expression) him much more than the HIV disease) The topic could be a little related
but I’m loosing the focus about my
patient. The fact of knowing if his
partner has or not HIV it doesn’t
contribute to identify the patient’s
feelings or problems.
1 Are you taking Yes, I'm taking 22 pills twice at day. I think 44 pills at day Exploring:
4 medicines to control But other problem is that the pills are is something that even Allows the nurse to gather more
. the HIV and the good for certain time and after a period myself I wouldn’t information regarding important
Bipolar Disorder? they are not effective anymore. even tolerate. topics mentioned by the client.
Thinking about what
( Light surprised (Continues willing to give information are the positives
expression after the about him) things in his life and
client’s answer) ways to help him to
find the support he
needs.
1 I know. It happens Yes he does. I believed he has Giving information:
5 because your body and I would like also here at the hospital let loneliness and I am Increases the client’s knowledge
. metabolism get use to us talk in groups, to have a way to share maybe helping him in about a topic, let the client know
them and the meds each other our problems. It is necessary some way to escape what to expect, and builds trust
turn not being as much to have therapy groups, that can help for from it. with the client.
effective than they our situation.
were before.
It is something that ( Showing hopeful interest on being
your doctor needs to accomplished his desire)
address periodically to
ensure you get the best
option available.
(Trying to be
explicative)
1 Have you ever Yes, I was member of a I realize that that the Encouraging comparison:
6 participated therapy group for many patient is willing to The client benefits from
. in therapy groups in talk
the
past and that has years, but now here we need and he trusts me. making this comparisons because he
helped you with your someone that listen to us. It is why might recall past coping strategies
depression? we are here. If nobody talk or listen that were effective
to us is the same that being at home. or remember that he has survived a
(Active listening ) similar situation.
(Increased interest in talking about it)
1 I understand what you Ok thanks. Trying to explain that Accepting:
7 mean. We do have people in this hospital An accepting response indicates the
. meetings groups here, (Showing doubt of the possibility of is willing to help him nurse has heard and follow the train
and you will have the being helped in the hospital) when he needs it. of thought. It does not indicate
opportunity to talk I believe that he really agreement but is nonjudgmental.
and express your feels lonely and Giving information:
feelings. But always desperate for Increases the client’s knowledge
remember you have communicating with about a topic, let the client know
the right to call the someone willing to what to expect, and builds trust with
nurse anytime you listen him. the client.
need it and ask help or
something else you
need.
(Trying to be
explicative)
1 Do you believe that I don’t know if it would relieves Thinking in orienting Encouraging expression:
8 maybe participating in 100% from my depression but it may the client to find a Asking the client to consider people
therapy groups can help something. support system that and events in light of his own
help you to deal with help him to resolve values , the nurse encourages the
your problems, (Slightly hopeful, but not convinced) his emotional client to make his own appraisal of
as it was in the past? problem. the situation.
(Active listening )
1 Tell me what No I don’t work, I have disability. Thinking also that Exploring:
9 activities you having a passive life Allows the nurse to gather more
. normally do? Do you (Flat expression) style doesn’t help to information regarding important
work? his disease. topics mentioned by the client.
(Active listening )
2 I see… and the fact Well, life is very difficult today but Trying to find more Non therapeutic:
0 that you don’t work, that is not affecting me so much with reasons that may This question could be done instead a
. can that situation also my depression. influence in his like: Does this situation contribute to
be contributing with depression. your distress? , because some people
economic problems (Sadness and flat expression) don’t like to speak about their
you may have? economic problems, and they
Since life is very actually can deny a fact that is real,
difficult today for without giving more information.
everybody. It is that
situation also
affecting you in your
depression? (Trying
not being too
invasive)
2 And, what about Yes, it could help for moments but Feeling that he Encouraging expression:
1 doing activities to the depression always come back. wanted to find help in Asking the client to consider people
. help you distract a therapeutic group as and events in light of his own
yourself from your (The sadness expression continues) he did in the past. values , the nurse encourages the
depression? client to make his own appraisal of
the situation.
(Active listening )
2 I believe that the fact Yes, I know. I wanted to remark Making observation:
2 that the positives aspects It verbalizes what the nurse
. you recognized your
suicidal thinking and (Hopeless) about himself, and his perceives when the client cannot
decide to come to the accomplishments to
hospital seeking help increase his self- verbalize or make themselves
it is a good point, and esteem. understood.
a positive alternative
you chose instead of Formulating a plan of action:
harming yourself. It is It may be helpful for the client
something that you to plan in advance what he or she do
would have to in future similar situations.
implement in the
future if it ever
happen again.
( Showing a positive
attitude)
2 You are doing a big Thank you for have listened to me. I think that it is Summarizing: Brings out the
3 progress seeking help, (Grateful expression) necessary help him to important points of the discussion,
. and coming here visualize the positive increase awareness and provides a
voluntary to the I think I have to take my medicines side of his situation in sense of closure at the completion of
hospital. I wish you a now… order to give him each discussion for both client and
soon relief of your some hope and nurse.
medical problems, ( He sudden remembers encouragement.
and the ability to something…)
continue increasing
strength dealing with
them.
(Trying to give some
hope)
2 Thanks to you for I’m going to get my medicines. It was a good Closing of the interview
4 share with me your conversation. I feel
. concerns. (Standing up) he wanted to talk and
it may helped
(Smiling, standing up) him.
PROCESS RECORDING
ON
MAJOR DEPRESSION

Student Name: Jyoti Batra
Date & Location:
Client Diagnosis: Mjor depression
History RT Diagnosis; suicide attempts, anhedonia, anergia, poor sleep, inability to function, hopelessness, helplessness, no violent
Onset, Duration & Prior toward others.
Treatment:
Dialogue Non Verbal Technique Student Student T/ Analysis
Communication Feelings Thoughts N
SN: Hello. I am a SN: Open Introductory Nervous “I hope she T 3) I felt nervous when I approached the
nursing student at and posture, eye Statement wants to talk client but she seemed to open up when I
I am assigned to this contact, smile to me.” appeared confident, so I felt like I
unit until 1:15 pm needed to maintain a confident
today. I’m here to Client: hunched appearance throughout the interview.
listen and observe the forward, looking 4) Client is looking down and avoiding
clients here today. down at a piece of eye contact indicating that she feels
Let’s talk. paper uncomfortable
Client: Okay
SN: Tell me what SN: Took a seat Open Anxious “I hope she T 2) Self-improvement- I should have
brought you here? in a private area. Question/ Relived opens up.” asked her more about her medication
Legs cross arms General Lead and compliance. I should have used
Client: I was on a CR at my side. clarification and asked What did you
for a petty mean by you didn’t know day from
misdemeanor, when Client: looking night? Or How did the medication make
my doctor changed my down, scribbling you feel?
medicine to Latuda I on paper. No eye 3) I started off feeling very anxious so I
didn’t know night contact didn’t know what to say to start off the
Dialogue Non Verbal Technique Student Student T/ Analysis
Communication Feelings Thoughts N
SN: You don’t show SN: leans Open question Curious, Why isn’t she T 3) I am confused as to why she has no
any emotion when you forward, Concerne angry? emotion about a man who I feel has
talk about your maintains eye d Maybe she’s ruined her life. PTSD can cause
husband, how do you contact completely detachment so I do not feel like I will be
feel about him now? detached. able to elicit any emotion from her at
Client: Maintains Maybe she’s this point. My thoughts contributed
Client: Were divorced eye contact, no following the negatively to my interview because she
now. He took half of expression steps, made wasn’t able to express her feelings
my money and tried to amends and toward this man who abused her for 20
get my children’s half forgave? years.
as well. I don’t know
he’s in the mainland
now.
SN: I see you’ve been SN: Sitting Open question Hopeful “She has T 4) Patient finally smiles when speaking
through a lot, how do upright slightly plans for the of her future plans. Her feelings of
you feel now? leaning forward, future! I optimism are congruent with her
maintains eye wonder what expression.
Client: Well… I feel contact they are?
optimistic. I finally
contacted my children Client: Makes eye
and I even have a contact, slight
HISTORY
TAKING
HISTORY TAKING
PARANOID SCHIZOPHERNIA

IDENTIFICATION DATA :-
NAME : Mr. xyz
AGE : 30 yrs
SEX : Male
BED NO. : C-3
MARITAL STATUS : Married
ADDRESS : Agroha
EDUCATION : 12th fail
OCCUPATION : Pharmacist
INCOME : 15,000Rs
IDENTIFICATION MARK : Scar on right eyebrow
RELIGION : Hindu
SOCIO ECONOMIC STATUS : Good
DIAGNOSIS : Paranoid Schizophrenia
MODE OF ENTRY : Brought by brother
INFORMANT : Brother
PRESENTING CHIEF COMPLAINTS:-

PATIENT VERSION:-
Decreased sleep
Diminished appetite
Muttering to self since 1 month
Aggressiveness
Irritability
HISTORY OF PRESENT ILLNESS:-
DURATION: 1 month
MODE OF ONSET: Insidious
COURSE: Continous
INTENSITY: Same
My client was apparently fine before 1 month. But one day he suddenly started showing
aggressive behaviour, decreased sleep, and diminished appetite. He also has irritabilities and
muttering to self.
PAST PSYCHIATRIC HISTORY:-
My client doesnot have any past psychiatric history
PAST MEDICAL HISTORY:-
My client is having Diabetes Meliitus and thyroid from 10 yrs
FAMILY HISTORY:-
NO. OF FAMILY MEMBERS: 3
TYPE OF FAMILY: Nuclear Family
FAMILY TREE:-
INDEX
Male Client
Female
PAST FAMILY HISTORY:-

No significant history of any psychiatric illness
No history of suicidal attempt and drug dependence
CONCURRENT SOCIAL SITUATION:-
Social economic status of client is very good as my patient is having job and he is earning
enough to run the family and to bear the expense of treatment
ATTITUDE OF FAMILY MEMBERS TOWARDS PATIENT:-
The attitude of family members is very supportive and caring
PREMORBID HISTORY:-
PERINATAL HISTORY:-
My client has full term normal delivery. No complications like convulsion, cyanosis were
present.
CHILDHOOD HISTORY:-
Primary care giver:- Mother
Feeding:- 2 yr (Breast milk)
Age at weaning:- 6-7 yr. Month onwards
Developmental mile stone:- Normal
Behavioural & emotional problem:- No
Illness during childhood:- No illness
EDUCATIONAL HISTORY:-
Age at beginning of formal education:- 3 yr
Academic performance:- Good in studies
Extracurricular achievement:- No achievements
Relationship with peers and teachers:- good
School phobia:- No
Reason for termination of studies:- failed in 12th
PLAY HISTORY:-
Game played:- Carrom & Cricket
Relationship with play mates:- Good
EMOTIONAL PROBLEM DURING ADOLESCENCE:-

My client has certain emotional problems , that is getting aggressive for small matters
OCCUPATIONAL HISTORY:-
Age at starting work:- 20 yr
Current job satisfaction:- Satisfied with his job
Whether job is appropriate to patients background:- Yes
PUBERTY
Age at appearance of secondary sexual characters:- 15 yrs
Anxiety related to puberty changes:- -
Age at menarche:- -
OBSTETRICAL HISTORY
LMP:- -
No. of children:- -
Any abnormalities associated with pregnancy:- -
Termination of pregnancy:- -
SEXUAL AND MARITAL HISTORY:-

Type of marriage:- Arrange marriage
Duration of marriage:- 8 yrs
Interpersonal and sexual relations:- satisfactory
PREMORBID PERSONALITY:-
Interpersonal relationship:- Extrovert
Family and social relationship:- Good
Use of leisure time:- By watching news and playing cricket
Predominant mood:- Fluctuating mood
Usual reaction to stressful situation:- He shows aggression behaviour
in small matter
Attitude to work and responsibility:- Satisfied
HABITS:-
Eating pattern:- Non-vegeterian (3-4 times/day)
Elimination :- Normal (urine output :4-5 times/day)
Sleep:- Insomnia
Use of drugs, tobacco, alcohol:- Patient Is Alcoholic
Dislike :- Bitter gord
Like:- Like all kind of food
GENERAL EXAMINATION
TEMPERATURE:- 98.6OF
PULSE:- 88beats/min
RESPIRATION:- 22 breaths/min
BLOOD PRESSURE:- 120/80mm / Hg
SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM
S1 and S2 sound is present
No cardiac abnormality is present
CENTRAL NERVOUS SYSTEM

Patient is little drowsy
Conscious
Oriented
RESPIRATORY SYSTEM
No dyspnea
Lungs are bilaterally symmetrical
INTEGUMENTARY SYSTEM
No rashes
No wrinkles
No bed sore
GASTROINTESTINAL SYSTEM
Inspection- No tenderness present
Palpation – No distension
Auscultation – Normal bowel sound
GENITOURINARY SYTEM
Elimination is normal
Urine output is normal
MUSCULOSKELETAL SYSTEM
Edema is absent
Range of motion – Present
HISTORY TAKING
ANXIETY DISORDER

IDENTIFICATION DATA
Name Mrs ABC
Age 55years
Sex Female
Bed no. 5
O.P.D no. 16/480626
Religion Hindu
Language Hindi
Diagnosis Anxiety Disorder
Identification mark Mole at left feet
Date of historytaking 5/7/2023
Informant Patient
a) Psychological:
According to patient:
Nind kam aana
Gussa karna
Akele bethe bolna


Duration 1 year
Mode of onset Acute
Course Episodic

Patient was apparently well 20year back now he gives history of consumption of anxiety
from the last 6year. Initially he started taking anxiety with his friends. Patient works as a
farmer and while working in a field patient feel lethargic and weakness sometime patient feel
pain all over the body and then one of his friend offer him opium husk then patient took
relief from body pain. . Patient took one spoon of opium husk per day for the next one year
and after one year patient feels weak again and body ache at afternoon time then patient
increased his opium husk intake habits to get the desire effect and patient starts to take opium
husk twice a day morning or afternoon time.
Treatment History

drug Name
SR Analgesic

No. Of previous episodes with onset and course:2 years

Duration : 6 years
Family history:-
Family tree
Male Male patient
Female
Personal History
Prenatal History
Antenatal period No any significant of prenatal history
Intranatal period
Birth
Birth defect
Childhood history
Primary care giver
Feeding
Age of weaning
Development Milestones No any significant of prenatal history
Educational history

Academic performance Normal
School phobia No
Play history


Habits

sleep during a day
HISTORY TAKING
SUBSTANCE
ABUSE

IDENTIFICATION DATA
Age 60years
Sex Male
Bed no. 5
O.P.D no. 15/467942
Occupation labrour
Religion Muslim
Language Hindi
Informant Patient
a) Psychological:
Nind kam aana
Gussa karna


Duration 1 year
Mode of onset Acute
Course Episodic
Patient was apparently well 30year back now he gives history of consumption of opium husk
from the last 30 year. Initially he started taking opium husk with his friends. Patient works as
a farmer and while working in a field patient feel lethargic and weakness sometime patient
feel pain all over the body and then one of his friend offer him opium husk then patient took
relief from body pain. After that patient starts taking opium husk daily. Patient took one
spoon of opium husk per day for the next one year and after one year patient feels weak again
and body ache at afternoon time then patient increased his opium husk intake habits to get the
desire effect and patient starts to take opium husk twice a day morning or afternoon time.
Treatment History

drug Name
SR Analgesic

Duration : 30 years
history.
Family history:-
Family tree
Male Male
Female
Male patient
Personal History
Prenatal History
Intranatal period
Birth
Birth defect
Childhood history
Primary care giver

Feeding
Age of weaning
Educational history

School phobia No
Play history


Habits

sleep during a day
MENTAL
STATUS
EXAMINATION
MENTAL STATUS
EXAMINATION ON
MANIA

Patient’s Profile
Identification data
Client name : Mr. XYZ
Age : 15 Years
Sex : Male
Ward : Male ward
Education : 9th class
Occupation : Student
Religion : Hindu
Address : Patna, Bihar
Informant : Father (Reliable)
Presenting Chief Complaints
Steroid dwa khai thi aankh ke operation ki wajah se isliye mjboori me aana pda
3 months
Sar ghumta hai
Nind nhi aati
Pahle se jyada bat krta tha
Kai bar same words ko repeat krta tha
3 months
Kahta tha ki main Bajrangbali hu or kele khata tha
Khta hai ki mujhe swarg dikhta hai
Date of MSE - 12 .07.23

Time of MSE - 11:00 pm
OBJECTIVES;
To do detailed mental health status

To record the data.
To identify nursing needs of the patients.
1) General Appearance and Behavior-
Facial Expression: normal

Posture: Normal
Mannerism: Absent
Eye to Eye contact: Maintained
Rapport: Built
Consciousness: conscious
Behavior: friendly
Dressing and Grooming: Appropriate
Physical Feature: looks according to the age
2) Psychomotor Activity- normal
3) Speech-
Coherence: coherent.
Relevance: relevant
Volume: Normal
Tone: low pitched.
Murmur: absent
Reaction Time: Normal.
4) Thought-
Form of Thought: Normal.

Stream of Thought: no flight of ideas.
Content of Thought:
Delusion :
Question : kya apme aisi koi baat hai jo apko dusro se alag karti hai ?
Ans : mujhe lgta hai ki mai bajarangbali hu.
Remarks : delusion of grandiosity present
Obsession : absent
Compulsion:
Phobia: Absent.
Preoccupation: Absent.
5) Mood and Affect-
Pleasurable affect: absent

Unpleasurable affect: No
Other Affects: Normal
Hallucination:
Q. aapko kuch ajib sa dikhayi ya sunai deti hai, jo dusro ko sunai ya dikhayi nahi
deta hai ?
A. Nahi Aisa kuch nai hai.
Inference: Normal, no hallucination present.

Nurse:”Hafte me kon kon se din hote hai ? “.
Patient: Sunday, Monday…….
Remark: He has normal concentration.
b) Memory:
Told patient three words ghoda, gadi, train
1) Immediate memory
Nurse: “abhi maine 3 shabd khe the unko repeat krengi?”.
Patient:”,gadi”.
Remark: Patient has poor immediate memory.
2) Recent Memory
Nurse:”aapne kal dinner me kya khaya tha?”.
Patient:”sabji, roti”.
Remark: My patient is having good recent memory.
3) Remote Memory
Nurse:”aapki date of birth kya hai ?”.
Patient: “04/02/2004”.
Remark: My patient is having good remote memory.
c) Orientation:
Time:
Nurse: “abhi kya time hoga ?”.
Patient: “11:00 a.m.”.
Place:
Nurse: “abhi aap kha ho?”
Patient: “hospital”.
Person:
Nurse: “aapke sath kon hai?”
Patient: “papa hai”.
Remark: My patient is oriented to time, person, and place.
d) Abstraction:
Nurse: “bulb or tubelight me kya difference hai?
Patient: “dono ki shape alg ahi”.
Nurse: “aam or seb me kya difference hai?
Patient: “dono ki shape or color alg hai”.
Remark: My patient’s abstraction is normal.
Q. India ka prime minister kaun h?
Answer: Moji Ji hain.
Q. Apne Desh Ki RAJDHANI kya h?
Answer. Delhi Hai.
Q. Bihar ki rajdhani kya hai?
A. patna.
Q. India ka president kon hai?
A. No answer.
INFERENCE: intelligence is average based on his formal education.
f) Judgment:
Q: agar ekdum se yhan aag lag jaaye to aap kya karoge?
A: fire bigrade ko phone krunga.
Remark: he has good judgment power.
g) Insight:
Nurse: “aap yehape kyoun aaye hain”?
Patient: Steroid dwa khai thi aankh ke operation ki wajah se isliye mjboori me aana pda
Remark: he has no insight.
Sleep
1) Insomnia: present.
2) Hypersomnia: Absent.
3) Non –organic sleep: Absent.
4) Early morning awakening: present.
5) Episodic Disturbances: Absent.
MENTAL STATUS
EXAMINATION
ON
PARANOID SCHIZOPHRENIA

Patient’s Profile
● Identification data
Client name : Mr. ABC

Age : 29 Years
Sex : Male
Ward : Male ward
Education : nil
Religion : Hindu
Address : Devrala
Informant : Brother (Reliable)
● Presenting Chief Complaints
● Mujhe log dikhai dete Hain woh log mujhe kehte hain ki tu sunn Raha hai Na
● Mujhe gaali dete Hain

10 months
● Nind nhi aati
● Sar Dard hota hai
● Mujhe lagta hai ki mere charo aur camera lage hue hey aur koi mere photo
khich kar net par daal raha hai

● Khta hai ki log dikhte hai or wo isko gali dete hai

10 months
● Khta hai ki mere charo aur camera lage hue hey aur koi mere photo
khich kar net par daal raha hai
● Preshan rhta hai

Date of MSE - 15 .07.23
Time of MSE - 11:00 pm
OBJECTIVES;
❖ To do detailed mental health status of Mr. Udit
❖ To record the data.
❖ To identify nursing needs of the patients.

