UNIT I & II

GENERAL CONCEPTS OF PSYCHIATRIC NURSING

Q1. Enlist the members of Mental Health Team
Ans : Mental Health Team or Multidisciplinary approach refers to collaboration
between members of different disciplines who provide specific services to the
patient .

Members of Mental Health Team : are

 A Psychiatrist

 A Psychiatric Nurse

 A clinical psychologist

 A psychiatric social worker

 An occupational therapist or an activity therapist

 A Pharmacist and a Dietitian

 A counselor

A Psychiatrist is a medical doctor with special training in psychiatry. He is

accountable for the medical diagnosis and treatment of patient.

A Psychiatrist nurse is a registered nurse with specialized training in the care and
treatment of psychiatric patients ,

Q2. Enlist the goals of National Mental Health Program

Ans : The Govt of India launch the National Mental Health Programme in 1982.

 To ensure availability and accessibility of minimum mental health care

for all in the foreseeable future , particularly to the most vulnerable and
underprivileged sections of population .

 To encourage application of mental health knowledge in general health

care and in social development .

 To promote community participation in the mental health service

development and to stimulate efforts towards self –help in the
 community .

 To distribute all the available resources of mental health services on

equal basis .

Q3. Define Mental Health Nursing

Ans : Introduction

It provides services to individuals whose primary health needs are related to

mental, emotional and developmental problems.

Definition

Psychiatric nursing is a specialized area of nursing practice , employing the wide

range of explanatory theories of human behaviour as its science and purposeful
use of self as its art and diagnosis and treatment of human responses to actual or
potential mental health problems .

Q4. Define Confabulation

Ans : Definition
Confabulation is the unconscious filling of memory gaps by imagined or untrue
experiences due to memory impairment .
Types of Confabulation
a. Provoked Confabulation
b. Spontaneous Confabulation
Symptoms of Confabulation
 A lack of awareness that memory is false or distorted
 No attempt to deceive or lie

Q5. Differentiate Circumstantiality and Tangentiality

Ans :
 Circumstantiality
Disturbance in the associative
thought and speech processes in
which a patient digresses in to
unnecessary details before
communicating the central idea.
Its seen in Schizophrenia , Dementia
& Obsessional disturbances
Tangentiality
Client uses two words with a similar
sound , ie his choice of words is
determined by their sound and not
by their meaning .
Its seen Schizophrenia or Mania

Q6. Describe Denial with example

Ans : A person may refuse to face reality and protects himself from unacceptable
pain or conflict by rejecting reality is called Denial .

Example

 A person who frequently suffers from abdominal pain knows that there is
something wrong with her health but tries to deny this by becoming more
pre occupied with her work.

Q7. Describe Projection with example

Ans : This is placing blame for one's difficulties upon others or attributing one's
own unethical desires to others is called Projection .

Example

 The student who fails in the examination may feel that the teacher was
unfair.

Q8. Differentiate Suppression and Repression with example

Ans :

Repression
Repression is nothing but 'selective
forgetting' whereby threatening or
painful thoughts and desires are
excluded from consciousness.
Suppression
Suppression is the conscious
process of pushing unwanted ,
anxiety provoking thoughts ,
memories , emotions and
Example
A student, who is caught cheating in
the examination hall, may exclude
these painful experiences from
consciousness and become
'amnesic' with regard to the guilty
incident.
desires out of awareness .
Example
A person has been unkind to
another and then avoids
thinking about it .

Q9. Define delusion and list down the types

Ans : Delusion is a false , unshakeable belief not true to fact and not ordinarily
accepted by other members explanation
Types of Delusion : are
a. Delusion of Grandeur
b. Delusion of Guilt
c. Delusion of Persecution
d. Delusion of Reference
e. Delusion of Infidelity

Q10. Describe types of auditory hallucination

Ans : Hallucination is a false sensory perception in the absence of an actual
external stimulus .
Auditory Hallucination
It is a false perception of sound usually voices but also other noises such as
music .

Types of Auditory Hallucination : are

a. Second person hallucination : Voice speaking to the person addressing him
as you .
b. Third person hallucination : Voice talking about the person as he or she .
 c. Thought echo : Hearing one’s own thoughts spoken aloud .

Q11. Define Amnesia and its types

Ans : Amnesia is a pathological impairment of memory .
Types of Amnesia : are
a. Anterograde Amnesia : Amnesia of events occurring after the episode
which precipitated the disorder .
b. Retrograde Amnesia : Amnesia of events occurring prior to the episode
which precipitated the disorder .