1) General Appearance and Behaviour-
Facial Expression: Anxious
Posture: Normal
Mannerism: Absent
Eye to Eye contact: not maintained
Rapport: Built, spontaneous
Consciousness: conscious
Behavior: friendly
Dressing and Grooming: Appropriate
Physical Feature: looks according to the age
2) Psychomotor Activity- normal
3) Speech-
Coherence: coherent.
Relevance: relevant
Volume: Normal
Tone: normal pitched.
Murmur: absent
Reaction Time: Normal.
4) Thought-
Form of Thought: Normal.
Stream of Thought: no flight of ideas.
Content of Thought:
a) Delusion :
Question : kya apme aisi koi baat hai jo apko dusro se alag karti hai ?
Ans : Nai aisa kuch nai hai.
Remarks : no delusion of grandiosity present
QUESTION : kya aapko lgta hai ki koi aapko hani phuchana chahta hai ?
Ans : mujhe lgta hai ki koi mere photo kheech kar net par dal rha hai
aur mere charo or camera lge hue hai
b) Obsession : absent
c) Phobia: Absent.
d) Preoccupation: Absent.
5) Mood and Affect-

Pleasurable affect: absent
Unpleasurable affect: No
Other Affects: normal
Hallucination:
Q. aapko kuch ajib sa dikhayi ya sunai deti hai, jo dusro ko sunai ya dikhayi nahi
deta hai ?
A. Mujhe log dikhai dete hai or wo mujhe khte hai ki tu sun rha hai na or gali dete hai.
Inference: auditory and visual hallucination present.
Nurse: “Hafte me kon kon se din hote hai ? “.
Patient: ravivar, somvar……..
Remark: he has normal concentration.
b) Memory:
Told patient three words ghoda, gadi, train
1) Immediate memory
Nurse: “abhi maine 3 shabd khe the unko repeat krenge?”
Patient:”ghoda, gadi, train”.
Remark: Patient has normal immediate memory.
2) Recent Memory
Nurse:”aapne kal dinner me kya khaya tha?”.
Patient:”sabji, roti”.
Remark: My patient is having good recent memory.
3) Remote Memory
Nurse:”aapki date of birth kya hai ?”.
Patient: “04/02/2000”.
Remark: My patient is having good remote memory.
c) Orientation:
Time:
Nurse: “abhi kya time hoga?”
Patient: “11:00 a.m.”.
Place:
Nurse: “abhi aap kha ho?”
Patient: “hospital”.
Person:
Nurse: “aapke sath kon hai?”
Patient: “mera bhai hai”.
Remark: My patient is oriented to time, person, and place.
d) Abstraction:
Nurse: “bulb or tubelight me kya difference hai?
Patient: “dono ki shape alg ahi”.
Nurse: “aam or seb me kya difference hai?
Patient: “dono ki shape or color alg hai”.
Remark: My patient’s abstraction is normal.
Q. India ka prime minister kaun h?
Answer: Moji Ji hain.
Q. Apne Desh Ki RAJDHANI kya h?
Answer. Ni pta.
Q. Haryana ka chief minister kon hai?
A. nhi pta.
Q. Haryana ki rajdhani kya hai?
A. nhi pta.
Q. delhi ka chief minister kon hai?
A. kejriwal hai.
INFERENCE: patient is not attended school.
f) Judgment:
Q: agar ekdum se yhan aag lag jaaye to aap kya karoge?
A: bhag jaunga.
Remark: he has good judgment power.
g) Insight:
Nurse: “aap yehape kyoun aaye hain”?
Patient: mujhe log dikhte hai or mujhe gali dete hai.
Remark: he has insight.
a) Sleep
1) Insomnia: present.
2) Hypersomnia : Absent.
3) Non –organic sleep: Absent.
4) Early morning awakening: Absent.
5) Episodic Disturbances: Absent.
MINI MENTAL
STATUS
EXAMINATION
MINI MENTAL STATUS
EXAMINATION
1

IDENTIFICATION DATA :-
NAME : Mr. ABC
AGE : 30 yrs
SEX : Male
BED NO. : C-8
MARITAL STATUS : Married
ADDRESS : Behal
EDUCATION : 12th fail
OCCUPATION : farmer
INCOME : 15,000Rs
IDENTIFICATION MARK : Scar on left leg
RELIGION : Hindu
SOCIO ECONOMIC STATUS : Good
DIAGNOSIS : Paranoid Schizophrenia
MODE OF ENTRY : Brought by father
INFORMANT : Father
PRESENTING CHIEF COMPLAINTS:-

1. PATIENT VERSION:-
Decreased sleep
Diminished appetite
Muttering to self since 1 month
Aggressiveness
Irritability
2. HISTORY OF PRESENT ILLNESS:-
DURATION: 1 month
MODE OF ONSET: Insidious
COURSE: Continous
INTENSITY: Same
My client was apparently fine before 1 month. But one day he suddenly started
showing aggressive behaviour, decreased sleep, and diminished appetite. He also has
irritabilities and muttering to self
3. PAST PSYCHIATRIC HISTORY:-
My client doesnot have any past psychiatric history
4. PAST MEDICAL HISTORY:-
My client is having Diabetes Meliitus and thyroid from 10 yrs
5. FAMILY HISTORY:-
NO. OF FAMILY MEMBERS: 3
TYPE OF FAMILY: Nuclear Family
6. FAMILY TREE:-
INDEX
Male Client
Female
7. PAST FAMILY HISTORY:-
No significant history of any psychiatric illness
No history of suicidal attempt and drug dependence
8. CONCURRENT SOCIAL SITUATION:-
Social economic status of client is very good as my patient is having job and he is
earning enough to run the family and to bear the expense of treatment
9. ATTITUDE OF FAMILY MEMBERS TOWARDS PATIENT:-
The attitude of family members is very supportive and caring
10. PREMORBID HISTORY:-
a) PERINATAL HISTORY:-
My client has full term normal delivery. No complications like convulsion,
cyanosis were present.
b) CHILDHOOD HISTORY:-
Primary care giver:- Mother
Feeding:- 2 yr (Breast milk)
Age at weaning:- 6-7 yr. Month onwards
Developmental mile stone:- Normal
Behavioural & emotional problem:- No
Illness during childhood:- No illness
c) EDUCATIONAL HISTORY:-
Age at beginning of formal education:- 3 yr
Academic performance:- Good in studies
Extracurricular achievement:- No achievements
Relationship with peers and teachers:- good
School phobia:- No
Reason for termination of studies:- failed in 12th
d) PLAY HISTORY:-
Game played:- Carrom & Cricket
Relationship with play mates:- Good
e) EMOTIONAL PROBLEM DURING ADOLESCENCE:-

My client has certain emotional problems , that is getting aggressive for small
matters
f) OCCUPATIONAL HISTORY:-
Age at starting work:- 20 yr
Current job satisfaction:- Satisfied with his

job
Whether job is appropriate to patients background:- Yes
g) PUBERTY
Age at appearance of secondary sexual characters:- 15 yrs
Anxiety related to puberty changes:- -
Age at menarche:- -
h) SEXUAL AND MARITAL HISTORY:-
Type of marriage:- Arrange
marriage
Duration of marriage:- 8 yrs
Interpersonal and sexual relations:- satisfactory
i) PREMORBID PERSONALITY:-
Interpersonal relationship:- Extrovert
Family and social relationship:- Good
Use of leisure time:- By watching news and
playing cricket
Predominant mood:- Fluctuating mood
Usual reaction to stressful situation:- He shows
aggression behaviour
in small
matter Attitude to work and responsibility:-
Satisfied
j) HABITS:-
Eating pattern:- Non-vegeterian
(3-4 times/day)
Elimination :- Normal (urine
output :4-5 times/day)
Sleep:- Insomnia
Use of drugs, tobacco, alcohol:- Patient Is
Alcoholic
Dislike :- Bitter gord
Like:- Like all kind
of food
MINI MENTAL STATUS EXAMINATION
GENERAL APPEARANCE:-
LEVEL OF CONSCIOUSNESS: - Conscious, awake & alert
FACIAL EXPRESSION:- Extreme facial expression
LEVEL OF CLEANLINESS:- Adequate cleanliness
LEVEL OF GROOMING:- Adequate dressed with proper personal hygiene. Kempt and tidy
MODE OF ENTRY:- Come willingly
CO-OPERATIVENESS:- Co-operative
EYE-TO-EYE CONTACT:- Maintained
PSYCHOMOTOR ACTIVITY :- Psychomotor activity is increased
RAPPORT:- Spontaneous
GESTURE:- Normal
POSTURING :- Normal
MOTOR BEHAVIOUR:-
LEVEL OF ACTIVITY:- Non- goal directed , but easily distracted by minimal external
stimulus
TYPE OF ACTIVITY:- Mannerism is present
PATTERN OF MOVEMENT:- Goal directed
SPEECH:-
INITIATION :- Spontaneous
TONE:- Appropriate with modulation
REACTION TIME :- Normal
CONTENT:- Fully relevant
COHERENCE:- Fully Coherent
PACE OF SPEECH :- Repetative

VOLUME:- High pitch
RATE:- Rapid
PRODUCTIVITY:- Elaborate replies
STREAM:- Circumstantiality
NURSE:- What is your name?
PATIENT:- My name is Gopal. She is my wife Reena. And I have taken medicines
NURSE:- Where are you now?
PATIENT:- I am in hospital
NURSE:- Who is she ?
PATIENT:- She is my wife Reena
THOUGHT:-
STREAM OF THOUGHT:- Flight of ideas
CONTENT:- Delusion of grandiosity
POSSESSION OF THOUGHT:- Thought blocking
NURSE:- What are you doing now?
PATIENT:- You don’t know who I am ? I am the owner of big Company and I am planning
for making apartment for my daughters
NURSE:- What will you do in your free time ?
PATIENT:- I am thinking of my daughter’s carrier
MOOD / AFFECT:-
MOOD: Happy
NURSE:- How are you feeling today?
PATIENT:- I am fine and feeling good today
AFFECT : Congruent
Patient is replying with a smiling face

PERCEPTION:-
HALLUCINATION:- Absent
ILLUSION:- Absent
COGNITIVE FUNCTION:-
1. ATTENTION:- Normally aroused

NURSE:- Do you know counting 1 to 10 in backward manner?
PATIENT:- Yes
NURSE:- Then count
PATIENT:- 10, 9, 8, 7, 6, 5, 4, 3, 2, 1
2. ORIENTATION
ORIENTATION TO TIME: Oriented
NURSE:- What is time now?
PATIENT:- It’s about 3:30 PM
ORIENTATION TO PLACE: Oriented
NURSE:- Which place is this?
PATIENT:- This is hospital
ORIENTATION TO PERSON:- Oriented
NURSE:- Who has come with you?
PATIENT:- My wife is staying with me.
3. MEMORY
IMMEDIATE MEMORY: Impaired
NURSE:- Repeat the words – rice, dal, fish, vegetables?
PATIENT:- Fish, vegetables…….don’t remember.
RECENT MEMORY: Intact

NURSE:- What you had in your breakfast?
PATIENT:- I ate Dhalia, Egg ….
REMOTE MEMORY: Intact
NURSE:- In which school you studied?
PATIENT:- Govt. H.S.School
4. ABSTRACT THINKING
NURSE:- Tell the similarity between orange and banana
PATIENT:- Both are fruits
5. INTELLIGENCE
COMPREHENSION:-Able to follow simple command
GENERAL KNOWLEDGE:- Adequate
NURSE:- Who is the Prime Minister of India
PATIENT:- Narendra Modi
6. JUDGEMENT
SOCIAL JUDGEMENT:- Intact
NURSE:- What you will do if house catches fire
PATIENT:- I will call fire brigade
PERSONAL JUDGEMENT:- Intact

NURSE:- What will you do after getting disharged
PATIENT:- I will go back to my work
INSIGHT:-
GRADE 4: Complete awareness of being ill
NURSE:- Where are you? What happen to you?
PATIENT:- I am in hospital. I used to think excessively so I had admitted here.
SUMMARY:-
MOTOR BEHAVIOUR : Increased And non Goal Directed
SPEECH CONTENT : Fully relevant
THOUGHT: Flight of ideas
MOOD: Mood happy
PERCEPTION: Auditory Hallucination Absent
JUDGEMENT: Both social and personal judgement intact
MEMORY: Immediate memory is impaired
MINI MENTAL STATUS
EXAMINATION

IDENTIFICATION DATA
Name Mrs ABC

Age 40years
Sex Female
Bed no. 5
O.P.D no. 16/480626
Religion Hindu
Language Hindi
Diagnosis Paranoid Schizophrenia
Identification mark Mole on neck
Informant Patient
a) Psychological:
According to patient: Shak karna
Nind kam aana
Gussa karna
Akele bethe bolna
Duration 1 year
Mode of onset Acute
Course Episodic

Duration : 6 years
history.
Family history:-
Family tree
Male Male patient
Female
Personal History
Prenatal History
Intranatal period
Birth
Birth defect
Childhood history
Primary care giver

Feeding
Age of weaning
Educational history

School phobia No
Play history


Habits

sleep during a day
MINI MENTAL STATUS EXAMINATION
❖ General Appearance and Behaviour

Behaviour: - Normal
Gesturing: - Normal
Posturing: - Normal
❖ Speech: -
Rate: - Normal
Volume: - low
Tone: - low pitch
Stream - Normal
● Nurse :- Aap apne bare me kuch btaye.
● Patient:- Mera naam deepa hai, mai bimar hu
● Inference- Patients speaks in Hindi. She have normal volume, tone, and rate of
speech.
❖ Mood and affect: -
Subjective
● Nurse: - Aapka man kaisa hai?
● Patient: - Mere man achha hai.
Objective
● Patient affect is appropriate his mood.
● Inference: - Patient is in normal mood.
● Mood: - Normal
● Affect: - Normal
● Inference: - Affect is appropriate to mood.
❖ Thought: -
Stream: Normal, Autistic thinking, Thought block, Poverty of speech,Pressure of thought all
are absent.
Form: Normal, Circumstantiality, tangantiality, neologism, verbigeration, flight of idea all
are absent.
Content:
1. Delusion:-
● Nurse: - Kya apko lgta hai ki aapki wife ka kisis se chakkar hai?
● Patient: - Ha mujhe aisa lagta hai.
● Inference: - Delusion of infidelity is abesent.
● Nurse: - Kya apko lgta hai koi apko wash mei krna chahta hai?
● Patient: - Nahi mujhe aisa nahi lgta.
● Inference: - Delusion of control is absent.
● Nurse: - kya apko lgta hai aap koi mahan insan hai?
● Patient: - nahi mujhe aisa nahi lagta or lgega bhi kyu.
● Inference: - Delusion of grandiosity is absent.
● Nurse: - kya apko lgta hai jab 2 log baat kar rahe hote hai to wo apke bare mei hi bat
krte hai?
● Inference: - Delusion of reference is absent.

2. Hypochondria:-
● Nurse: - Kya apko lgta hai apko koi khtarnak bimari hai? Apne kayi hasptalo sei dwai
li hai?
● Patient: - na, mujhe nahi lgta hai or mane phle bhi dwai nahi li hai.
● Inference: - Hypochondria delusion is absent.
⮚ Ideas: -
● Nurse: - kya apke man mei aisa khyal ata hai ki apki zindgi khtm hone wali hai?
● Patient: - Nahi mujhe aisa nahi lagta lekin mujhe apni patni pe gussa ata hai to mujhe
marne ka khayal ata hai.
● Inference: - Suicidal ideas are present.
● Nurse: - Kya apko lgta hai ki apke hath gande hai or aap unhe bar bar dhote hai?
● Patient: - Nahi aisa nahi hai.
● Inference: - No Obsessional/Compulsive phenomena present.
4) Phobia: -
● Nurse: - Kya apko kisi cheej sei dar lgta hai?

● Patient: - Nahi, Mujhe kisi cheej sei dar nahi lgta.
● Inference: - Phobia is not present.
❖ Perception: -
1) Illusions:-
● Nurse: - kya apko rassi ko dekh ke aisa to nahi lagta hai ki ye saanp hai?
● Patient: - Nahi mujhe aisa nahi lagta.
● Inference: - Illusion is not present.
2) Hallucination: -
a) Auditory Hallucination:-
● Nurse: - Kya jab aap akele bathe hote to apko kisi kism ki awaje to nahi suniee deti?
● Patient: - Haa, mujhe awaje sunai deti hai aisa lagta hai meri patni or sadu apas me
bate karte ho.
● Inference: - Auditory Hallucination is present.
● Nurse: - Kya apko aisa kuch dikhayi deta hai jo kisi ko dikhayi nahi deta?
● Patient: - Ha mujhe mere sadu dikhaiee dete hai.
● Inference: - Visual Hallucination is present.

● Nurse: - kya apko aisi koi badbu aati hai jaise kuch jal raha hai?
● Patient: - Nahi aisa kuch nahi hai.
● Inference: - Olfactory hallucination is absent.
● Nurse: - Kya apko aisa lgta hai ki kisi cheej ko khane per kdwa swad ata hai?
● Patient: - Nahi aisa kuch nahi hota.
● Inference: - Gastatory hallucination is absent.
● Nurse: - Kya apko aisa lgta hai ki apke body pei kuch chalra hai mtlb jaise kuch reing
raha hai?
● Patient: - Nahi mujhe aisa kuch nahi lgta.
● Inference: - Tactile hallucination is absent.
● Nurse: - Kya aapko aisa lgta hai kisi jgah aap pehli bar gaye ho lekin apko lge ki aap
yha phle bhi aa chuke ho?