Q12. Differentiate Hallucination and Illusion

Ans :
Hallucination
Hallucination is a false
sensory perception in the
absence of an actual external
stimulus .
Example
A crawling feeling on the skin
or movement of internal
organs
Illusion
Misinterpretation of a real , external
sensory experience .
Example
A rope in the dark and its shadow is
perceived as snake .

Q13. Differentiate Echolalia and Echopraxia

Ans :
Echolalia Echopraxia
Echolalia is a repetition , echo Echopraxia is a repetition , echo or
or mimicking of phrases or mimicking of actions observed
words heard even when asked not to do so
Example Example
If you ask the child , do you You may observe someone
want a cookie ? the child says yawning and then have the urge to
cookie instead of yes . yawn

UNTI IV & V

THERAPEUTIC COMMUNICATION AND TREATMENT MODALITIES

Q1. Differentiate Transference and Counter transference

Ans :

Transference Counter transference

Transference is an unconscious
response in which the patient
experiences feelings and attitudes
toward the nurse that were originally
associated with significant figures in
the patient's early life.
It refers to a specific emotional
response by the nurse towards the
patient that is inappropriate to the
content and context of the
therapeutic relationship or
inappropriate in its emotional
intensity.

Q2. Explain the types of communication

Ans: Communication refers to the giving and receiving of information.

Types of Communication: are

 a. Verbal communication involves the use of spoken words or sign language
to share information.

Example: words, spoken or written.

b. Non-verbal communication involves passive communication through the

use of gestures, tone of voice & body language.

Example: Tone of your voice and Posture

c. Written Communication: Communicating through writing, typing or printing.

d. Visual Communication : It involves graphs , charts , photographs , maps to

share information .

Q3. Differentiate Empathy and Sympathy

Ans :

Empathy
Ability to identify and understand
another person’s situations and
feelings .
Can understand another’s situation
Sympathy
Feelings of sorrow and pity for
someone else’s misfortune .
Cannot understand another’s
situation

Q4. Define Process Recording and list down the purposes

Ans : Definition

 Process recording is a written account or verbatim recording of all that

transpired, during and immediately following the nurse-patient interaction.

 In other words, it is the recording of the conversation during the interaction

or the interview between the nurse and the patient in the psychiatric setup
with the nurse's inference.

Purpose and Uses

 The aim of process recording is to improve the quality of the interaction for
better effect to the patient and as a learning experience for the nurse to
continuously improve her clinical interaction pattern,

 Assists the nurse or student to plan, structure and evaluate the interaction
on a conscious rather than an intuitive level.

 Assists her to gain competency in interpreting and synthesizing raw data

under supervision

 Helps to consciously apply theory to practice

 Helps the nurse to learn to identify thoughts and feelings in relation to self
and others .

Q5. Define Akathesia

Ans : Definition

Akathesia is a subjective feeling of motor restlessness manifested by a

compelling need to be in constant movements may be seen in adverse effects of
antipsychotic drugs .

Akathesia usually occurs in the first two weeks of treatment with antipsychotic
drugs .

Q6. Define Token Economy

Ans : Token economies are treatment programs for severely to moderately ill
psychiatric populations .

They include specific treatment goals , ongoing observation of the desired

behaviours , trained staff who reinforce behaviour and adaptive behaviors

Q7. Describe Aversion therapy

Ans : Aversion therapy involves producing an unpleasant sensation in the patient ,

usually by influencing pain in association with a stimulus .

Indications

 Alcohol dependence

 Transvestism

 Homosexuality

 Sexual deviations

Q8. Enlist the symptoms of Dystonia

Ans : Dystonia is a muscle rigidity that affects posture , gait , eye movements .

Symptoms

 Patient has a dragging leg

 Involuntary pulling of the neck

 Difficulty in speech

 Uncontrollable blinking

Q9. Explain Psychodrama

Ans : Psychodrama is a specialized type of group therapy that employs a

dramatic approach in which patients become actors in life situation scenarios .

In Psychodrama , the patient is brought directly in to the situation as an active

participant .
Goal : To resolve interpersonal conflicts

Q10. Define tardive dyskinesia

Ans : Tradive Dyskinesia consists of abnormal , irregular choreoathetoid

movements of the muscles of the head , limbs and trunk .