● Inference: - Dejavu is absent.
● Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha
nai aaye ho
● Patient:- Nahi mujhe aisa nai lgta
● Infrence:-Jamaisvu is absent
● Nurse: - Kya apko aisa lagta hai ki apme ya apki body mei kch change hua hai?
● Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha
nai aaye ho
● Patient:- Nahi mujhe aisa nai lgta
● Infrence:-Jamaisvu is absent
● Inference: - Depersonalization is absent.
❖ Cognitive function (Neuropsychiatric assessment)
I. Consciousness:-
II. Attention: -
● Nurse: - Aap mujhe 20 tak ginti sunao?
● sPatient: - Haa mujhe aati 1,2,3,4,5.......
● Nurse:- kya aapko 10 se 1 tak ulti ginti aati hai?
● Patient:- Haa mujhe atti hai 10,9,8,7,6...........
● Inference: - Patient attention is normally aroused.
III. Concentration: -
● Nurse: -100 me se 7 panch bar ghtaoo
● Patient: - 93,86,79…. hote hai
● Inference: - Patient concentration is normally sustained.
IV. Orientation: -
a) Time: -
● Nurse: - Abhi kya time hua hai?
● Patient: - 2:50 pm huei hai.
● Inference: - Patient is oriented to time.
b) Place: -
● Nurse: - Yei Kaun si jagah hai?
● Patient: - hospital
● Inference: - Patient is oriented to place.
c) Person: -
● Nurse: - Kya apko pta hai apke sath kaun hai?
● Patient: - Haa meri maa h.
● Inference: - Patient is oriented to person.
V. Memory: -
● Nurse - Mai apko ek no. duga apko wo no. mujhe dobara btana hai 9835664?
● Patient: - 9835664
● Inference: - Immediate memory is intact
b) Recent memory: -
● Nurse: - Kal rat ko kya khaya tha aapne?
● Patient: - yaad nai h
● Inference: - Recent memory is poor.
c) Remote Memory: -
● Nurse: - Aapka janam tithi kab hoti hai?
● Patient: - august me 5 ko
● Inference: - Remote memory is intact.
VI. Intelligent: -
● Nurse: - Diwali kab aati hai?
● Patient: - November main.
● Inference: - Patient intelligence is adequate.
Arithmatic ability
● Nurse:- Mai apko 100 rs dekr agar 20rs le lu to btao ki apke pas kitne bachenge
● Patient:- Mere paas 80rs bachenge
● Infrence :-Intellegence is present
VII. Abstractions: -
a) Proverbs
● Nurse: - 9 or 2 11 hona ka kya matlab hai?
● Patient: - Bhag jana
● Inference: - Patient understanding regarding the proverb is good.

● Nurse: - Pen or copy mei kya farak hai?
● Patient: - pen se copy main likhte hai.
● Inference: -Abstract thinking is Present
VIII. Judgement: -
● Nurse:- Aap yaha se jane ke baad kya kroge?
● Patient:- Mai ghr walo ki dekhbaal krungi.
● Infrence:-Personal judgement is intact.
● Nurse: - Agar aapke samne koi accident ho jaye to aap kya kroge?
● Patient: - Logo ko mdad kei liye bulaugi.
● Inference: - Social Judgement is intact.
● Nurse: Agar apke ghr me aag lag jaye aap kya kroge?
● Patient: sab milke aag nhujaynge.
● Infrence: Test judgement is Present.
❖ Insight: -
● Nurse: - Aap yha kiske sath aye ho?
● Patient: - Apni maa k sath

● Nurse:- aapke yaha ane ka kya karan hai?
● Patient:- mai yaha doctr banne aayi hu.
● Nurse: - Kya aapko lgta hai aapko koi bimari hai?
● Patient: - Nahi mujhe nahi lagta mai bimar hu.
● Nurse:- kya aap dawaie rozana lete ho?
● Patient:-kabi kabi

HEALTH TALK
ON
STRESS MANAGEMENT

TOPIC : STRESS MANAGEMENT
DATE : 18-4-2023
TIME : 9.30 am
VENUE: F.Y.PBBSC NURSING CLASS ROOM
CLASS TAUGHT: F.Y.PBBSC STUDENTS

METHOD OF TEACHING: LECTURE CUM DISCUSSION
AUDIO VISUAL AIDS : PPT,VIDEO
PREVIOUS KNOWLEDGE OF THE GROUP: THE GROUP HAS SOME KNOWLEDGE ABOUT THE MANAGEMENT OF
STRESS
General Objective
At the end of the class, the students will gain knowledge regarding Management of Stress
Specific Objectives
At the end of teaching students will be able to,

-the meaning of stress management
-explain the strategies of coping with stress
explain unhealthy ways of coping with stress
discuss the nurse managers’ role in stress management

S Specific Duratio Content Teacher AV aids B/B activity Evaluation
No Objectives n /learning
1. Introduce 1 min INTRODUCTION Teacher Ppt Teacher
the topic Right from the time of birth till the last breath introduce writes What is
2. drawn, an individual is invariably exposed to the topic introduction stress
The 2 min various stressful situations. The modern world Ppt on the management
meaning of which is said to be a world of achievement is also a Teacher blackboard ?
stress world of stress and has been called the – Age of explains the
managemen Anxiety and Stress. The word stress was originally meaning of
t used by Selyle in 1956 to describe the pressure stress Teacher
experienced by a person in response to life managemen writes the
demands. These demands are referred to as t meaning of
stressors. Stress can be positive or negative. stress
management
MANAGEMENT OF STRESS
Stress management involves controlling

and reducing the tension that occurs in
stressful
situations by making emotional and physical
changes. The degree of stress and the desire to
make the changes will determine how much change
takes place.
3 Explain the 15 min STRATEGIES OF COPING WITH STRESS Teacher ppt Teacher What are the
strategies of a)Awareness explains writes the strategies of
coping with The initial step in managing stress in awareness- to strategies of strategies of coping with
stress become aware of the factors that create stress and coping with coping with stress ?
the feeling associated with a stressful response. As stress the stress the
one can become aware of stressors, he or she can
omit, avoid, or accept them.
b) Got organized
Coping with stress is all about planning. You can
plan to fall or plan to successes. Organized time for
work, family, hobbies, spiritual time, time with
friends and time alone, time for exercise and time
for relaxation.
c) Visualized the best outcome

Coping with stress knows how to deal with a
stressful situation before it occurs. Rehearse how
you are going to handle it. Picture yourself being
successful in coping with stress
Don’t postpone action

One of the best strategies for coping with stress is
not to put off actions until tomorrow if you can do
it today. Coping with stress become more difficult
when you defer. Do your least favorite chores first,
followed by rewards.
Be realistic
Set realistic goals. Emphasize quality over
quantity.
Work at a leisurely pace, taking breaks often
Sleep, eat, and exercise
Coping with stress is all about treating your body
properly. Eat food that nourish you, exercise and
get plenty of sleep.
Laughter
Adopting a humorous view
towards life`s situations can take the
edge off everyday stressors h)Getting a Hobby
Hobby is an activity or interest that is undertaken
for pleasure or relaxation, typically done during
one's leisure time.eg: collecting, games, outdoor
recreation, gardening, performing the arts, reading,
cooking and etc.
DEEP BREATHING EXERCISES
Sit or lie down comfortably, inhale slowly through

the nose and exhale through the mouth. While
inhaling place one hand below the ribs
Allow that hand to extend outwards when inhaled,
let the hand fall back to its original position when
exhaled. Exhalation should take twice as long as
inhalation.
PROGRESSIVE MUSCLES RELAXATION
Muscles relaxation can be done in sitting or lying

down position
Each muscles group is tensed for 5 to 7 seconds
and then relaxed for 20 to 30 seconds, during
which time the individual concentrates on the
difference in sensations between the two
conditions.
Soft, slow background music may facilitate
relaxation.
RELAXATION TECHNIQUES:
Be specific when exploring your options. You
might consider the following,
Going to walk,
Meeting with friends,
Reading for pleasure,
Listening to music,
Taking a bath
Begin practicing relaxation techniques like:
Meditation
Deep breathing exercises
Progressive muscles relaxation.
MEDITATION
Meditation is a holistic discipline during which
time the practitioner trains his or her mind in order
to realize some benefit. Meditation is generally a
subjective, personal experience and most often
done without any external involvement, except
perhaps prayer beads to count prayers.
UNHEALTHY WAYS OF COPING WITH
4. Explain 3 min STRESS Teacher ppt Teacher What are the
unhealthy explaines writes unhealthy
ways of Smoking unhealthy unhealthy ways of
coping with Drinking too much ways of ways of coping with
stress Over eating or under eating coping with coping with stress?
Using pills or drugs to relax stress stress
-Sleeping to much
Withdrawing from friends, family, and activities -
Zoning out for hours in front of the T.V or
computer.
Taking your stress out on others (lashing out, angry
outbursts, physical violence)
NURSE MANAGER’S ROLE IN STRESS

MANAGEMENT
Ensure that the workload is in line with
nurses’ capabilities and resources.
Clearly define the nurse’s role and responsibility. ppt
5. 3min Planned orientation programmes for the newly Teacher Teacher What are the
Discuss the joined staff. discusses writes the nurse
nurse Give nurses the opportunities to participate in the nurse nurse managers
managers decision making and actions in patients care. managers managers role in stress
role in stress role in stress role in stress management
managemen managemen management ?
t t
Improve the communications and
provide supportive environment
Provide opportunities for social
interaction
among the nurses.
Organize group meeting to solve the problems.
SUMMARY
5 Summarize 1 min
the topic Teacher
Today we have learned about stress management, summarize
its meaning, coping strategies and relaxation the topic
technique and nurses role in the management of
stress.
CONCLUSION
Managing stress can help reduce the stress and
6 Conclude 1 min make you feel healthier. We have to remember that
the topic we cannot change the view of others but prepare Teacher
ourselves to prove our point. No one is perfect so concludes
do not underestimate yourself. Always practice out the topic
for different relaxation techniques. Always think
positively and keep a positive attitude.
7 ASSIGNMENT
What are the coping strategies in

stress management?
BIBLIOGRAPHY:
Principles And Practices Of Nursing Management
8 And Administration For B.Sc. And M.Sc. Nursing,
Jogindar Vati, JAYPEE Publication, Pg No: 532-
535
A Guide To Mental Health And Psychiatric
Nursing, R.Shreevani, 3 rd Edition, Pg No:259
Mental Health For Nursing, Lalit Batra, PEEPEE
Publishers, Pg No:31
Leadership And Nursing Care Management, Diane
L. Huber, Fourth Edition, Pg No: 131)
Text Book Of Psychiatric Nursing, Anbu.T,
EMMESS Publication, Pg No: 198, 200
Voice of Research, Vol. 2, Issue 3, December
2013.http://www.voiceofresearch.org/doc/Dec-
2013/Dec2013_20.
HEALTH TALK
ON
EATING DISORDERS

Eating disorders
Defination
Eating disorders are mental health problems that involve disordered eating behaviour - this
can include eating too little or too much or becoming fixated with one’s weight or shape. 1
There are several types of eating disorder, including:
▪ Anorexia nervosa - where someone tries to keep their body weight as low as possible
(by for example, not eating enough and / or exercising excessively) and has a
distorted view of their body, thinking they are larger than they are.
▪ Bulimia nervosa - where someone is caught in an unhealthy eating cycle of binge

eating then purging to compensate for their overeating, for instance by vomiting or
taking laxatives.
▪ Binge eating – where someone eats excessively in a short period of time in an out of-
control way and feels compelled to do so on a regular basis
Symptoms
Symptoms of eating disorders will vary between individuals and type of eating disorder. Not
matching the symptoms exactly does not mean that someone does not have an eating
disorder, however, some common symptoms include:
▪ Eating very little food or eating large amounts of food in a short time in an
uncontrolled way
▪ Having very strict habits, rituals, or routines around food
▪ Spending a lot of time worrying about your body weight and shape
▪ Changes in mood
▪ Deliberately making yourself ill after eating
▪ Avoiding socialising when food may be involved
▪ Withdrawing from social groups, hobbies you used to enjoy or from family life
▪ Physical signs such as digestive problems or weight being very high or very low for
someone of your age and height
Predisposing factor associated with anorexia and bulimia nervosa

Eating disorders are complex mental health problems that can be caused by a combination of
factors. These factors include
• Biological factors (for example genetics or neurochemical changes serotonine and
norepinehirine
• Neuroendocrine abnormality,
• Psychological or social factors (lack of confidence or self-esteem, perfectionism, , or
difficulties with school or work)
• Psychodynamic influence mother childe separation, family issue
• Family influence marital conflict , sick childe
Anorexia nervosa
● Anorexia - refer to loss of appetite
● Nervosa – indicate that loss due to emotional reason
● Mainly in adolescent girls 12-30 yr of age
● 10% in male
Anorexia nervosa is an eating disorder characterized by an abnormally low body weight, an

intense fear of gaining weight and a distorted perception of weight. People with anorexia
place a high value on controlling their weight and shape,
Life threatening disorder
Food intakes less then 200 calories/ day that hunger sensation actually cease.
Physical symptoms
Physical signs and symptoms of anorexia may include:
● Extreme weight loss or not making expected developmental weight gains

● Thin appearance
● Abnormal blood counts
● Fatigue
● Insomnia
● Dizziness or fainting
● Bluish discoloration of the fingers
● Hair that thins, breaks or falls out
● Soft, downy hair covering the body
● Absence of menstruation
● Constipation and abdominal pain
● Dry or yellowish skin
● Intolerance of cold
● Irregular heart rhythms
● Low blood pressure
● Dehydration
● Swelling of arms or legs
● Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia.
But people with anorexia generally struggle with an abnormally low body weight, while
individuals with bulimia typically are normal to above normal weight.
Emotional and behavioral symptoms
Behavioral symptoms of anorexia may include attempts to lose weight by:
● Severely restricting food intake through dieting or fasting
● Exercising excessively
● Bingeing and self-induced vomiting to get rid of food, which may include the use of
laxatives, enemas, diet aids or herbal products
Emotional and behavioral signs and symptoms may include:
● Frequent refusing to eat
● making excuses for not eating
● Eating only a few certain "safe" foods, usually those low in fat and calories
● Not wanting to eat in public
● Frequent checking in the mirror for perceived flaws
● Complaining about being fat or having parts of the body that are fat
● Covering up in layers of clothing
● Flat mood (lack of emotion)
● Social withdrawal
● Irritability
● Insomnia
● Reduced interest in sex
Treatment modality
Psychological therapies
Behaviour modification – to change maladaptive eating behaviour

Individual therapy is not therapy choice for eating disorder, it can be helpful when
underlying psychological problems, to explore unresolved conflict and recognise the
maladaptive eating behaviour.
Family therapy
Psychological therapies involve working through your thoughts, feelings and behaviours with
a mental health professional in regular sessions over a set period of time.1
Common psychological therapies for treatment and management of eating disorders include
cognitive behavioural therapy (CBT), family therapy or psychotherapy and what is right for
you may depend on your age. During your therapy sessions, you may work with the mental
health practitioner to agree on an eating plan to ensure you are getting the appropriate
vitamins and minerals from your diet.11 Your GP may also conduct an X-ray to check the
health of your bones as being underweight for a prolonged period of time can lead to low
bone strength.11
Self-Help and Self-Management
People with bulimia may be able to participate in a guided self-help programme, which
involves completing exercises in a workbook alongside having short sessions with a
practitioner. While this approach can be helpful to some, it is not a suitable treatment
approach for everyone.11
Individual Therapy
A form of therapy called cognitive behavioral therapy is often used to treat anorexia nervosa.
CBT helps change unhealthy thoughts and behaviors. Its goal is to help you learn to cope
with strong emotions and build healthy self-esteem.
Family Therapy
Family therapy gets family members involved in keeping you on track with your healthy
eating and lifestyle. Family therapy also helps resolve conflicts within the family. It can help
create support for the family member learning to cope with anorexia nervosa.
Group Therapy
Group therapy allows people with anorexia nervosa to interact with others who have the same
disorder. But it can sometimes lead to competition to be the thinnest. To avoid that, it’s
important that you attend group therapy that is led by a qualified medical professional.
Medication
While there is no medication at this time that is proven to treat anorexia nervosa,
antidepressants may be prescribed to deal with the anxiety and depression common in those
with anorexia. These may make you feel better. But antidepressants do not diminish the
desire to lose weight.
Hospitalization
Depending on the severity of your weight loss, your primary care provider may want to keep
you in the hospital for a few days to treat the effects of your anorexia nervosa. You may be
put on a feeding tube and intravenous fluids if your weight is too low or if you’re dehydrated.
If you continue to refuse to eat or exhibit psychiatric issues, your primary care provider may
have you admitted into the hospital for intensive treatment.
Psychopharmacology
Various medication prescribed for anxiety and depression fluoxetine ,clomiperamine with
anorexia nervosa
Bulimia nervosa
fluoxetine
SSRI
Imiperamine
Phenalzine
Bulimia nervosa
Onset late adolescent or early adulthood
A serious eating disorder marked by bingeing, followed by methods to avoid weight gain.
Bulimia is a potentially life-threatening eating disorder.
People with this condition binge eat. They then take steps to avoid weight gain. Most
commonly, this means vomiting (purging). But it can also mean excessive exercising or
fasting.
Treatments include counselling, medication and nutrition education.
Usually self-diagnosable
People with this condition binge eat. They then take steps to avoid weight gain. Most
commonly, this means vomiting (purging). But it can also mean excessive exercising or
fasting.
People may experience:
Behavioural: binge eating, compulsive behaviour, impulsivity, self-harm, vomiting after

overeating, or lack of restraint
Whole body: dehydration, fatigue, food aversion, hunger, or water-electrolyte imbalance
Mood: anxiety, general discontent, guilt, or mood swings
Mouth: bad breath, dental cavities, or dryness
Gastrointestinal: constipation, heartburn, or inflamed oesophagus
Weight: body weight changes or weight loss
Menstrual: absence of menstruation or irregular menstruation
Also common: abnormality of taste, depression, poor self-esteem, or sore throat
Treatment consists of antidepressants and therapy
Treatments include counselling, medication and nutrition education.
Therapies
Support group
Cognitive behavioral therapy
Cognitive therapy
Behavior therapy
Counseling psychology
Psychoeducation
Family therapy
Behaviour therapy and Psychotherapy
Medications
SSRIs
Self-care
Physical exercise
-
ECT REPORT
ON
RECURRENT DEPRESSION
ECT REPORT
I. IDENTIFICATION DATA:-
Name of the patient- XYZ
Age /Sex- 50Y/M
Religion- Hindu
C.R No.- 74029
Marital status- Married
Education-Illiterate
Occupation- Wage Worker
Income- 9000/Month
Address- Khadi, Dadri

D.O.A-14-08-2023 at 11:15am
Ward/Unit No- psychiatric ward 13, Unit no-1
Informant-Patient himself and Sarla, 44Y/F
Relation with patient- Wife
II. Presenting Chief Complaints:-
As per patient:-
Mann udas rahta hai x2month
Neend nahi aati
As per informant:-
Akela rahta hai
Kisi se baat nahi karta x1month
Gussa karta hai bolne par x1month
Sota nahi hai poori raat
Onset-Acute
Course-Episodic
TDI-14years
Episode-2 episode
PPT Factor-Not Known
III. History of Present Illness:-
XYZ 42y male married and illiterate wage worker by occupation belong to rural
area of MSES. Patient was known case of depressive disorder and discharge from
ward.Patient was maintaining well on treatment but after 1month of discharge he
start consuming Buphi daily 1tolla. After that he developed difficulty in inititation
and maintenance of sleep, patient remains awake all night, remain sitting on bed.
Patient feels sad all the time; don’t want to talk with anyone. He lost interest in
daily routine activity. He got irritated when family member try to talk with him
and sometime he shout on grandson who play in front of him. And after this he
has stopped to going on work.His appetite also reduced to once in a day.
According to patient he wants to commit suicide as there is nothing left in his life.
Once he went to river side and sit there with intention to jump into river. His
family member reaches there and brings back to home.
Diagnosis – Recurrent Depressive Disorder
IV. Treatment History:-Patient was known case of depressive disorder and discharge
from ward. She took treatment from PGIMS and treatment was
Tab. Sertraline 50mg BD
Tab. Clanazepam 1mg 2HS
No other treatment record is available with them.
ECT History:- 1month back patient admitted in PGIMS Rohtak with same chief
complaint and diagnosed with recurrent Depressive Disorder. 4MECT had been
given during this.
V. Past Psychiatric and Medical History:-
No history of any substance abuse
No history of DM/HTN/CAD/HIV positivit
VI. Family History:- Client belongs to Hindu nuclear family of middle socio economic
status
44yrs/Female 50yrs/Male
Illiterate Illitrate
Housewife Wage worker
Wife Self
25yrs/Male 18yrs/Male 15yrs/Male

B.Tech B.A 9th Class
Son Son Son
Pvt.Job
VII. Personal History:-
a) Perinatal history
Antenatal period –Not Significant
Intranatal period –Not Significant
Birth cry –Not Significant
Birth defects –Not Significant
Postnatal complications -Not Significant
b) Childhood history
Development milestone- Not Significant
Behavior and emotional problems- Not Significant
Illness during childhood- Not Significant
c) Educational history
i. Age at beginning of formal education –Didn’t have any formal
education
d) Emotional problems during adolescence –Not present
e) Occupational History-
i. Age at starting work:- 20years
ii. Job held :-Wage worker
iii. Current job satisfaction:-Satisfied
f) Sexual and marital History
i. Type of marriage –Non consanguineous arranged marriage with
consent of both families
ii. Duration of marriage-22yrs
iii. Interpersonal and sexual relations-Satisfactory
iv. Extramarital relationship if any specify -No
g) Premorbid personality
Interpersonal relationship -Introvert
Family and social relationships –Cordial relationship[
Attitude towards work and responsibility –Responsible, and do all the work assigned
to her
Habits –Watching news and listening religious songs
Eating pattern –Regular
Elimination –Regular
Sleep –Regular
Use of drugs, tobacco, alcohol –No
VIII. Physical Examination

o Temperature-98.4F
o Pulse-72b/min
o Blood pressure-130/90mmHg
o Respiration rate-14/min
o BMI- Weight in kg = 55 =20.3
▪ ( Height in mm)2 (1.64)2
o CVS –S1 S2 Normal

o Normal heart sound
o Respiration- No abnormal sound
IX. Assessment of patient’s and family knowledge of indications, side effects, therapeutic
effects and risk associated with ECT:-Both have some knowledge regarding
indications, side effects, therapeutic effects and risk associated with ECT
Pre ECT Care Checklist:-
✔
a. Informed consent
✔
b. Assess vital sign
✔
c. Nil per oral
✔
d. Withhold night dose drug
✔
e. Head shampooing
✔
f. Remove jewelry
✔
g. Empty bladder
✔
h. Pre ECT medication
Intra Procedure Care Checklist

a. Place patient in comfortable position
✔
b. Stay with patient

✔
c. Insert mouth gag

✔
d. Apply gel and electrode

✔
e. Monitor voltage intensity and duration

✔
of electrical activity
f. Monitor seizure activity

✔
g. Monitor vital signs

✔
Post Procedure Care Checklist
h. Place patient in sideline position

✔
i. Monitor vital signs

✔
j. Oxygen administration
✔
k. Use of side railing to prevent falls

✔
l. Re-orient the patient after recovery

✔
m. Recording the case

✔
ECT REPORT
No of ECT Received
Date Time Frequency Duration Temperature Pulse Respiration B.P Level of consciousness
27/8/19 9:00am 70 HZ 0.7 sec. 99 F 88b/min 16b/min 130/90

▪ Conscious
mmHg
▪ Semi-conscious
▪ Conscious after
10min
29/8/19 9:20am 70 HZ 0.8 sec. 98.2 F 80b/min 18b/min 110/70

▪ Conscious
mmHg
▪ Semi-conscious
▪ Conscious after
15min
31/8/19 9:05am 70 HZ O.8 sec. 98.6 F 78b/min 20b/min 120/80

▪ Conscious
mmHg
▪ Unconscious
▪ Conscious after
10min
3/9/19 10:00am 70 HZ 0.9 sec. 99.6 F 92b/min 22b/min 110/80

▪ Conscious
ECT REPORT
ON
SCHIZOPHRENIA

ECT REPORT
I. IDENTIFICATION DATA:-
Name of the patient-ABC
Age /Sex- 33Y/F
Religion- Hindu
C.R No.- 79857
Marital status- Unmarried
Education-M.A, BEd
Occupation- Unemployed
Income- 10000/month
Address- Sheetal Nagar, Agroha
D.O.A-29/8/2023 at 14:00pm
Ward/Unit No- psychiatric ward 13, Unit no-II
Informant- Sonu
Relation with patient- Brother
II. Presenting Chief Complaints:-
As per patient:-
Mai thik hu mere bhai bhabhi ka illaj karo vo bimar hai
As per informant:-
Bak bak karti hai
Khud ka dhyan nahi rakhti x10 years
Kamre me akeli rahti hai

Khud se baate karti hai
Ghar chhod kar chali gyi x 3 days back
Onset-Insidious
Course-Continuous
TDI-10years
Episode-2 episode
PPT Factor-Not Known
III. History of Present Illness:-

Patient was apparently well till 10years back. One day she was seen hiding God
picture in the soil and when asked why she is doing so she would not answer. She
would awake during night. She does worship of God most of time. She hides the gold
ornaments of younger sister and didn’t give any explanation for this. After this
decreased interest in daily routine work and didn’t interact with people. She wears
same clothes for many days. She would not bath for many days and her appetite
decreased gradually. She stops visiting her friends. Family considered that it is may
be because of black magic.
In 2012 she was admitted in 13/II PGIMS, Rohtak for 2month and 14MECT was
given and tab. Haloperidol was given for 30 days. She shows improvement in her
condition then discharged from hospital. After going home, 2month later she perform
unusual behavior. She would say that his family member want to kill her by giving
poison with food. She was seen muttering to self. She starts to speak in two different
voices. Sometime she speaks abusing language. One day she finds naked in her room
and when asked she replied in 4 different voices ‘hat jao yha se mere sath raat bhar
gande kaam karta hai’ she shows suspicious behavior all time. One day she went to
the police station and complains that they are not her real siblings and they want to
kill her. Her sleep status also decreased.
Diagnosis – F20
IV. Treatment History:-Patient was known case of Schizophrenia and discharge from
ward. She took treatment from PGIMS and treatment was
Tab. Haloperidol 5mg 1-X-2
Tab. THP 2-1-X 2month
Tab. Clonazepam
No other treatment record is available with them.
ECT History:-In 2012 patient admitted in PGIMS Rohtak with chief

complaint of delusion. 14MECT had been given during this.
V. Past Psychiatric and Medical History:-
No history of any substance abuse
No history of DM/HTN/CAD/HIV positivit

VI. Family History:- Client belongs to Hindu nuclear family of middle socio economic
status
50yrs/Female 55yrs/Male
Illiterate 12th pass
Housewife Clerk
Mother Father
25yrs/M 30yrs/F 28yrs/F 33yrs/F

ITI B.A & JBT 12th pass M.A & B.Ed.
Brother Sister Sister Self
Pvt.Job Pvt teacher Unemployed unemployed
VII. Personal History:-

a) Perinatal history
● Antenatal period –Normal
● Intranatal period –Normal delivery
● Birth –At full term
● Birth cry –Delayed
● Birth defects –Not Significant
● Postnatal complications -Not Significant

b) Childhood history
● Development milestone- Normal
● Behavior and emotional problems- Not Significant
● Illness during childhood- Not Significant
c) Educational history
Age at beginning of formal education –5year
d) Emotional problems during adolescence -No
e) Puberty
● Anxiety related to puberty changes-Not Significant
● Age at menarche -14Yrs
● Regularity of cycles, duration of flow -Normal
f) Occupational History-Unemployed
g) Premorbid personality
● Interpersonal relationship -Introvert
● Family and social relationships -Good
● Attitude to Self – Confident and respect everyone
● Attitude towards work and responsibility –Responsible, and do all the
work assigned to her
● Religious belief-She has faith in god
● Habits –Watching T.V and talking with family member and friends

Sleep -Regular
Use of drugs, tobacco, alcohol -No
VIII. Physical Examination
o Temperature-98.4F
o Pulse-72b/min
o Blood pressure-110/70mmHg
o Respiration rate-16/min
o BMI- Weight in kg = 48 =20
▪ ( Height in mm)2 (1.55)2
o CVS –S1 S2 Normal

o Normal heart sound
o Respiration- No abnormal sound
Assessment of patient’s and family knowledge of indications, side effects, therapeutic

effects and risk associated with ECT:-patient hasn’t knowledge regarding ECT but
attendant have little knowledge regarding indications, side effects, therapeutic effects
and risk associated with ECT
Pre ECT Care Checklist:-

a. Informed consent
✔
b. Assess vital sign

✔
c. Nil per oral

✔
d. Withhold night dose drug

✔
e. Head shampooing
✔
f. Remove jewelry
✔
g. Empty bladder
✔
h. Pre ECT medication

✔
Intra Procedure Care Checklist

a. Place patient in
✔
comfortable position
b. Stay with patient

✔
c. Insert mouth gag

✔
d. Apply gel and electrode

✔
e. Monitor voltage intensity

✔
and duration of electrical
activity
f. Monitor seizure activity

✔
g. Monitor vital signs

✔
Post Procedure Care Checklist
h. Place patient in sideline

✔
position
i. Monitor vital signs

✔
j. Oxygen administration
✔
k. Use of side railing to

✔
prevent falls
l. Re-orient the patient after

✔
recovery
m. Recording the case

✔
ECT REPORT: No. of ECT received- 4
Date Time Frequency Duration Temperatur Pulse Respiratio B.P Level of consciousness
e n
3/9/19 9:00am 70 HZ 0.7 sec. 98.6 F 88b/min 16b/min 100/60mmHg

▪ Conscious
▪ Semi-conscious
▪ Conscious after
10min
5/9/19 9:20am 70 HZ 0.8 sec. 98.2 F 72b/min 15b/min 110/70mmHg

▪ Conscious
▪ Semi-conscious
▪ Conscious after
15min
7/9/19 9:05am 70 HZ O.8 sec. 98.6 F 78b/min 16b/min 100/70mmHg

▪ Conscious
▪ Unconscious
▪ Conscious after
10min
ASSIGNMENT
ON
PHOBIA

PHOBIA
INTRODUCTION
The word is derived from the Greek phobos meaning extreme fear and flight. The
ancient Greek god, Phobos, was believed to be able to reduce the enemies of the Greeks to a
state of abject terror, making victory in battle more likely.
Fear, aversion, or the strong aversion tested by people of any age or any gender is generally
named like phobia. It is an intensive, most of the time an unexplainable concern and a fear in
certain specific situations or compared to certain specific objects which at the end carries out
to the action to avoid with this situation or object.
Definition
Phobia is persistent avoidance behaviour secondary to irrational fear of a specific object,
activity or situation.
Marks has defined phobia on the following four criteria:
1 The fear is out of proportion to the demands of the situation
2 It cannot be explained or reasoned away
3 It is beyond voluntary control
4 The fear leads to an avoidance of the feared situation.
Epidemiology
Phobias affect people of all the ages, all the long walks of the life, and in each place in world.
The national institute of the mental health has disclosed that 5.1%-12.5% of Americans have
phobias. Phobias form the psychiatric disease commonest between the women of all the ages
and are the second common disease between the men oldest of 25, according to NIMH
statistic.
Aetiology
A Behavioural Factor
1Stimulus Response Model
Involves the traditional Pavlovian stimulus response model of the conditioned response to
account for the creation of phobia. That is, anxiety is aroused by a naturally frightening
stimulus that occurs in contiguity with a second inherently neutral stimulus .As a result of the
contiguity, especially when the two stimuli are paired on several occasions, the originally
neutral stimulus takes on the capacity to arouse anxiety by itself. The neutral stimulus,
therefore, becomes a conditioned stimulus for anxiety production.
2 Operant Conditioning Theories
In the classic stimulus response theory, the conditioned stimulus gradually loses its
potency to arouse a response, if it is not reinforced by a periodic repetition of the
unconditioned stimulus. In the phobic symptoms the attenuation of the response to the phobic
stimulus (that is reconditioning of stimulus) does not occur. The symptom may last for years
without any apparent external reinforcement. The operant conditioning theory provides a
model to explain that phenomenon .According to it, anxiety is a drive that motivates the
organism to do what it can, to obviate the painful affect. In the course of its random
behaviour, the organism learns that certain actions enable it to avoid the anxiety-provoking
stimulus.Those avoidance patterns remains stable for long periods of time; as a result of the
reinforcement they receive from their capacity to diminish activity.
B Psychoanalytic Theories
According to the psychoanalytic theory, the major function of anxiety is a signal to the ego,
that a forbidden unconscious drive is pushing for conscious expression, thus altering the ego
to strengthen and marshal its defences against the threatening instinctual force.
In social and specific phobia, the conflict is regarding sexual arousal, leading to castration
anxiety. When repression fails to be entirely successful, the ego must call on auxiliary
defences. These defences in social and specific phobia are of displacement, symbolization
and avoidance .In agoraphobia, it is the separation anxiety playing a central role.
Neurobiology
Phobias are generally caused by an event recorded by the amygdala and hippocampus and
labelled as deadly or dangerous; thus whenever a specific situation is approached again the
body reacts as if the event were happening repeatedly afterward. Treatment comes in some
way or another as a replacing of the memory and reaction to the previous event perceived as
deadly with something more realistic and based more rationally. In reality most phobias are
irrational, in that the subconscious association causes far more fear than is warranted based
on the actual danger of the stimulus; a person with a phobia of water may admit that their
physiological arousal is irrational and over-reactive, but this alone does not cure the phobia
Phobias are more often than not linked to the amygdala, an area of the brain located
behind the pituitary gland in the limbic system. The amygdala may trigger secretion
of hormones that affect fear and aggression. When the fear or aggression response is initiated,
the amygdala may trigger the release of hormones into the body to put the human body into
an "alert" state, in which they are ready to move, run, fight, etc. This defensive "alert" state
and response is generally referred to in psychology as the fight-or-flight response.
Classification
According to ICD-10
F40-48 Neurotic, Stress-Related and Somatoform Disorders
F40 Phobic Anxiety Disorders
F40.0 Agoraphobia
.00 Without panic disorder
.01 With panic disorder
F40.1Social phobias
F40.2 Specific (isolated) phobias
F40.8 Other Phobic anxiety disorders
F40.9 Phobic anxiety disorder, Unspecified
SIGNS AND SYMPTOMS

Specific phobia (formerly called simple phobias, most common in children)
Social Phobia
Agoraphobia
Specific Phobia
It 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 attack.
Common examples of specific phobias, which can begin at any age, include animal type,
example fear of insects, snakes, and dogs; natural environment type example; high places;
and open spaces, situational type example escalators, elevators, and bridges and other types
Signs &Symptoms
Irrational and persistent fear of object or situation
Immediate anxiety on contact with feared object or situation
Loss of control, fainting, or panic response.
Avoidance of activities involving feared stimulus.
Anxiety when thinking about stimulus.
Worry with anticipatory anxiety.
Possible impaired social or work functioning.
Social Phobia
It is an irrational fear of performing activities in the presence of other people or interacting
with others. The patient is afraid of his own actions being viewed by others critically,
resulting in embarrassment or humiliation.
Social phobia is not the same as shyness. Shy people may feel uncomfortable with others, but
they do not experience severe anxiety, they do not worry excessively about social
situations beforehand, and they do not avoid events that make them feel self-conscious. On
the other hand, people with social phobia may not be shy; they may feel perfectly
comfortable with people except in specific situations. Social phobias may be
only mildly irritating, or they may significantly interfere with daily life. It is not unusual for
people with social phobia to turn down job offers or avoid relationships because of their
fears.
Signs &Symptoms
● Hyperventilation
● Sweating, cold, and clammy hands
● Blushing
● Palpitations
● Confusion
● Gastrointestinal symptoms
● Trembling hands and voice
● Urinary urgency
● Muscle tension
● Anticipatory anxiety
● Fear or embarrassment or ridicule
Agoraphobia
It is characterised 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.
Usually begins between ages 15 and 35 and affects three times as many women as men or
approximately 3 percent of the population.
As the agoraphobia increases in severity, there is a gradual restriction in normal day-to-day
activities. The activity may become severely restricted that the person becomes self
imprisoned at home.
Signs &Symptoms
● Overriding fear of open or public spaces (primary symptom)
● Deep concern that help might not be available in such places.
● Avoidance of public places and confinement to home.
● When accompanied by panic disorder, fear that having panic attack in public will lead to
embarrassment or inability to escape (for symptoms of a panic attack).
Differential features of common phobias
Agoraphobi Anxiety about or avoidance of being trapped in situations or places with no way to
a escape easily if panic develops. Agoraphobia is more common than panic disorder. It
affects 3.8% of women and 1.8% of men during any 6-mo period. Peak age of onset is
the early 20s; first appearance after age 40 is unusual.
Specific Clinically significant anxiety induced by exposure to a specific situation or object,

Phobia often resulting in avoidance. Specific phobias are the most common anxiety disorders
but are often less troubling than other anxiety disorders. They affect 7% of women and
4.3% of men during any 6-mo period.
Social Clinically significant anxiety induced by exposure to certain social or performance