Its characterized by chewing , sucking , grimacing and perioral movements .

Q11. Define EPS and list down the symptoms of EPS

Ans : Extra Pyramidal Symptoms ( EPS ) are antipsychotic drug induced

movement disorders that affects movements of the body .

Symptoms of EPS

 Acute dystonia

 Akathisia

 Tardive dyskinesia

 Neuroleptic malignant syndrome

Q12. Explain the components of therapeutic relationship

Ans : Components

a. Rapport

b. Empathy

c. Warmth

d. Genuineness

Rapport

Rapport is a relationship or communication , especially when useful and

harmonious .

Empathy
Empathy is an ability to feel with the patient while retaining the ability to critically
analyze the situation .

Warmth

Warmth is the ability to help the patient feel cared for and comfortable .

Genuineness

Genuineness involves being one’s own self.

Q13. Enumerate the types of relationship

Ans : A relationship is defined as a state of being related or s state of affinity

between two individuals .

Types of Relationship: are

a. Social Relationship

b. Intimate Relationship

c. Therapeutic Relationship

Social Relationship : It is defined as a relationship that is primarily initiated with

the purpose of friendship , socialization or enjoyment .

Intimate Relationship : It occurs between two individuals who have an emotional

commitment to each other .

Therapeutic Relationship : It occurs between nurse and the patient in order to

enhance the patient’s growth .

Q14. List down the various techniques of therapeutic communication.

Ans : Therapeutic communication is an inter personal interaction between the

nurse and the patient during which the nurse focuses on the patient's specific
needs to promote an effective exchange of information.

Techniques : are

1. Listening
 2. Broad openings

3. Restating

4. Clarification

5. Reflection

6. Humor

7. Informing

8. Focusing

9. Sharing perceptions

10. Theme identification

11. Silence

12. Suggesting

Q15. Explain Lithium Toxicity

Ans : Lithium Toxicity

Toxicity occurs when serum lithium level above 2.0 mEq/l.

Signs & symptoms

 Ataxia , Coarse tremor , Nausea , Vomiting , Impaired memory
 Impaired concentration , Nephrotoxicity , Muscle weakness ,
 Convulsions , Muscle twitching , Lethargy , Confusion .

Management of Lithium Toxicity

 Discontinue the drug immediately

 For significant short term ingestions , residual gastric content should be
removed by induction of emesis , gastric lavage and adsorption with
activated charcoal .
 If possible , instruct the patient to ingest fluids .
 Assess serum lithium levels , serum electrolytes , renal functions , ECG as
soon as possible .
 Maintenance of fluid and electrolyte balance .
 In a patient with serious manifestations of lithium toxicity , hemodialysis
 should be initiated .

Q16. Enlist the steps of Systematic desensitization

Ans : Systematic desensitization is a technique of behavior therapy used for

maladaptive behavior .

Steps of Systematic desensitization

a. Relaxation training

b. Hierarchy construction

c. Desensitization of the stimulus

a. Relaxation training: There are many methods used to induce relaxation such as

 Hypnosis

 Meditation or Yoga

 Mental Imagery

 Biofeedback

b. Hierarchy Construction: Patient is asked to list all the conditions which provoke
anxiety.

c. Desensitization of the stimulus: This can either be done in reality or through

imagination.

Q17. Explain assertive skill training

Ans : Assertive training is a behavior therapy technique in which the patient is

given training to bring about change in emotional and other behavioral pattern by
being assertive .

Social skills training helps to improve social manners like encouraging eye contact,
speaking appropriately , observing simple etiquette and relating to people .

Q18. Explain Time out

Ans : Time out is a method of behavior therapy used to correct maladaptive

behavior .

Time out method includes removing the patient from the reward or the reward
from the patient for a particular period of time following a problem behavior .

Example: The child is not allowed to go out of the ward to play if he fails to
complete the given work .

Q19. Explain the types of family therapy

Ans: Types of family therapy : are

a. Individual family therapy

b. Conjoint family therapy

c. Couples therapy

d. Multiple family group therapy

Individual Family Therapy

In individual family therapy , each family member has a single therapist .

Conjoint family therapy

The nuclear family is seen and the issues and problems raised by the family are
the ones addressed by the therapist .

Couples therapy

The couple may be experiencing difficulties in their marriage and they are helped
to work together to seek a resolution for their problems .