Phobia situations, often resulting in avoidance. Social phobias affect 1.7% of women and
1.3% of men during any 6-mo period. However, more recent epidemiologic studies
suggest a substantially higher lifetime prevalence of about 13%. Men are more likely
than women to have the most severe form of social anxiety, avoidant personality
disorder.
Facts and Tips about Phobic Disorders
1. Phobic Disorders is common form of anxiety disorder, having unreasonable fear of certain
situations, conditions, or substance.
2. Phobic Disorders is further divided into three types such as agoraphobia, social phobia (social
anxiety disorder) and specific phobias.
3. Agoraphobia includes fear of that places from where escape is difficult. Social phobia is fear
of certain social or presentation situations and specific phobias includes fear about specific
situation or object.
4. Patient is aware during this situation but cannot control it.
5. Distress, anxiety and avoidance of situation that causes fear, decreased attention and memory,
travelling on buses, trains or planes are some symptoms of phobic disorders.
6. Treatment for phobic disorders includes exposure therapy, cognitive-behavior therapy,
antidepressant drugs therapy, facing situation systematically and social skills training.
KINDS OF PHOBIA AND THEIR MEANING
Phobia Feared Object or Situation
Acrophobia - Heights
Aerophobia - Flying
Agoraphobia - Open spaces, public places
Aichmophobia - Sharp pointed objects
Ailurophobia - Cats
Amax phobia - Vehicles, driving
Anthropophobia - People
Aqua phobia - Water
Arachnophobia - Spiders
Astraphobia - Lightning
Batrachophobia - Frogs, amphibians
Blennophobia - Slime
Brontophobia - Thunder
Carcinophobia - Cancer
Claustrophobia - Closed spaces, confinement
Clinophobia - Going to bed
Cynophobia - Dogs
Dementophobia - Insanity
Dromophobia -Crossing streets
Emetophobia - Vomiting
Entomophobia - Insects
Genophobia - Sex
Gephyrophobia - Crossing bridges
Hematophobia - Blood
Herpetophobia - Reptiles
Homilophobia -Sermons
Linonophobia - String
Monophobia -Being alone
Musophobia - Mice
Mysophobia -Dirt and germs
Nudophobia - Nudity
Numerophobia -Numbers
Nyctophobia - Darkness, night
Ochlophobia - Crowds
Ophidiophobia -Snakes
Ornithophobia - Birds
Phasmophobia - Ghosts
Pnigophobia - Choking
Pogonophobia - Beards
Siderodromophobia - Trains
Taphephobia - Being buried alive
Thanatophobia - Death
Trichophobia - Hair
Triskaidekaphobia - The number 13
Trypanophobia - Injections
Zoophobia - Animals
Treatment
● Psychotherapy
● Behavior therapy
● Pharmacotherapy
● Supportive therapy
Insight-oriented Psychotherapy
Ii is superior to psychoanalytic psychotherapy. Insight-oriented psychotherapy enables the
patient to understand the origin of the phobia, phenomena of secondary gain and the role of
resistance, and enables the patient to seek healthy ways of dealing with anxiety provoking
stimuli.
Behaviour therapy
Cognitive behaviour therapy and various techniques of behaviour therapy like
desensitization; flooding and social skill training are used.
Desensitization is carried out entirely in imagination and geared around the hierarchy of
anxiety provoking situations whereas in flooding most therapeutic effect is concentrated at
the top of hierarchy. The therapist teaches the patient various techniques to deal with the
anxiety , including relaxation, breathing control and cognitive approaches to situation.
One cognitive-behavioral therapy is desensitization (also known as exposure therapy), in
which people are gradually exposed to the frightening object or event until they become used
to it and their physical symptoms decrease For example, someone who is afraid of snakes
might first be shown a photo of a snake. Once the person can look at a photo without anxiety,
he might then be shown a video of a snake. Each step is repeated until the symptoms of fear
(such as pounding heart and sweating palms) disappear. Eventually, the person might reach
the point where he can actually touch a live snake. Three-fourths of affected people are
significantly improved with this type of treatment
Another, more dramatic, cognitive-behavioral approach is called flooding. It exposes the
person immediately to the feared object or situation. The person remains in the situation until
the anxiety lessens.
Social skill training includes such methods as modelling and role-playing. All the three types
of behaviour therapies are useful in the treatment. The key aspects of successful behaviour
therapy
The patient’s commitment to treatment
Clearly identified problems and objectives
Available alternative strategies for coping with the patient’s feelings.Cognitive-behavioural
treatment of social phobia includes imaginal exposure, in which patients visualize their own
participation in phobic events, performance based exposure in which patients enacted
simulated phobic situations during sessions, cognitive restricting, in which patient’s
cognitions experienced during exposure situation and home work assignments involving
confrontation of environmental events. Most patient gain significantly and improvement is
maintained at 3 and 6 months.
Pharmacotherapy
For generalized type or social phobia
Antidepressant -Phenelzine, imipramine, sertraline.
Benzodiazipines- clonazepam, alprazolam, lorazepam, diazepam and SSRI have been found
useful.
Supportive therapy
The support afforded to patients by a positive relationship with their physicians has a
beneficial effect.
Eye Movement Desensitization and Reprocessing (EMDR) has been demonstrated in peer-
reviewed clinical trials to be effective in treating some phobias. Mainly used to treat Post-
traumatic stress disorder, EMDR has been demonstrated as effective in easing phobia
symptoms following a specific trauma, such as a fear of dogs following a dog
bite. Hypnotherapy coupled with Neuro-linguistic programming can also be used to help
remove the associations that trigger a phobic reaction. However, lack of research and
scientific testing compromises its status as an effective treatment. These treatment options are
not mutually exclusive. Often a therapist will suggest multiple treatments.
Prognosis
Phobias are among the most treatable mental health problems; depending on the severity of
the condition and the type of phobia, most properly treated people can go on to lead normal
lives. Research suggests that once a person overcomes the phobia, the problem may not
return for many years, if it returns at all. Children most often outgrow their specific phobias,
with or without treatment.
Untreated phobias are another matter. In adults, only about 20 percent of specific phobias go
away without treatment, and agoraphobia gets worse with time if untreated. Social phobias
tend to be chronic and are not likely go away without treatment. Moreover, untreated phobias
can lead to other problems, including depression, alcoholism, and feelings of shame and low
self-esteem. Therefore, specific phobias that persist into adolescence should receive
professional treatment.
A group of researchers in Boston reported in 2003 that phobic anxiety appears to be a risk
factor for Parkinson's disease (PD) in males, although as of 2004 it is not known whether
phobias cause PD or simply share an underlying biological cause .While most specific
phobias appear in childhood and subsequently fade away, those that remain
in adulthood often need to be treated. Unfortunately, most people never get the help they
need; only about 25 percent of people with phobias ever seek help for their condition.
Nursing management
Assessment
Focus on physical symptoms, precipitating factors, avoidance behavior associated with
phobia, impact of anxiety on physical functioning, normal coping ability,thought content and
social support systems.
Nursing diagnosis 1
Fear related to a specific stimulus or causing embarrassment to self in front of others,
evidenced by behaviour directed towards avoidance of the feared object/situation.
Objective:
Patient will be able to function in the presence of a phobic object or situation without
experiencing panic anxiety.
Nursing interventions
Reassure the patient that he is safe
Explore patient’s perception of the threat to physical integrity or threat to self concept.
Include patient in making decisions related to selection of alternative coping strategies.
If the patient elects to work on eliminating the fear, techniques of desensitization or
implosion therapy may be employed.
Encourage patient to explore underlying feelings that may be contributing to irrational fears.
Nursing Diagnosis 2
Social isolation related to fear of being in a place from which one is unable to escape,
evidenced by staying alone, refusing to leave the room/home.
Objective:
Patient will voluntarily participate in group activities with peers.
Interventions
Convey an accepting attitude and unconditional positive regard.
Make brief, frequent contacts.
Be honest and keep all promises.
Attend group activities with the patient that may be frightening for him.
Administer anti-anxiety medications as ordered by physician, monitor for effectiveness and
adverse effects.
Discuss with the patient signs and symptoms of increasing anxiety and techniques to
interrupt the response.
Give recognition and positive reinforcement for voluntary interactions with others.
Nursing diagnosis-3
Ineffective coping related to the fear attacks associated with disease condition
Nursing diagnosis -4
Ineffective communication pattern related to the fear associated with social gatherings
Evaluation
Effectiveness of planned interventions will be demonstrated in the patient’s ability to
recognize and deal with the anxiety producing factors .Relaxed participation in unit activities
and reports longer periods of restful sleep indicates reduced anxiety.
Conclusion
Phobias vary in severity among individuals. Some individuals can simply avoid the subject of
their fear and suffer relatively mild anxiety over that fear. Others suffer full-fledged panic
attacks with all the associated disabling symptoms. Most individuals understand that they are
suffering from an irrational fear, but they are powerless to override their initial panic reaction.
ASSIGNMENT
ON
MENTAL HEALTH ACT
2017

MENTAL HEALTH ACT, 2017
INTRODUCTION
In India, the Mental Health Care Act 2017 was passed on 7 April 2017 and came into
force from 29 May 2018. The act effectively decriminalized attempted suicide which was
punishable under Section 309 of the Indian Penal Code.[1] The law was described in its
opening paragraph as "An Act to provide for mental healthcare and services for persons with
mental illness and to protect, promote and fulfill the rights of such persons during delivery of
mental healthcare and services and for matters connected therewith or incidental thereto."[2]
This Act superseded the previously existing Mental Health Act, 1987 that was passed on 22
May 1987.
It states that mental illness be determined "in accordance with nationally and
internationally accepted medical standards (including the latest edition of the International
Classification of Disease of the World Health Organization) as may be notified by the Central
Government." Additionally, the Act asserts that no person or authority shall classify an
individual as a person with mental illness unless in directly in relation with treatment of the
illness.
► The Convention on Rights of Persons with Disabilities and its Optional Protocol was
adopted on the 13th December, 2006 at United Nations Headquarters in New York and came
into force on the 3rd May, 2008 (UNCRPD)
► India signed and approved the Convention on 1st October, 2007
► The MHCA 2017 on 7th april got assent of president of India and eventually come
into force from May 29, 2018
Need For Mental Health Legislation
►Necessary for protecting the rights of people with mental disorders

►To address the stigma, discrimination and marginalization in all societies and increased
likelihood of human rights violations.
►Provide a legal framework for addressing critical issues such as Community integration of
persons with mental disorders.
►Provision of high quality care, improvement of access to care.
RELEVANCE
• Legislation to empower persons with physical and mental disabilities has great implications
for the mental health professionals.
• Many services listed under the MHA Act fall within our scope. Therefore, It is essential for
mental health professionals to familiarize themselves with mental health related legislation as
it presents both opportunities and challenges to their practice.
OVERVIEW OF THE ACT
It has 126 sections arranged in 16 chapters

CHAPTER CONTENT
CHAPTER I Preliminary
CHAPTER II Mental illness and capacity to make

mental healthcare and treatment
decisions
CHAPTER III Advance directive
CHAPTER IV Nominated representative
CHAPTER V Rights of persons with mental illness
CHAPTER VI Duties of appropriate government
CHAPTER VII Central mental health authority
CHAPTER VIII State mental health authority
CHAPTER IX Finance, accounts and audit
CHAPTER X Mental health establishments
CHAPTER XI Mental health review boards
CHAPTER XII Admission, treatment and discharge
CHAPTER XIII Responsibilities of other agencies
CHAPTER XIV Restriction to discharge functions by

professionals not covered by
profession.
CHAPTER XV Offences and penalties
CHAPTER XVI Miscellaneous
CHAPTER -I
PRELIMINARY
It contains basic definitions
 Advance directive -a written document made by a person expressing their wishes
 Care-giver - providing care to a person with mental illness

 Mental illness - a substantial disorder of thinking, mood,
perception, orientation or memory that grossly impairs judgment, behavior, capacity to
recognize reality or ability to meet the ordinary demands of life, but does not include
mental retardation.
 Informed consent - consent given for a specific intervention, without any force, undue
influence, fraud, threat, mistake or misrepresentation, and obtained after disclosing adequate
information including risks and benefits and alternatives to the specific intervention in a
language and manner understood by the person
 Minor - not completed eighteen years
 Mental healthcare - analysis and diagnosis and treatment as well as care and rehabilitation
of a person for his mental illness or suspected mental illness
 Mental health establishment - means any health establishment, including Ayurveda, Yoga
and Naturopathy, Unani, Siddha and Homeopathy establishment and includes any general
hospital or general nursing home, either wholly or partly meant for care of persons with
Mental illness.
 Mental health nurse - diploma or degree in general nursing or diploma or degree in

psychiatric nursing
 Mental health professional – means either a Psychiatrist, Psychologist, PSW, MHN or a

professional with Doctorate of Medicine (Ayurveda) or Doctorate of Medicine (Homeopathy)
in psychiatry or Unani doctor
 Prisoner with mental illness - a person with mental illness under-trial or convicted of an
offence and detained in a jail or prison
►Clinical psychologist means a person –– having a recognised qualification in Clinical

Psychology from an institution approved and recognised, by the Rehabilitation Council of
India,;
►Having a Post Graduate degree in Psychology or clinical psychology or Applied

Psychology and a Master of Philosophy in Clinical Psychology or medical and social
psychology or in mental health and social psychology
►obtained after completion of a full time course of two years which includes supervised
clinical training or doctorate in clinical psychology which includes supervised clinical
training, from any university recognised by the University Grants Commission established
under the University Grants Commission Act, 1956
CHAPTER II
 Mental illness shall be determined in accordance with nationally or internationally

accepted medical standards
 No person or authority shall classify a person as a person with mental illness, except for
purposes directly relating to the treatment or in other matters as covered under this Act
 Mental illness of a person shall not be determined on the basis of political, economic or
social status or membership of a cultural, racial or religious group, or for any other reason not
directly relevant to mental health status of the person
Capacity to make mental healthcare and treatment decisions.
Every person, including a person with mental illness shall be deemed to have capacity to
make decisions regarding his mental health care or treatment, if such person has ability to,––
a) Understand the information relevant to the mental health care or treatment decision;
b) Retain that information
c) Use or weigh that information as part of the process of making the mental health care or
treatment decision
d) Communicate his decision by any means
CHAPTER III
Advance directive
Every person, who is not a minor, shall have a right to make an advance directive in writing
specifying any or all of the following:
 May be made by a person irrespective of his past mental illness or treatment for the same
 Invoked only when the person ceases to have capacity to make decisions
 Effective until such person regains capacity to make decisions
 An advance directive made may be revoked, amended or cancelled by the person who
made it at any time.
• It shall be the duty of every mental health establishment to propose or give treatment to a
person with mental illness, in accordance with his valid advance directive.
• The legal guardian shall have right to make an advance directive in writing in respect of a
minor, till such time he attains majority
• Review of advance directives -central authority can make regulations and modifications to
protect patient’s rights
CHAPTER IV
Nominated representative
• Every person, who is not a minor, shall have a right to appoint a nominated representative.
• The nomination shall be made in writing on plain paper with the person’s signature or
thumb impression of the person referred to.
• The person appointed as the nominated representative shall not be a minor, be competent to
discharge the duties or perform the functions assigned to him under this Act, and give his
consent in writing to the mental health professional.
CHAPTER V
Rights of persons with mental illness
1. Right to access mental health care without discrimination Provisions –
a) outpatient and inpatient,
b) half-way homes,
c) sheltered accommodation
d) supported accommodation
e) home based rehabilitation
f) hospital and community based rehabilitation
g) child and old age mental health services
► Right to community living (Clause 19)
► Right to protection from cruel, inhuman and degrading treatment (Clause 20)
 Right to equality and non – discrimination. (Section 21)
 Right to information - The PMI and nominated representative will have the RTI for the
clause under which patient is admitted, nature of illness and treatment options available.
(Section 22)
► Right to confidentiality and right to access medical records. (section 23 – 25 )
Right to personal contacts and information - Right to receive and refuse visitors, Right to
receive and make phone calls, send and receive mail through electronic mode including
through email (section 26)
Right to legal aid (section 27)
Right to make complaints about deficiencies in provision of services. (section 28)
Duties of appropriate Government
► Promotion of mental health and preventive programmes.
► Creating awareness about mental health and illness and reducing stigma associated with
mental illness.
► Appropriate Government to take measures as regard to human resource development and

training, etc.
► Co-ordination within appropriate Government
Admission, Treatment and Discharge
INDEPENDENT ADMISSION
► Any person who considers himself to have mental illness and desire admission, who is not
minor.
►Admitted if the medical officer or Psychiatrist is satisfied that:
a) Mental illness or severity requiring admission
b) Patient should benefit from admission and treatment

C) Request made is under free will and not under duress or undue influence and has capacity
to make mental health care decisions.
D) Informed consent
E) Bound to rules and regulations of establishment
► Nominated representative to be with the minor for the entire duration of admission
► Treatment for the minor with informed consent of nominated representative.
► Any admission of a minor which continues for a period of thirty days shall be immediately
informed to the concerned Board.
DISCHARGE OF INDEPENDENT ADMISSION
► On Request (DOR)
► Minor becoming Major under-in patient care, can decide as independent patient.
► A mental health professional may prevent discharge of a person admitted as an

independent person under section 86 for a period of twenty-four hours if—
a) SUCH Person is unable to understand the nature and purpose of his decisions and requires
substantial or very high support from his nominated representative; or
b) Has recently threatened or attempted or is threatening or attempting to cause bodily harm

to himself
c) Behaved or is behaving violently towards another person or is causing another person to

fear bodily harm from him
d) Showing an inability to care for himself to a degree that places the individual at risk of
harm to himself.
Leave of absence
►A PMI admitted maybe granted leave from the MHE by the psychiatrist After securing
consent of Nominated Representative.
►Power with the practitioner to terminate when appropriate to do so.
►If the PMI does not return, to contact the person on leave, or Nominated Representative
Absence without leave or discharge
► If any person absents himself without leave or without discharge from the mental health
establishment:
► He shall be taken into protection by any Police Officer
► Shall be sent back to the mental health establishment immediately.
Leave of absence
►The medical officer or mental health professional in charge of the mental health
establishment may grant:
► Leave to any person with mental illness
► To be absent from the establishment subject to such conditions, if any, and for such
duration as such medical officer or psychiatrist may consider necessary.
EMERGENCY TREATMENT
► "emergency treatment" includes transportation of the person with mental illness

to a nearest mental health establishment for assessment.
► WHO CAN TREAT- By any Registered Medical Practitioner, subject to informed consent
from the Nominated Representative.
► WHEN? – When its necessary to prevent
a) Death or irreversible harm to health
b) Person inflicting serious harm to himself/ others
c) Person causing damage to property.
PSYCHOSURGERY
► Psychosurgery as treatment only with patient’s informed Consent and Mental health
Review Board or concerned.
CHAPTER XV
► It deals with penalty and punishment.
► Unauthorized institutions will be punished 5000-50000 for 1st time, upto 2 lakhs for 2nd
time.
► Any person who do the work against the Act, are liable to give upto ten thousand rupees
or six months of jail or both.
CHAPTER XVI
►Decriminalization of Suicide
► Any person who attempts to commit suicide shall be presumed to be suffering from
mental illness at the time of attempting suicide and shall not be liable to punishment under
this section. (ie dissolution of IPC 309)
MERITS OF THE ACT
► Any person who attempts to commit suicide shall be presumed, unless proved otherwise,
to have severe stress and shall not be tried and punished under the said code.
► The act states that every citizen has right to access mental health care and treatment from
facilities run or funded by the appropriate government
► It assures free treatment to those who are homeless or below poverty line.
► A person with mental illness will also have the right to confidentiality with respect to his
mental health, mental health care and treatment.
►The bill mentions that every insurer shall make provisions for medical insurance for
treatment of mental illness on the same basis is available for treatment on physical illness.
► It bans electroconvulsive therapy (ECT) without anesthesia and any type of ECT to
children and restricts psychosurgery
► It also empowers the mentally ill person to choose the treatment and appoint individual as
nominated representatives who can take decisions on behalf of them.
(Math et al. 2019)
LIMITATIONS:
► The act mentions that a six member mental review board formed by the states will take
decisions on what treatments to offer at government facilities. “While the idea of board is
good, to have only one psychiatrist to take decision is not sufficient.”
► Some psychiatrists are also concerned that giving all patients to choose forms of treatment
could hamper the process.
► As this act provides advance directives it increases the work of psychiatrist whose number
is very less in our country.
► This act mentioned establishing new improvised institutions without concerning about
reforming already established institutions
► The definition of mental health is too restrictive. Going entirely by this definition,
disorders like conversion disorder, phobia, panic disorders and personality disorders which
are mental illnesses as per international classification of diseases (ICD 10), get excluded.
► Further adding to the confusion is the section 2 of MHCA 2017 which states that the
determination of mental illness is as per national or international guidelines like ICD or
Diagnostic and statistical manual (DSM).So there is a dilemma whether to follow the
definition of MHCA 2017 or ICD 10 (Math et al. 2019)
REVISIONS MADE FROM THE MENTAL HEALTH ACT 1987
The Mental Healthcare Act 2017 aims at decriminalizing the attempt to die by suicide by
seeking to ensure that the individuals who have attempted suicide are offered opportunities
for rehabilitation from the government as opposed to being tried or punished for the attempt.
The Act seeks to fulfill India's international obligation pursuant to the Convention on Rights
of Persons with Disabilities and its Optional Protocol.
It looks to empower persons suffering from mental illness, thus marking a departure from the
Mental Health Act 1987. The 2017 Act recognizes the agency of people with mental illness,
allowing them to make decisions regarding their health, given that they have the appropriate
knowledge to do so.
The Act aims to safeguard the rights of the people with mental illness, along with access to
healthcare and treatment without discrimination from the government. Additionally, insurers
are now bound to make provisions for medical insurance for the treatment of mental illness
on the same basis as is available for the treatment of physical ailments.
The Mental Health Care Act 2017 includes provisions for the registration of mental health
related institutions and for the regulation of the sector. These measures include the necessity
of setting up mental health establishments across the country to ensure that no person with
mental illness will have to travel far for treatment, as well as the creation of a mental health
review board which will act as a regulatory body.
The Act has restricted the usage of Electroconvulsive therapy (ECT) to be used only in cases
of emergency, and along with muscle relaxants and anaesthesia. Further, ECT has
additionally been prohibited to be used as viable therapy for minors.
The responsibilities of other agencies such as the police with respect to people with mental
illness has been outlined in the 2017 Act.
The Mental Health Care Act 2017 has additionally vouched to tackle stigma of mental illness,
and has outlined some measures on how to achieve the same.
Conclusion
► The mental health care act has some unprecedented measures aimed towards a sea of
change for better, regarding access to treatment for the mentally ill across the country and
particularly so for unprivileged. The mental health care act has brought a lot of promises for
the patients with mental illness.
REFRENCES
"Mental health bill decriminalising suicide passed by Parliament". The Indian Express. 27
March 2017. Archived from the original on 27 March 2017. Retrieved 27 March 2017.
"The Mental Health Care Act, 2017" (PDF). Government of India. Archived from the
original (PDF) on 12 October 2019. Retrieved 12 October 2017.
"Mental Health Act, 1987" (PDF). Archived from the original (PDF) on 5 January 2018.
Retrieved 5 January 2018.
ASSIGNMENT
ON
NATIONAL MENTAL
HEALTH PROGRAM