Q20. Differentiate restitution and response cost

Ans :

Restitution Response Cost

( Over – correction ) Restitution means This procedure is used with
restoring the disturbed situation to a individuals who are on token
state that is much better than what it programs for teaching adaptive
was before the occurrence of the behavior.
problem behavior .

Q21. Define therapeutic community

Ans : Definition : Therapeutic community as a therapy in which patients social

environment would be used to provide a therapeutic experience for the patient by
involving him as an active participant in his own care and the daily problems of his
community .

Elements of Therapeutic Community

 Free communication

 Shared responsibilities

 Active participation

 Involvement in decision making

Q22. List down the indications of ECT

Ans : Electroconvulsive therapy is the artificial induction of a grandma seizure

through the application of electrical current to the brain .

Indications
 Major Depression
 Severe Catatonia
 Severe Psychosis
 Organic mental disorders

Q23. List down the contraindications of ECT

Ans : Electroconvulsive therapy is the artificial induction of a grandma seizure
through the application of electrical current to the brain .
 a. Absolute
 Raised ICP
b. Relative
 Cerebral aneurysm
 Cerebral hemorrhage
 Brain tumor
 Congestive heart failure
 Myocardial Infarction
 Pneumonia

Q24. Explain the types of ECT

Ans : Electroconvulsive therapy is the artificial induction of a grandma seizure

through the application of electrical current to the brain .

Types of ECT
a. Direct ECT: In this , ECT is given in the absence of anesthesia and
muscular relaxation .
b. Modified ECT: Here ECT is modified by drug induced muscular
relaxation and general anesthesia .

Q25. List down the side effects of ECT

Ans : Side effects : are

 Memory impairment

 Drowsiness , confusion and restlessness

 Poor concentration , anxiety

 Headache , weakness , backache , muscle aches

 Dryness of mouth , palpitations , nausea , vomiting

  Unsteady gait

 Tongue bite and Incontinence

UNIT VI , VII & IX

SCHIZOPHRENIA , MOOD DISORDERS & ORGANIC BRAIN DISORDERS

Q1. Explain the characteristics features of Catatonic stupor

Ans : Catatonic (Cata = disturbed) schizophrenia is characterized by marked

disturbance of motor behavior.

Characteristics Features of Catatonia Stupor

 Mutism: Absence of speech.

 Rigidity: Maintenance of rigid posture against efforts to be moved.
 Negativism: A motiveless resistance to all commands and attempts to be
moved, or doing just the opposite.
 Posturing: Voluntary assumption of an inappropriate and often bizarre
posture or long periods of time.
  Stupor: Does not react to his surroundings and appears to be unaware of
them.
 Echolalia: Repetition or mimicking of phrases or words heard.
 Echopraxia: Repetition or mimicking of actions observed.

Q2. List down the negative symptoms of Schizophrenia

Ans : Negative Symptoms

 Affective flattening or blunting

 Avolition – apathy

 Attentional impairment

 Anhedonia

 Alogia

Q3. List down the symptoms of paranoid schizophrenia

Ans : The word ‘paranoid’ means ‘delusional’. Paranoid schizophrenia is at present

the most common form of schizophrenia.

Signs and symptoms of Paranoid Schizophrenia

 Delusions of persecution
 Delusions of reference
 Delusions of jealousy
 Delusions of grandiosity
 Hallucinatory voices
 Other features include disturbance of affect(though affective blunting is less
than in other forms of schizophrenia), volition, speech and motor behavior.

Q4. Explain the characteristics features of Catatonic excitement .

Ans : Catatonic excitement is seen in the Schizophrenia .

Characteristics Features of Catatonic excitement

 Increase in psychomotor activity (ranging from restlessness, agitation,

excitement, aggressiveness to at times violent behavior)
 Increase in speech production
 Loosening of associations and frank incoherence

Q5. Enlist 4 A ‘s of Bleular

Ans : Eugene Bleular cited symptoms such as
A : Affective Disturbance
A : Autistic Thinking
A : Ambivalence
A : Associative looseness

Q6. Explain the characteristics features of Hebephrenic Schizophrenia

Ans : Hebephrenic Schizophrenia is also called as Disorganized Schizophrenia .

Characteristic Features

 Marked thought disorder

 Incoherence

 Severe loosening of associations

 Social impairment

 Hallucinations & Delusions are present .