Mental Health and Mental illness

Clarity is essential when using the terms ‘mental health’ and ‘mental illness’. In all phases of
arecent small-scale research project, conceptual confusion was identified in the literature
reviewand among participants (Leighton 2008). Ironically, referring to mental illness in terms
ofmental health originated in the 1960s in an attempt to reduce stigma (Rowling et al. 2002).
There is no widely agreed consensus on the meaning of these terms and their use. Mental
healthand mental illness can be perceived as two separate, yet related, issues.Ryff and Singer
(1998) suggest that health is not a medical concept associated with absenceof illness, but
rather a philosophical one that requires an explanation of a good life – being one
where an individual has a sense of purpose, is engaged in quality relationships with others,
andpossesses self-respect and mastery. This is synonymous with the World Health
Organization(WHO) (2000, 2005b) definition of positive mental health.
However, such a definition is incomplete as individuals do not exist in isolation, but
areinfluenced by, and influence, their social and physical environments. Furthermore, people
willhave their own individual interpretations of what a good life is. Rowling et al. (2002: 13)
definemental health as thecapacity of individuals and groups to interact with one another and
the environment in ways thatpromote subjective wellbeing, the optimal development and use
of cognitive, affective and relationalabilities, the achievement of individual and collective
goals consistent with justice.This is a more rounded definition, and one that can coexist
alongside the WHO (1992) definitionof mental disorder.
Mental health – one of many factors
It is also important to recognize that neither physical nor mental health exist separately
mental, physical and social functioning are interdependent (WHO 2004). Furthermore,
allhealth issues need to be considered within a cultural and developmental context, as do
thesocial constructs of childhood and adolescence (Walker 2005). The quality of a person’s
mentalhealth is influenced by idiosyncratic factors and experiences, their family relationships
andcircumstances and the wider community in which they live (WHO 2004). Additionally,
eachculture influences people’s understanding of, and attitudes towards, mental health issues.
However, a culture-specific approach to understanding and improving mental health can
beunhelpful if it assumes homogeneity within cultures and ignores individual differences
(WHO2004). Culture is only one, albeit important, factor that influences individuals’ beliefs
andactions (Tomlinson 2001; Dogra 2003). Interaction between different factors may lead to
different outcomes for different individuals.
It can be argued that the above approaches are rooted in western perspectives. However,
theyprovide a useful starting point from which to discuss mental health issues with children
andtheir families.
Historical perspectives
Attitudes and views toward psychopathology in the medical and larger social community
have undergone drastic transformation throughout history, at times progressing through a
rather tortuous course, to eventually receive validation and scientific attention. Departing
from a simplistic view centred on supernatural causes, modern theories in the early 20th
century began to recognize mental disorders as unique disease entities, and two main theories
of psychodynamics and behaviorism emerged as potential explanations for their causes. With
the increasing acceptance of mental illness as a unique form of pathology, official diagnostic
classification systems were adopted, new avenues of research spawned, and modern
approaches to treatment incorporating pharmaacotherapy and psychotherapy were
established. Although much scientific progress has been made in the fields of diagnosing and
treating mental illness, at a societal level the recent psychiatric deinstitutionalization
movement has been met with mixed success, calling into question how to most effectively
implement into clinical practice the knowledge that has been gained over the previous
centuries.
The prevailing views of early recorded history posited that mental illness was the product of
supernatural forces and demonic possession, and this often led to primitive treatment
practices such as trepanning in an effort to release the offending spirit. Relatively little in the
way of improvements were achieved throughout the European Middle Ages, and the
oppressive sociopolitical climate saw many sufferers of mental illness being submitted to
physical restraint and solitary confinement in the asylums of the time. It was not until the late
19th and early 20th centuries that modern theories of psychopathology began to emerge.
Around this time, two main theoretical approaches began to inform our understanding of
mental illness: the psychodynamic theory proposed by Austrian neurologist Sigmund Freud
(1856–1939), and the theory of behaviorism advanced by American psychologist John B.
Watson (1878–1958). Freud’s theory of psychodynamics centred on the notion that mental
illness was the product of the interplay of unresolved unconscious motives, and should be
treated through various methods of open dialogue with the patient.[2] Behaviorism, on the
other hand, suggested that psychopathology was more closely related to the effects of
behavioral conditioning, and that treatment should focus on methods of adaptive
reconditioning, using the same principles of classical conditioning elucidated by the Russian
physiologist Ivan Pavlov (1849–1936).
Against the backdrop of these broad theoretical frameworks, modern approaches to the
diagnosis and treatment of psychopathology began to emerge and, along with these, the need
to systematically categorize mental illness became apparent. In post–Second World War
North America a need for a formal classification system was recognized in order to provide
more efficient and targeted mental health services for veterans. This led to the creation of the
first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952,
which was largely drawn from the World Health Organization’s sixth edition of the
International Classification of Diseases (ICD-6).Early editions of the DSM described mental
disorders in terms of “reactions,” postulating that such illnesses should be classified with
reference to antecedent socio-environmental and biological causative factors. However, in
1980 with the publication of the third edition, the DSM shifted its focus and intentionally
remained neutral on the potential etiological causes of the various forms of mental illness.
This position was maintained in subsequent editions, including the current DSM-5, published
in 2013.
With theoretical frameworks and a classification system in place, the study and treatment of
mental illness began to expand significantly in the mid-20th century. Important developments
in this period laid the foundation for modern pharmacologic and psychotherapeutic
approaches aimed at addressing mental illness. From a pharmacological perspective, the
catecholamine hypothesis, published in the 1950s, was an influential milestone although
perhaps overly simplistic. Following research into the actions of drugs like reserpine and
monoamine oxidase inhibitors, the catecholamine hypothesis proposed that depression and
other affective disorders were likely caused by decreased levels of catecholamines such as
norepinephrine.
The field of psychotherapy, with its early roots in Freud’s psychodynamic theory, also saw
new developments in this period. In particular, individuals such as American psychologist
Albert Ellis (1913–2007) and American psychiatrist Aaron T. Beck (b. 1921) began adopting
treatment approaches aimed at addressing the maladaptive cognitions and emotions
underlying mental disorders.When combined with principles of behaviorism, this approach
led to the eventual development of cognitive-behavioral therapy (CBT), the current gold
standard psychotherapeutic approach in the treatment of anxiety disorders. Taken together,
the catecholamine hypothesis and the development of CBT have had a substantial impact on
the modern treatment of depression and anxiety, the two disorders accounting for the highest
proportion of disability-adjusted life years among mental illnesses across the globe.
Trends, issues and magnitude

Psychiatric-mental health nursing is an integral part of the continuum of nursing practice. The
American Nurses Association (ANA) describes psychiatric-mental health nursing as “a
specialized area of nursing practice committed to promoting mental health through the
assessment, diagnosis, and treatment of human responses to mental health problems and
psychiatric disorders” (ANA, 2007, p. 1). As a core mental health profession, psychiatric
mental health nursing “employs a pur-poseful use of self as its art and a wide range of
nursing, psychosocial, and neurobiological theo-ries and research evidence as its science”
(ANA, 2007, p. 1). The practice of psychiatric-mental health registered nurses includes the
provision of “comprehensive, patient-centered mental health and psychiatric care and
treatment and outcome evaluation in a variety of settings across the entire continuum of
care”.
The phenomena of concern specifi c to psychiatric-mental health nursing (ANA, 2007, pp.
15–16) include actual or potential mental health problems pertaining to the following:
● The promotion of optimal health and well-being and the prevention of mental illness
Impaired ability to function related to psychiatric, emotional, and physiological

distress.
● Alterations in thinking, perceiving, and communicating due to psychiatric disorders or
mental health problems.
● Behaviors and mental states that indicate potential danger to self or others.
● Emotional stress related to illness, pain, disability, and loss.
● Symptom management, side effects, and toxicities associated with self-administered
drugs, psychopharmacological intervention, and other treatment modalities.
● Barriers to treatment efficacy and recovery posed by alcohol and substance abuse and
dependence.
● Self-concept and body image changes, developmental issues, life process changes,
and end of life issues.
● Physical symptoms that occur along with altered physiological status.
● Psychological symptoms that occur along with altered physiological status.
● Interpersonal, organizational, sociocultural, spiritual, or environmental circumstances
and events that affect the mental and emotional well-being of the individual, family,
or community.
● Elements of recovery including the ability to maintain housing, employment, and
social support that help individuals re-engage in the seeking of meaningful lives.
Contemporary practices
Based on the biopsychosocial model of psychiatric nursing, this text provides thorough
coverage of mental health promotion, assessment, and interventions in adults, families,
children, adolescents, and older adults. On the forefront of the shift towards today's emphasis
on evidence-based psychiatric nursing, this text continues to highlight current research
evidence and describe evidence-based care. Included in the book's many useful and engaging
features are psychoeducation checklists, therapeutic dialogues, NCLEX[registered] notes,
vignettes of famous people with mental disorders, research for best practice boxes, and
illustrations showing the interrelationship of the biologic, psychological, and social domains
of mental health and illness. The Fifth Edition has been updated with an emphasis on
recovery throughout the chapters, plus a new chapter on sexual disorders.
Know thyself is a basic now thyself is a basic principle of psychiatric ciple of psychiatric
nursine. Possessing ing. Possessing self-awareness indicates that the nurse has arrived at a
philosophical belief about life, death, and the overall human condition. Introspection is
critical to the development of selfunderstanding. It involves objectively examining one's
personal beliefs, attitudes, motivations, strengths, and limitations. This process is believed to
be important because nurses' psychological state influences the way patient information is
analyzed. Additionally, nurses' social biases can influence the way they interact with clients
(Boyd, 1998). This process of personal introspection adds dimension to the nurse-client
relationship and is pertinent to understanding client responses, thus enabling nurses to
explore these issues with their clients.
According to Arnold and Boggs (1999), in addition to being essential for successful
implementation of the therapeutic relationship, self-knowledge is a necessary precursor to
professionalism. Professional development, according to Schon (1983), is evident in the
reflection of expert practitioners using a critical process that involves discovery of previously
implicit assumptions. Reflective practice and the development of self-awareness are
important concepts to the advancement of nursing as a profession. However, many
practitioners find reflective practice mysterious and confusing (Wilson, 1996), as well as
anxiety provoking. Because self-awareness is a necessary characteristic of professional
nurses, its essence should be well understood. Becoming acquainted with the work of the
primary contributors to the construct of self-awareness is one way to appreciate more fully
the way self-awareness evolves and its meaning.
Socrates, Plato, and Aristotle distinguished themselves as the earliest scholars of the mind,
speculating about and debating the existence and location of the mind (Eckroth-Bucher,
2001). Examining their philosophical tenets and applying their philosophical principles helps
nurses understand the contemporary relevance of the concept and practice of self-awareness
in psychiatric nursing as a tool to facilitate mental health in patients (Eckroth-Bucher, 2001).
In ancient Greece, philosophers, poets, and tragedians, as well as physicians, influenced the
population. Therefore, individuals often turned to philosophers to find relief for their various
psychological problems or to improve their relationships with others. This article discusses
the influence of ancient Greek philosophers, poets, and tragedians on contemporary
psychiatric nursing.
Mental health Laws/Act
Good mental health involves a sense of wellbeing, confidence and self-worth. It enables us to
fully enjoy and appreciate other people, day-to-day life, and our environment. However,
sometimes people can lose their sense of wellbeing and become mentally unwell. On
occasions when their welfare is at risk (or if others welfare is at risk) they may need to be
treated without their consent in hospital or in the community. They become what are known
as an involuntary patient. The law that enables that to happen is called Mental Health Act
(2014) (Act).
The Act relates to:
● when a person can be provided with mental health treatment
● the criteria for referring a person for an examination by a psychiatrist
● when a person can be made an involuntary patient on an inpatient treatment order or a

community treatment order
● how inpatient treatment orders and community treatment orders operate
● The rights of persons with mental illness and their personal support persons.
The Mental Health Commission (MHC) is responsible for the ongoing monitoring and
evaluation of the Act and the Mental Health Regulations. Mental Health Act 2014
resources are available to help key groups understand and apply the Act:
● mental health professionals
● referrers to mental health services
● people experiencing a mental illness
● people supporting a person with a mental illness
● non-government organisations and private psychiatric hostels
● Transport officers.
Consumer handbook to the Mental Health Act 2014 (Handbook) is an invaluable resource for
the community regarding understanding the Act. The Handbook has been prepared to help
people experiencing mental illness and their family members, to navigate the mental health
system and uphold their rights. This handbook has been written by people with lived
experience of mental illness it is user friendly, relevant and informative. The Handbook
outlines:
● consumer and carer rights
● assessment, referral and examination
● hospital admission, treatment options and discharge
● further opinions
● community treatment orders
● the roles of the Mental Health Advocacy Service, the Mental Health Tribunal and the
Chief Psychiatrist
● Complaints and feedback pathways.
The legislation is built around 15 principles described in a Charter of Mental Health Care
Principles. Mental health services and private psychiatric hostels must always consider these
principles when they are providing treatment, care and support to a person experiencing
mental illness. The Charter applies to voluntary and involuntary patients.
National Mental health Program
It is estimated that 6-7 % of population suffers from mental disorders. The World Bank report
(1993) revealed that the Disability Adjusted Life Year (DALY) loss due to neuropsychiatric
disorder is much higher than diarrhea, malaria, worm infestations and tuberculosis if taken
individually. Together these disorders account for 12% of the global burden of disease (GBD)
and an analysis of trends indicates this will increase to 15% by 2020 (World Health Report,
2001). One in four families is likely to have at least one member with a behavioral or mental
disorder (WHO 2001). These families not only provide physical and emotional support, but
also bear the negative impact of stigma and discrimination. Most of them (>90%) remain un-
treated. Poor awareness about symptoms of mental illness, myths & stigma related to it, lack
of knowledge on the treatment availability & potential benefits of seeking treatment are
important causes for the high treatment gap. The Government of India has launched the
National Mental Health Programme (NMHP) in 1982, with the following objectives:
● To ensure the availability and accessibility of minimum mental healthcare for
all in the foreseeable future, particularly to the most vulnerable and
underprivileged sections of the population;
● To encourage the application of mental health knowledge in general healthcare

and in social development; and
● To promote community participation in the mental health service development

and to stimulate efforts towards self-help in the community.
The District Mental Health Program (DMHP) was launched under NMHP in the year
1996 (in IX Five Year Plan). The DMHP was based on ‘Bellary Model’ with the
following components:
● Early detection & treatment.
● Training: imparting short term training to general physicians for

diagnosis and treatment of common mental illnesses with limited
number of drugs under guidance of specialist. The Health workers are
being trained in identifying mentally ill persons.
● IEC: Public awareness generation.
● Monitoring: the purpose is for simple Record Keeping.
References:
Below mentioned websites link were used:
1. www.google.com
2. www.wikepedia.com
3. www.shodhganga.com
ASSIGNMENT
ON
BEHAVIOUR THERAPY

BEHAVIOUR THERAPY
Introduction
Behavior therapy involves changing the behavior of the patients to reduce the dysfunction
and to improve the quality of life. The principles of behavior therapy are based on the early
studies of Classical conditioning by Pavlov (1927) and operant conditioning by Skinner
(1938).
Techniques based on classical conditioning
Classical conditioning is the learning of involuntary responses by pairing a stimulus that
normally causes a particular response with a new, neutral stimulus after enough parings, the
new stimulus will also cause the response to occur. Through classical conditioning ‘the old
and undesirable responses can be replaced by the desirable ones.
There are several techniques that have been developed using this type of learning to treat the
disorders such as phobias, obsessive compulsive disorder, and similar anxiety disorder. The
techniques are,
Relaxation Therapy
Relaxation therapy refers to a number of techniques designed to teach someone to be

able to relax voluntarily. These techniques can include special breathing practices and
progressive muscle relaxation exercises, which are designed to reduce physical and mental
tension.
Relaxation therapy refers to a number of techniques designed to teach someone to be
able to relax voluntarily. These techniques can include special breathing practices and
progressive muscle relaxation exercises, which are designed to reduce physical and mental
tension.
There are a number of other activities that can promote relaxation, including massage,
listening to music, yoga and meditation.
Muscle tension is usually associated with stress and anxiety, which are strongly associated
with depression. Becoming aware of the link between depressive thoughts and mental and
muscle tension, and learning to voluntarily let go of this tension, may help to reduce
depression symptoms.
There have been a number of randomised controlled trials on the effect of
relaxation therapy for people with depression. In general, these studies have found that
relaxation therapy works better than no treatment, but not as well as psychological treatments
such as cognitive behaviour therapy. The longer-term effects of relaxation therapy are
uncertain.
Relaxation therapy is not for everyone. Some people who are very depressed
or anxious, or who have other types of mental health problems, can find that relaxation
doesn’t help. It might even make them feel worse. It's best to check with your doctor before
trying relaxation therapy.
Community groups often run relaxation classes. There are also therapists who
teach relaxation, who can be found in the Relaxation,
Relaxation therapy can be helpful for depression, but does not work as well as
psychological treatments such as cognitive behaviour therapy.
Relaxation therapy is not for everyone. Some people who are very depressed or
anxious or who have other types of mental health problems find that relaxation doesn't help.
It might even make them feel worse. Please check with your doctor before trying relaxation
therapy.
Before you begin, make sure you are not hungry or thirsty and that you haven't been
drinking alcohol. Do not listen to this recording in places where you must concentrate for
safety reasons (such as when driving a car). Find a place where you won't be disturbed, where
you can lower the lights and let your mind relax. It is best to do the exercise sitting rather
than lying down. There are periods of quietness on this recording and you will know that the
tape is about to finish when you hear "Open your eyes". If at any time you feel that the
exercise doesn't suit you, just open your eyes and turn off the recording.
Cognitive Therapy
Cognitivebehavioraltherapy (CBT) is a form of psychological treatment that has been
demonstrated to be effective for a range of problems including depression, anxiety disorders,
alcohol and drug use problems, marital problems, eating disorders and severe mental illness.
Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been
demonstrated to be effective for a range of problems including depression, anxiety disorders,
alcohol and drug use problems, marital problems, eating disorders and severe mental illness.
Numerous research studies suggest that CBT leads to significant improvement in functioning
and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more
effective than, other forms of psychological therapy or psychiatric medications.
It is important to emphasize that advances in CBT have been made on the basis of both
research and clinical practice. Indeed, CBT is an approach for which there is ample scientific
evidence that the methods that have been developed actually produce change. In this manner,
CBT differs from many other forms of psychological treatment.
CBT is based on several core principles, including:
1. Psychological problems are based, in part, on faulty or unhelpful ways of thinking.

2. Psychological problems are based, in part, on learned patterns of unhelpful behavior.
3. People suffering from psychological problems can learn better ways of coping with
them, thereby relieving their symptoms and becoming more effective in their lives.
CBT treatment usually involves efforts to change thinking patterns. These strategies might
include:
● Learning to recognize one's distortions in thinking that are creating problems, and
then to re-evaluate them in light of reality.
● Gaining a better understanding of the behavior and motivation of others.
● Using problem-solving skills to cope with difficult situations.
● Learning to develop a greater sense of confidence is one's own abilities.
CBT treatment also usually involves efforts to change behavioral patterns. These strategies
might include:
● Facing one's fears instead of avoiding them.
● Using role playing to prepare for potentially problematic interactions with others.
● Learning to calm one's mind and relax one's body.
Not all CBT will use all of these strategies. Rather, the psychologist and patient/client work
together, in a collaborative fashion, to develop an understanding of the problem and to
develop a treatment strategy.
CBT places an emphasis on helping individuals learn to be their own therapists. Through
exercises in the session as well as “homework” exercises outside of sessions, patients/clients
are helped to develop coping skills, whereby they can learn to change their own thinking,
problematic emotions and behavior.
CBT therapists emphasize what is going on in the person's current life, rather than what has
led up to their difficulties. A certain amount of information about one's history is needed, but
the focus is primarily on moving forward in time to develop more effective ways of coping
with life.
Positive-Negative Reinforcement
For positive reinforcement, think of it as adding something positive in order to
increase a response. For negative reinforcement, think of it as taking something negative
away in order to increase a response.
Reinforcement
● Reinforcement is used to help increase the probability that a specific behavior will
occur in the future by delivering or removing a stimulus immediately after a behavior.
● Another way to put it is that reinforcement, if done correctly, results in a behavior

occurring more frequently in the future.
Positive Reinforcement
Positive reinforcement works by presenting a motivating/reinforcing stimulus to the person

after the desired behavior is exhibited, making the behavior more likely to happen in the
future.
The following are some examples of positive reinforcement:
● A mother gives her son praise (reinforcing stimulus) for doing homework (behavior).
● The little boy receives $5.00 (reinforcing stimulus) for every A he earns on his report
card (behavior).
● A father gives his daughter candy (reinforcing stimulus) for cleaning up toys
(behavior).
Negative Reinforcement
Negative reinforcement occurs when a certain stimulus (usually an aversive stimulus) is

removed after a particular behavior is exhibited. The likelihood of the particular behavior
occurring again in the future is increased because of removing/avoiding the negative
consequence.
Negative reinforcement should not be thought of as a punishment procedure. With negative
reinforcement, you are increasing a behavior, whereas with punishment, you are decreasing a
behavior.
The following are some examples of negative reinforcement:
● Bob does the dishes (behavior) in order to stop his mother’s nagging (aversive
stimulus).
● Natalie can get up from the dinner table (aversive stimulus) when she eats 2 bites of
her broccoli (behavior).
● Joe presses a button (behavior) that turns off a loud alarm (aversive stimulus)
When thinking about reinforcement, always remember that the end result is to try to increase
the behavior, whereas punishment procedures are used to decrease behavior. For positive
reinforcement, think of it as adding something positive in order to increase a response. For
negative reinforcement, think of it as taking something negative away in order to increase a
response.
Bio Feedback
Biofeedback therapy is a technique that trains people to improve their health by
controlling certain bodily processes that normally happen involuntarily, such as heart rate,
blood pressure, muscle tension, and skin temperature.
Biofeedback therapy is a non-drug treatment in which patients learn to control bodily
processes that are normally involuntary, such as muscle tension, blood pressure, or heart rate.
It may help in a range of conditions, such as chronic pain, urinary incontinence, high blood
pressure, tension headache, and migraine headache.
As it is noninvasive and does not involve drugs, there is a low risk of undesirable side effects.
This could make it suitable for those who wish to avoid medications, or those who cannot use
them, such as during pregnancy.
It is often combined with relaxation training.

There are three common types of biofeedback therapy:
1. Thermal biofeedback measures skin temperature.

2. Electromyography measures muscle tension.
3. Neurofeedback, or EEG biofeedback focuses on electrical brain activity.
EEG biofeedback may help patients with attention deficit hyperactivity disorder (ADHD),
addiction, anxiety, seizures, depression, and other types of brain condition.
During a biofeedback session, the therapist attaches electrodes to the patient’s skin, and these
send information to a monitoring box.
The therapist views the measurements on the monitor, and, through trial and error, identifies
a range of mental activities and relaxation techniques that can help regulate the patient’s
bodily processes.
Eventually, patients learn how to control these processes without the need for monitoring.
It remains unclear why or how biofeedback works, but it appears to benefit people with
conditions related to stress, according to The University of Maryland Medical Center
(UMM). When a person experiences stress, their internal processes — such as blood pressure
— can become irregular. Biofeedback therapy teaches relaxation and mental exercises that
can alleviate symptoms.
Guided Imagery
Guided therapeutic imagery, a technique in which mental health professionals help

individuals in therapy focus on mental images in order to evoke feelings of relaxation, is
based on the concept of mind-body connection. Mind-body connection upholds the
interaction between body and mind as one important factor in a person’s overall health and
well-being. In guided therapeutic imagery, a person can call on mental images to improve
both emotional and physical health.
History of Guided Therapeutic Imagery
Various forms of guided imagery have been used for centuries, as far back as ancient Greek
times, and the technique is an established approach in Chinese medicine and American Indian
traditions as well as other healing and religious practices. Jacob Moreno’s technique of
psychodrama, developed in the 1940s, can also be linked to guided imagery, as the enactment
of the person in therapy’s unique concerns can be understood as a method of directing a
person’s own imagery. In fact, Hans Leuner, who further developed psychodrama, called the
approach guided affective imagery.
In the 1970s, Dr. David Bressler and Dr. Martin Rossman began establishing support for
guided imagery as an effective approach for the treatment of chronic pain, cancer, and other
serious illnesses. Their work led them to co-find the Academy for Guided Imagery in
1989. Throughout the 80s, a number of health advocates and professionals began to publish
materials exploring the positive impact of guided imagery on health concerns both mental
and physical. Ulrich Schoettle, Leslie Davenport, and Helen Bonny were a few such
individuals.
Currently, guided imagery is an established approach in complementary and alternative

medicine, and studies show it is frequently helpful when used as part of the therapeutic
process.
Guided Therapeutic Imagery Techniques
Guided therapeutic imagery is a technique used in a wide range of therapeutic modalities and
settings including group and individual therapy. Once learned, the technique can also be
practiced independently, without the direction of a therapist. Guided imagery scripts can be
found online and in self-help books. Many individuals may obtain benefit from practicing
guided imagery on their own, but seeking instruction from a trained professional
before attempting to use guided imagery alone is typically recommended. Instruction in the
technique can help individuals obtain maximum effect from the intervention.
Typically a therapist using this approach will provide verbal prompts to direct the focus of
the imagery, often encouraging the participant to notice various sensory aspects of the scene.
A person in therapy may, for example, be asked to envision a peaceful place, including in this
vision any aromas, sounds, and textures present. In this way, guided therapeutic imagery
expands beyond visualization because it involves all five senses. Guided imagery is designed
to impact the body as well as the mind, and breathing typically becomes slower and more
controlled during the process while muscles relax, creating a state of calm and relaxation.
Some practitioners may use music as part of the technique.
The process of guided therapeutic imagery has some similarities to other techniques designed
to invoke a state of relaxation, such as hypnosis. Both techniques involve some visualization,
a focus on the inner mental experience, and a relaxed state of mind. However, hypnosis tends
to place more focus on suggestion while guided imagery emphasizes the senses. When used
therapeutically, hypnosis can utilize the relaxed state to help a person become more receptive
to new ideas and beliefs. Guided imagery works to incorporate a person's senses in order to
better direct and focus attention on a particular area of concern, imagining a desired outcome
for that concern.
Issues Treated with Guided Imagery
While initially considered to be no more than an alternative or complementary approach, the

approach's proven effectiveness has garnered support in recent years. Guided therapeutic
imagery is now widely used and supported by research. The technique is commonly used for
stress management, with the person in therapy encouraged to picture a place that instills a
sense of relaxation.
Research shows guided imagery to be helpful in the treatment of a number of concerns,

including:
● Stress
● Anxiety
● Depression
● Substance abuse
● Grief
● Posttraumatic stress
● Relationship issues
● Diminished self-care
● Family and parenting issues

In addition to emotional and behavioral issues, guided imagery is also often used by medical
professionals to address pain management, high blood pressure, and the reduction of
unwanted behaviors such as smoking. Guided imagery is also commonly used among athletes
in order to enhance performance. Guided imagery techniques are generally used to target
specific problems. A person with cancer, for example, may use guided imagery to visualize
healthy cells and strong, powerful organs.
Training for Guided Therapeutic Imagery
The Academy for Guided Imagery offers professional certification in guided therapeutic
imagery, or Interactive Guided Imagery, as it is also known. Interested practitioners must
complete 150 hours of training, 33 hours of independent study, and be licensed to practice as
a mental health professional. Health educators, personal coaches, body
workers,andcounselors may also pursue training in this method.
Training, which consists of three levels that must be completed within 24 months, is offered
through home-study modules and online group study workshops. Additional continuing
education trainings are also available through AGI's website.
Limitations of Guided Therapeutic Imagery
Although the use of guided therapeutic imagery is supported by research, some studies
suggest it can lead to false memories. However, there are typically other factors contributing
to the recovery of false memories, such as group pressure, personality factors, and personal
experiences.
Guided imagery may not work for every individual, and some people may prefer to address
their concerns with other approaches.
This technique is generally considered to be safe for use by most people, whether they choose
to seek the support of a mental health professional or use guided imagery on their own. The
initial guidance of a therapist is encouraged, and when a person experiences a serious
concern, the support of a mental health professional is always recommended.
Abreaction Therapy
Abreaction Therapy focuses on reliving a traumatic event and going through the emotions
associated with them to heal and move forward. Originally created by Sigmund Freud the
method gives patients a way to release their unconscious pain and escape from the memories
and feelings that have kept them from moving forward. Therapists who work as Abreaction
counselors use catharsis or the cleansing of emotions to get rid of the spirit and thoughts
associated with the experience. As a process that brings out difficult emotions the client will
go through an emotional removal that takes away the burden of the traumatic event after
treatment.
Goals of Abreaction Therapy
The goal of Abreaction Therapy is to cleanse the patient's body by going through their trauma
yet again and letting go of painful thoughts and emotions. When the client has completed
their treatment they should be able to speak openly about the event without feeling
uncomfortable or unable to cope. Therapy clears up what has happened and heals the
individual so that they can move forward and prevent the trauma from ruining their personal
lives and relationships. As a traditional and direct form of therapy this is an awareness tool
that helps clear up the conscious tension which can be extremely dramatic when it is
associated with heavy emotions and painful memories.
When is Abreaction Therapy Used?
Abreaction Therapy is implemented when a client is in need of an emotional and spiritual

breakdown. By leading them through the event again and reliving the memories and feelings
it releases fears and rejections that have been kept in since the event. It is used only for those
who've dealt with trauma and hardship which is also affecting their current lives and
relationships with others. Traumatic events can ruin trust, love and security. It's common that
the clients suffer from a lack of self esteem and assurance in themselves because of what's
happened to them. They may be participating in behavior that's detrimental to their health
because they have yet to face the feelings associated with trauma.
How Abreaction Therapy Works
As a form of "reliving" in psychotherapy, Abreaction Treatment may take longer than other
treatment plans. Currently Abreaction is not used in its current form but as a combination
approach which outlines the traumatic event to integrate the past and constructively deal with
the pain associated with it. Being that the trauma is complex and affects the patients in
various ways the counselor works with the technique carefully to relive memories and
overcome the patient's disassociation from the event and pain. The treatment works by
acknowledging the flashbacks and distrust. It is likely that the patient will also undergo
disorientation toward the beginning of treatment. The counselor has to be careful when they
are reliving the event being that it often promotes flashbacks as an unavoidable element in
working with trauma. The therapist will have to ensure that a trusting relationship has been
put in place with the patient before thoughts are expressed. Security between the two will
create safety in the presence of the therapist during Abreaction.
Toward the beginning of the treatment the counselor creates stabilization in the room and
provides the patient with a psycho-education so that they can possess a deeper understanding
of what's happening and why. The moment when the event is relived could occur quickly
because of a trigger that's been made accidentally. Although it may feel like internal pressure
and conflict for a period of time the counseling will release the unprocessed emotions and
material for the purpose of bringing them closer to the surface. The pressure may feel like a
power struggle although it results in conscious and sub-conscious clarity.
When the thoughts and feelings are released the client gains understanding, clarity and a new
identity. This is a beneficial strategy in working with hostile memories because it creates a
new role for the individual. This is a collaboration platform between the therapist and patient
to rid of disturbing memories, close them and move forward in life. Being that the counselor
is a hand to hold during the process it acts as a physical anchor. The creation and
development of the relationship is essential and it could take a lengthy session time until the
client is ready to relive the event. For patients that are severely damaged it can take many
sessions before internalizing the security and commitment.
References:
4. www.google.com
ASSIGNMENT
ON
ROLE OF NURSE IN
PSYCHO-
PHARMALOGICAL
THERAPY
Antianxiety Agents
Agents that alleviate ANXIETY, tension, and ANXIETY DISORDERS, promote sedation,
and have a calming effect without affecting clarity of consciousness or neurologic conditions.
ADRENERGIC BETA-ANTAGONISTS are commonly used in the symptomatic treatment
of anxiety.
Anxiety is a complex and prevalent cluster of psychiatric disorders consisting of generalized

anxiety disorder, panic disorder, social phobia, obsessive‐compulsive disorder, posttraumatic
stress disorder, and specific phobias. These conditions are most commonly treated with
benzodiazepines, buspirone, and serotonin reuptake inhibitors, all of which fall some way
short of the ideal anxiolytic. The clinical applications, side effects, and drug metabolism of
these medications are discussed. A multitude of neurotransmitter systems are implicated to a
greater or lesser degree in the complex underlying neurobiology and physiology of anxiety,
including GABA, serotonin, norepinephrine, glutamate, as well as neuropeptides such as
CCK, CRF, and NPY. The increasing understanding of the roles of each neurobiological
pathway provides a platform for medicinal chemistry efforts in anxiolytic research. The
structure‐activity relationships of current medications and newer, investigational compounds
interacting with these systems are discussed, as well as the future prospects for the
development of improved anxiolytics.
Anxiolytic agents—usually defined in the past as chiefly the benzodiazepines—are among

the most commonly used psychotropic drugs. The vast majority of prescriptions for these
medications are written by primary care physicians. Psychiatrists write less than 20% of the
prescriptions for anxiolytics in this country, reflecting, in part, the fact that most anxious
patients never see psychiatrists. Moreover, anxiolytics are prescribed for a wide variety of
patients who do not have a primary anxiety disorder—namely, patients who present to
primary care physicians with somatic complaints or true somatic disease.
Antidepressants Agents
Antidepressants are drugs used to prevent or treat depression. The available
antidepressant drugs include the selective serotonin reuptake inhibitors (SSRIs),
norepinephrine-dopamine reuptake inhibitors (NDRIs), monoamine oxidase inhibitors
(MAOIs), tricyclic antidepressant, tetracyclic antidepressants, and others.
The antidepressants are some of the most commonly prescribed medications in current use.
They are also important causes of drug induced liver injury accounting for 2% to 5% of
clinically apparent cases. The antidepressants can be grouped into four categories: monamine
oxidase inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, and
miscellaneous agents.
The monamine oxidase inhibitors are a large group of hydrazide derivatives which were
found to have antidepressant activity when first used in the therapy of tuberculosis in the
1950s. These agents inhibit the enzyme monamine oxidase that is responsible for inactivation
of many amine neurotransmitters such as norepinephrine and serotonin, thus increasing their
levels and activity in the brain. MAO inhibitors (with initial trade name and year of approval)
currently in clinical use for depression include phenelzine (Nardil: 1961), tranylcypromine
(Parnate: 1961), and isocarboxazid (Marplan: 1959). MAO inhibitors are currently not widely
used, having been replaced by the tricyclic antidepressants and selective serotonin reuptake
inhibitors which have greater potency and fewer adverse side effects. The MAO inhibitors
can cause serum aminotransferase elevations and rarely lead to clinically apparent liver
injury, generally with a hepatitis-like clinical presentation 1 to 3 months after starting
therapy.
The tricyclic antidepressants share a tricyclic chemical structure somewhat resembling the
phenothiazines. The tricyclics are believed to act by inhibition of reuptake of serotonin and
norephinephrine, thus increasing levels of these neurotransmitters. Tricyclic antidepressants
in current use includeANCHALriptyline (Elavil: 1961), clomipramine (Anafranil: 1989),
desipramine (Norpramin: 1964), doxepin (Sinequan: 1969), imipramine (Tofranil: 1959),
nortriptyline (Aventyl or Pamelor: 1964) and protriptyline (Vivactil: 1967). Two more
recently approved agents are usually categorized as tricyclics, but have some unique
characteristics: trimipramine (Surmontil: 1979) and amoxapine (Asendin: 1992). The various
tricyclic antidepressants are capable of causing transient serum aminotransferase elevations to
varying degrees and, in rare instances, clinically apparent acute liver injury. Various pattern
of hepatic injury have been associated with different tricyclic antidepressants.
The selective serotonin reuptake inhibitors (SSRIs) are a group of structurally unrelated
agents characterized by a common mechanism of action, the inhibition of reuptake of
serotonin in synaptic clefts which results in an increase in brain serotonin activity. These
agents are considered selective, because they have little activity in blocking reuptake of
norepinephrine or other neurotransmitters. The SSRIs are currently the most commonly used
antidepressants. Those in current use include citalopram (Celexa: 1998), escitalopram
(Lexapro: 2002), fluoxetine (Prozac: 1987), fluvoxamine (Luvox: 1994), paroxetine (Paxil:
1992), sertraline (Zoloft: 1991), venlafaxine (Effexor: 1965) and duloxetine (Cymbalta:
2004). Two more recently approved serotonergic agents are unique in that they have bimodal
activity, inhibiting serotonin reuptake like typical SSRIs, but also having partial agonist-
antagonist activity directly against serotonin receptors: vilazodone (Viibryd: 2011) and
vortioxetine (Brintellix: 2013). Serum aminotransferase elevations occur in up to 10% of
patients taking conventional SSRIs. Varying patterns of acute liver injury have been
described with most agents, but clinically apparent liver injury due to these agents is rare.
Miscellaneous antidepressants include tetracyclic agents that act by inhibition of reuptake of

both serotonin and norepinephrine and are thus known as SNRIs (mirtazapine: Remeron,
1996), aminoketones (bupropion: Wellbutrin: 1985), and triazolopyradine derivatives
(trazodone: Desyrel, 1981; and nefazodone: formerly Serzone, 1994). The latter two agents,
but particularly nefazodone, have been linked to cases of drug induced acute liver injury that
can be severe and lead to liver failure and death.
Several antidepressant medications have been withdrawn from use because of their potential
for hepatotoxicity. Thus, the initial MAO inhibitor and hydralazine derivative iproniazid was
introduced into clinical use in 1956, but withdrawn in 1961 because of multiple reports of
acute hepatic injury more than 10% of which were fatal. Amineptine is a tricyclic
antidepressant that was introduced in 1978 in Europe, but subsequently withdrawn because of
several reports of prolonged cholestatic hepatic injury associated with its use in rates higher
than with other tricyclic antidepressants. Finally, nefazodone, an antidepressant related in
structure to trazodone that was approved for use in 1997, was withdrawn by the sponsor in
2003 after multiple reports of acute liver failure arising in patients treated for more than 4 to
6 months. Nefazodone, however, remains available in generic forms.
Mood Stabilizers
Mood stabilisers are a type of medication that can help if you have unhelpful moods
swings such as mania, hypomania and depression They help to control and ‘even out’ these
mood swings.
Mania
Symptoms of mania can include:
● feeling happy or excited, even if things are not going well for you,
● being full of new and exciting ideas,
● moving quickly from one idea to another,
● hearing voices that other people can’t hear,
● being more irritable than normal,
● feeling more important than usual,
● talking very quickly, jumping from one idea to another, racing thoughts,
● being easily distracted and struggle to focus on one topic,
● being over familiar with people,
● not being able to sleep, or feel that you don’t want to sleep,
● thinking you can do much more than you actually can,

● making unusual, or big decisions without thinking them through, and
● doing things you normally wouldn’t which can cause problems. Such as:
o spending a lot of money,

o being more interested in sex,
o using drugs or alcohol,
o gambling or
o making unwise business decisions.
Hypomania
Hypomania is like mania but you will have milder symptoms. Treatment for hypomania is
similar to the treatment for mania.
Depression
Symptoms of depression can include:
● low mood,
● having less energy and feeling tired,
● feeling hopeless or negative,
● feeling guilty, worthless or helpless,
● being less interested in things you normally like doing or enjoying them less,
● difficulty concentrating, remembering or making decisions,
● feeling restless or irritable,
● sleeping too much or not being able to sleep,
● feeling more or less hungry than usual,
● losing or gaining weight, when you do not mean to, and
● thoughts of death or suicide, or suicide attempts.

Your mood may change quickly between mania and depression.
Your doctor may prescribe mood stabilisers if you have an episode of mania, hypomania or
depression that changes or gets worse suddenly. This is called an acute episode. Some people
need to take mood stabilisers as a long-term treatment to stop this from happening. You may
experience mania or depression if you have a condition such as bipolar disorder,
schizoaffective disorder, depression or personality disorder.
Antipsychotics
Psychosis is a medical term. If you have psychosis, you might see or hear things
(hallucinations) that are not there or you might have ideas or beliefs that do not match reality
(delusions). Some people describe it as a break from reality. Doctors may call these
‘psychotic symptoms’, a ‘psychotic episode’ or a ‘psychotic experience’.
Psychotic symptoms can be part of conditions such as schizophrenia, schizoaffective

disorder, personality disorder and bipolar disorder. But some people can have psychotic
symptoms without having any of these conditions.
If you have psychosis, your doctor may offer you antipsychotic medication to help you with
your symptoms. Antipsychotics can help to control symptoms of psychosis. This can help
you feel more in control of your life, particularly if you are finding the psychotic symptoms
distressing.
According to the Royal College of Psychiatrists, 4 out of 5 people who take antipsychotics
find they are successful in treating their symptoms. It is not possible to predict which one will
work best for you, so you may have to try a few before you find the right one.
Some antipsychotics are used to treat mania (which is a symptom of illnesses such as bipolar
disorder) and psychotic symptoms of depression.
How do antipsychotics work?
Your brain contains chemicals which help to carry messages from one part of the brain to
another. One of these chemicals is called dopamine. It is thought that high levels of dopamine
may cause the brain to function differently and may cause the symptoms of psychosis.
Antipsychotic medications reduce the amount of dopamine in the brain or restore the balance
of dopamine with other chemicals in the brain.
Types of antipsychotics
● Typical or ‘first generation’. These medications have been used since the 1950s.
● Atypical or ‘second generation’. These medications have been used since the 1990s.
The main difference between these types is in their side effects. First generation
antipsychotics may have more of an effect on your movement than newer ones. Although this
does not mean newer generation antipsychotics don’t have any side effects on your
movement.
This distinction can make it easier to talk about the different medications. But you should
think about each antipsychotic individually. This is because everyone reacts differently to
medication. You can never be certain how you will be affected by side effects or whether the
medication will work for you. This can mean that the first medication you try may not be the
right one for you.
If you have been on an antipsychotic for a few weeks and the side effects are too difficult to
cope with, you should ask your doctor about trying a different one.
Antipsychotic medication can come as tablets, a syrup or as an injection. The injections are
called a depot. You may find a depot useful if you struggle to remember to take your
medication, or might take too much. Your doctor should take your views into account when
prescribing you medication.
The main types of antipsychotics are mentioned below.
⮚ First generation antipsychotics (Typical)
The first generation of antipsychotics have been prescribed since the 1950s. The following
medications are typical antipsychotics. They have been listed by their generic name with the
brand name in brackets.
● Benperidol (Anquil)
● Chlorpromazine (Largactil)
● Flupentixol (Depixol)
● Fluphenazine (Modecate)
● Haloperidol (Haldol)
● Levomepromazine (Nozinan)
● Pericyazine
● Perphenazine (Fentazin)
● Pimozide (Orap)
● Promazine
● Sulpiride (Dolmatil, Sulpor)
● Trifluoperazine (Stelazine)
● Zuclopenthixol (Clopixol)
⮚ Second generation antipsychotics (Atypical)
The second generation of antipsychotics have been used more since the 1990s. Although
some of them were developed before then. They have been listed by their generic name with
the brand name in brackets.
● Amisulpride (Solian)
● Aripiprazole (Abilify, AbilifyMaintena)
● Clozapine (Clozaril, Denzapine, Zaponex)
● Risperidone (Risperdal & Risperdal Consta)
● Olanzapine (Zyprexa)
● Quetiapine (Seroquel)
● Paliperidone (Invega, Xeplion)
⮚ Clozapine
Clozapine works slightly differently to others. It is sometimes given to people who are
treatment resistant. This means other medication hasn’t helped their symptoms. The National
Institute for Health and Care Excellence (NICE) says that people with schizophrenia should
only be offered clozapine after having tried 2 other drugs.
Clozapine can cause your white blood cell numbers to drop, but this is rare. This could mean
that you get infections more easily. If you take clozapine, you will need regular blood tests to
make sure your white blood cell count is healthy.
If your white blood cell numbers start dropping, you will be asked to stop taking the
medication. You will have another blood test after you have stopped clozapine to make sure
they are back to normal. Your doctor might decide to change your dose of clozapine or offer
you another type of medication.
What are the side effects?
Side effects of antipsychotics can include the following:
● Stiffness and shakiness. This can often be reduced by lowering the dose. But, if a high
dose is necessary, the shakiness can be treated with anticholinergic drugs. This is the
same kind of medication that is used for Parkinson’s disease.
● Uncomfortable restlessness (akathisia).
● Movements of the jaw, lips and tongue (tardive dyskinesia).
● Sexual problems due to hormonal changes.
● Sleepiness and slowness.
● Weight gain.
● A higher risk of getting diabetes.
● Constipation.
● Dry mouth.
● Blurred vision.
Not all antipsychotics will have these side effects. Second generation or atypical
antipsychotics are less likely to cause movement side effects, but you might still experience
them. If you do then your doctor might change your medication.
Sedative – Hypnotics
Sedative-hypnotics are a class of drugs that cause a dose-dependent depression of the
CNS function, inducing sedation, sleep, and unconsciousness with increasing dose. Agents in
this class of drugs include benzodiazepines and Z-drugs, barbiturates, and melatonin agonists.
Sedative-hypnotics are a class of drugs that cause a dose-dependent depression of the
CNS function, inducing sedation, sleep, and unconsciousness with increasing dose. Agents in
this class of drugs include benzodiazepines and Z-drugs, barbiturates, and melatonin agonists.
Most of the sedative-hypnotic drugs affect GABAergic transmission, increasing the inhibition
of neuronal excitability, with the exception of melatonin agonists, which act on
hypothalamicmelatonin receptors. Sedative-hypnotic drugs are used as anxiolytics, sedatives,
muscle relaxants, anesthetics, and anticonvulsants. Common side effects result from
excessive CNS depression and include confusion, drowsiness, somnolence, and respiratory
depression. Long-term use of sedative-hypnotics is associated with a risk of dependence.
Side effects
General adverse effects
● Drowsiness, sleepiness, or dizziness
● Blunted affect
● Increased appetite
● Next-day hangover effect

● Anterograde amnesia
● Drug tolerance
● Paradoxical excitability
Treatment
Supportive therapy
● Single dose of activated charcoal if the patient is fully conscious and presents within
30 minutes of overdose
● GCS ≤ 8: endotracheal intubation (see airway management and ventilation)
● Hypotension: fluid resuscitation
Central Nervous system Stimulants

A type of drug that increases the levels of certain chemicals in the brain and increases
alertness, attention, energy, and physical activity. Central nervous system stimulants also
raise blood pressure and increase heart rate and breathing rate. They are used to treat
depression, attention deficit hyperactivity disorder (a disorder in which a person has problems
paying attention, controlling actions, and remaining still or quiet), and narcolepsy (a sleep
disorder). Also called CNS stimulant.
Central nervous system stimulants used for attention deficit disorder, narcolepsy or excessive
sleepiness include methylphenidate, atomoxetine, modafinil, armodafinil and the
amphetamines. Stimulants that are no longer used for medical conditions, but that are abused,
include cocaine and ecstasy or methylenedioxymetamphetamine (MDMA).
Central nervous system stimulants are used to treat ADHD, narcolepsy, and aid in weight loss
by increasing certain activity in the brain to speed up mental and physical processes.
CNS depressants slow normal brain function. In higher doses, some CNS depressants can
become general anesthetics. Tranquilizers and sedatives are examples of CNS depressants.
CNS depressants can be divided into two groups, based on their chemistry and
pharmacology.
Purpose
Centralnervous system stimulants are used to treat conditions characterized by lack of
adrenergic stimulation, including narcol epsyandneonatalapnea.Additionally,
methylphenidate (Ritalin) and dextroamphetamine sulfate (Dexedrine) are used for their
paradoxical effect in attention—deficit hypera ctivity disorder (ADHD).
Theanerexiants,benzphetamine(Didrex),diethylpropion(Tenuate),phendimetrazine(Bontril,Ple
gine),phentermine(Fastin,Ionamine),andsibutramine(Meridia)areCNSstimulantsusedforappeti
tereduction in severeobesity. Although these drugs are structurally similar to amphetamine,
they cause less sensation of stimulation, and are less suitedforuse in conditionscharacterized
by lack of adrenergic stimulation.
Phenyl propanolamine and ephedrine have been used both as dietaidsand as vasoconstrictors.
Description
The majorities of CNS stimulants are chemically similar to the neuro hormone
norepinephrine, and simulate the traditional"fight or flight" syndrome associated with
sympathetic nervous system arousal. Caffeine is more closely related to the xanthines, such as
theophylline. A small number of additional members of the CNS stimulant class do not fall
into specific chemical groups.
Precautions
Amphetamines have a high potential for abuse. They should be used in weight reduction
programs only when alternative therapies have been ineffective. Administration for
prolonged periods may lead to drug dependence.These drugs are classified as schedule II
under federal drug control regulations.
The amphetamines and their cogeners are contraindicated in advanced arteriosclerosis,
symptomatic cardiovascular disease, and moderate to severe hypertension and hyperthyroidism.
They should not be used to treat patients with hypersensitivity or idiosyncrasy to the
sympathomimeticamines, or with glaucoma, a history of agitatedstates, a history of drugabuse,
or during the 14 days following administration of monoamineoxidase (MAO) inhibitors.
Methyl phenidate may lower the seizure threshold.
Benzphetamine is category X during pregnancy. Diethylpropion is category B. Other
anorexiants have not been rated; however their use during pregnancy does not appear to be
advisable. Safety for use of an orexiants has not been evaluated.
There have been reports that when used in children, methyl phenidate and amphetamines may
retard growth.Although these reports have been questioned, it may be suggested that the
drugs not be administered outside of school hours (because most children have behavior
problems in school), in order to permit full stature to be attained.
The most common adverse effects of CNS stimulants are associated with their primary
action. Typical responses include over stimulation, dizziness, restlessness, and similar
reactions. Rarely, hematologic reactions, including leukopenia, agranulocytosis, and bone
marrow depression have been reported. Lowering of the seizure thre shold has been noted
with most drugs in this class.
References:
7. www.google.com
DRUG STUDY
ON
PSYCHIATRIC DRUGS
NAME CLASS INDICATIO MECHANIS CONTRAIND SIDE ADVERS NURSING
N M OF I CATION EFFECT E RESPONSIBILITIES
ACTION S EFFECTS
Generic Therapeuti Acute chronic Alters Contraindicate dro CNS: 1. Asses patients
Name: c class: psychosis d wsiness neuroleptic mental status
Chlorpromazin Antipsychoti particularly the dry malignant 2. Monitor blood
e c when effect in mouth or syndrome , pressure
accompanied of hypersensitivit stuffy sedation 3. Keeppatient
Brand Name: Pharmacol by increased dopamine y: nose; ENT: recumbent for
Thorazine, ogic class: psychomotor in blur red blurred at least
Chlorpromanyl phenothiazi activities. the CNS. Has cross vision; vision, 30 minutes
nes significant sensitivity with constipatio dry eyes following
Availability: Nausea anticholinergi other n; or CV: parenteral
Tablets c phenothiazines imp hypotensio administration
and vomiting, may occur otence, n 4. Advise to take
Route of intractable alpha- trouble GI: medication as
administratio hiccups adrenergic having an constipatio directed
n: blocking orgasm. n, dry 5. Caition
PO, IM, IV pre- operative activity. mouth to avoid alcohol
sedation DERM: or other CNS
photosens depressants
etivity 6. Inform that this
may turn urine
NAME CLASS INDICATIO MECHANIS CONTRAIND SIDE ADVERSE NURSING
N M OF I CATION EFFECTS EFFECTS RESPONSIBILITIE
ACTION S
Generic Therapeuti To Block Contraindicate >weigh CNS: • Use
Name: c class: dopamine d to t gain drowsiness, clozapine cautiously
Clozapine Antipsychot treat severe receptors in patients >dizziness sedation, in patients with
ic schizophreni the with allergy to >tremor seizures,dizzi hepatic, renal, or
Brand a unresponsiv clozapine, CNS >fast heart ness, cardiovascular
Name: Pharmacol e to standard brain, depression, rate syncope, disease and in elderly
Clozaril, ogic class: drugs; depresses the comatose >headache headaches patients
FlazaClo, Dibenzapine to states, >drowsines CV:tachycard with dementia-
Versacloz derivatives reduce RAS; s ia, related psychosis
risk of anticholinergi history of >nausea hypotension, because they have
Avaulabi c, >constipatio potentially increased risk of
l ity: recurrent antihistaminic seizure n fatal serious or fatal
Tablets suicidal , and alpha- disorders, >dry mouth myocarditis adverse
behavior adrenergic lactation, >vision GI: nausea, reactions. Also use
Route: in blocking therapy vomiting, cautiously in patients
problems
PO schizophreni activity with constipation with risk
>fever
a may other GU: urinary factors for a stroke
>increased
or contribute abnormalities because drug
sweating.
schizoaffecti to drugs Hematologic use may increase
ve disorders some of that cause bone risk of
:arganulocyto A transient increase
Clozapine sis above 100.4° F (38°
produces Others: C) may occur, most
fewer fever, weight often within the first 3
extrapyramid gain, rashes weeks of therapy.
al •When therapy ends,
expect to check WBC
effects count and ANC
than weekly for at least 4
weeks or until WBC
other count is 3,500/mm3 or
antipsychotic more and ANC is
s. 2,000/mm3 or more.
•Monitor
patients,
especially
male patients and

younger patients, for
dystonia, particularly
during the first few
days of treatment. Be
•Instruct
patient
taking
orally disintegrating
tablets (Fazaclo) to
leave tablet in blister
pack until ready to
take it. Tell him to peel
foil back to remove
tablet (rather than
pushing tablet through
foil) and then to
immediately place
tablet in mouth and let
it dissolve before
swallowing. Explain
that no water is
needed.
•Inform patient that
he’ll need weekly
blood tests. Review
NAME CLASS INDICATIO MECHANIS CONTRAI SIDE ADVERSE NURSING
N M OF N EFFECT EFFECTS RESPONSIBILITIES
ACTION DICATIO S
N
Therapeu General: Absorption: Blood >restlessn CNS: Ataxia, 1. Monitor the
Generic tic class: Acute Well- dycrasias, ess cerebral patient’s
Name: Antipsych absorbed after bone >mask-like edema, blood
Fluphenazin o tic and chronic marrow facial dizziness, pressure
e psychoses. PO/IM depression, expression drowsiness, routinely.
hydrochlori Pharmaco administratio cerebral >greatly headache, 2. Assess
d e/ logic n, deconoate arterioscleri increased insomnia, mental status
Fluphenazin class: salt in same osis, saliva lightheadedn (mood,
e deconoate Phenothia oil >tremors ess behaviour,
zines has coma >unusual orientation)
,
Brand delayed concomitant mental/mo 3. Administer oral
nervousness,
Name: release from use of large od doses with
seizures,
Modecate oil amounts of changes food, milk, or
slurred
(CAN), CNS >frequent full glass of
speech,
Modecate vehicle and depressant, urination water.
syncope,
Concentrate subsequent coronary >unusual 4. To prevent
worsening
release from artery dreams contact
fatty tissues. disease, dermatitis,
avoid getting
Prolixin
Availabili
ty
(CAN), Metabolism hepatic psychotic ion hands.
and dysfunction, symptoms. 5. Advise patient
Excretion: hypersensiti not to mix oral
CV: AV
Mostly vity solution with
conduction
Injection metabolized beverages that
disorder,
, tablets, by to contain
bradycadia,
elixir. phenothiazi caffeine
cardiac
liver; undergo nes, (coffee, cola),
arrest,
Rout of enterohepatic myeloprolife tannins(tea), or
Hypercholest
Administr recurculation. rative pectins (apple
erolemia,
a tion: disorder, juice).
hypertension,
PO, IM severe 6. Observe
orthostatic
hypertention patient
hypotension,
or carefully when
QT-interval
hypotension administering
prolongation,
, subcortical medication to
shock, ST-
brain ensure that
segment
damage medication is
depression,
taken not
tachycardia
hoarded or
cheeked.
EENT: 7. Document
blurred given
impaction
, ileus,
increased
appetite,
nausea,
vomiting
GU:
Amenorrhea,
bladder
paralysis,
decreased
libido,
enuresis,
menstrual
irregularities,
polyuria,
urinary
frequency,
urinary
incontinence,
urine
retentions

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MENTAL HEALTH

SIGNATURE OF EXTERNAL EXAMINER

SIGNATURE OF INTERNAL EXAMINER

SUBMITTED TO: SUBMITTED BY:

SUBMITTED TO: SUBMITTED BY:

Presenting Chief Complaints

History of Present Illness

MENTAL STATUS EXAMINATION

General appearance and behavior

3. Respiration 14-20 Breath/M. 18 Breath/M.

4. Blood Pressure 120/80mmHg 130/80mmHg

Clinical act. Repeated hand washing.

Features Majority of OCD individual will

SUBMITTED TO: SUBMITTED BY:

Presenting Chief Complaints:-

History of Present Illness:-

Mode of onset -Acute

Precipitating factors –Not known

She took treatment was

Patient get relieved in 3-4days.

Past Psychiatric and Medical History

Illiterate Died in 2012

Unemployed due to cancer

Died 21yrs/F Died

1996 12th pass 2014

VII. Personal History

Emotional problems during adolescence -No

Level of consciousness:-fully conscious

Mode of entry:-came willingly

Eye to eye contact:-maintained

Initiation:- speaks when spoken

C. MOOD AND EFFECT:-

Student-aapka mann kesa hai?

Client-mann udas rahta hai

Student-mann kyo udaas rahta h?

Impression-Irritable and depressed, idea of hopelessness

Sad and irritable

Impression:-depressed, Inappropriate mood and affect, non- reactive

Stream(flow of thought)-Retarded thinking(poverty of thought)

Student- Kya aapne khana kha liya?

Client- Nhi abhi nhi khaya.

Impression:- Helplessness, Hopelessness and suicidal ideation, autistic thinking

Impression:- No Delusional thinking

Thought alienation phenomenon:-

Student:-Aap khali baithkar kya sochti ho?

Student:-kya aapko kisi cheej se dar lagta hai?

Client:-nahi mujhe nahi lagta

Student:-aapke ghar me kon kon hai?

Client:- mai, bhai, bhabhi or papa or bachhw bhi hai

Impression:-decreased social relations

Helplessness, hopelessness, suicidal ideation

Student:-mere hath me kya hai?

Client:-pen or copy hai

Client:- muje har jagah ek ldki dikhti hai.

Impression:- No illusion, visual and auditory hallucination

F. COGNITIVE FUNCTION(Neuropsychiatric assessment):-

Student:-hum yha par kitne log hai?

Impression:-patient is fully conscious

Student:-abhi kya time hua hai

Student:-aap is time kaha par h?

Client:-Hospital, Medical Rohtak

Student:-sath me kon hai, mai kon hu?

Client-sath me bhabhi or aap ho.