Q7. Explain the four stages of elevated mood

Ans : Elevated mood present in the mania .

Four stages of elevated mood

 Euphoria (Stage I): Increased sense of psychological well-being and

happiness not in keeping with ongoing events
 Elation (Stage II): Moderate elevation of mood with increased psychomotor
 activity
 Exaltation (Stage III): Intense elevation of mood with delusions of grandeur
 Ecstasy (Stage IV): Severe elevation of mood, intense sense of rapture or
blissfulness seen in delirious or stuporous mania .

Q8. Differentiate cyclothymia and dysthymia

Ans :

Cyclothymia
A chronic mood disturbance
involving numerous episodes of
hypomania and depressed mood.
Dysthymia
A state of chronic low level
depression lasting for more than
two years that may lead to more
severe depression if untreated .

Q9. List down the classification of BPAD

Ans : Bipolar Affective Disorder ( BPAD ) is characterized by recurrent episodes of

mania and depression in the same patient at different times .

Classification

 Bipolar affective disorder with Hypomania

 Bipolar affective disorder with mania but without psychotic symptoms

 Bipolar affective disorder with mania and psychotic symptoms

 Bipolar affective disorder with mild or moderate depression

 Bipolar affective disorder with severe depression but without psychotic

symptoms

 Bipolar affective disorder with severe depression and psychotic symptoms

10. Classify Depression

Ans : Definition
Depression is characterized by persistent sadness and a lack of interest or
pleasure in previously rewarding or enjoyable activities .

Classification

 Depressive episode

 Mild depressive episode

 Moderate depressive episode

 Severe depressive episode without psychotic symptoms

 Severe depressive episode with psychotic symptoms

 Atypical depression

 Recurrent depressive disorder

Q11. Explain depressive cognitions

Ans : Depression is a mood disorder that causes a persistent feeling of sadness

and loss of interest .

Depressive Cognition is one of the clinical feature of depression that includes

 Hopelessness

 Helplessness

 Worthlessness

 Unreasonable guilt

 Self blame over trivial matters in the past .

Q12. List down the symptoms of Hypomania

Ans : Hypomania is a lesser degree of mania .

Symptoms

 Persistent mild elevation of mood

  Increased sense of well being

 Happiness not in keeping with ongoing events

 Concentration and attention may be impaired

 In some cases irritability , conceit and boorish behavior .

Q13. Classify antidepressants with examples

Ans : Antidepressants are drugs used for the treatment of depressive illness.

Classification

Class Example
Tricyclic Antidepressants ( TCA’s) Imipramine
Selective serotonin reuptake Fluoxetine
inhibitors
Dopaminergic antidepressants Fluvoxamine
Monoamine oxidase inhibitors Trazodone

Q14. List the psychological therapies for depression

Ans : Depression is a mood disorder that causes a persistent feeling of sadness

and loss of interest .

Psychological Therapies : are

 Psychotherapy

 Cognitive therapy

 Supportive psychotherapy

 Group therapy

 Family therapy

 Behavior therapy

Q15. Enlist the somatic symptoms of depression

Ans : Depression is a mood disorder that causes a persistent feeling of sadness

and loss of interest .

Somatic Symptoms : are

 Significant decrease in appetite or weight

 Early morning awakening at least 2 or more hours before the usual time

 Pervasive lack of interest

 Psychomotor agitation or retardation

Q16. Differentiate delirium and dementia

Ans :

Delerium Dementia
It is also called as Acute organic Its also called as Chronic Organic
Brain Syndrome Brain Syndrome .

Delirium is an acute organic mental Dementia is an acquired global

disorder characterized by impairment of intellect, memory and
impairment of consciousness, personality but without impairment
disorientation and disturbances in of consciousness.
perception and restlessness.

Q17. Define Alzheimer’s disease

Ans : Definition

It is progressive , irreversible , degenerative neurologic disease that begins

insidiously and characterized by gradual losses of cognitive function and
disturbances in behavior and affect .

Warning signs

 Memory loss

 Difficulty performing familiar tasks

 Problems with language

  Disorientation to time and place

 Poor or decreased judgement

Q18. Explain the stages of Dementia

Ans : Dementia is an acquired global impairment of intellect, memory and

personality but without impairment of consciousness.

Stages of Dementia

Stage I: Early Stage (2 to 4 years)

 Forgetfulness
 Declining interest in environment
 Hesitancy in initiating actions
 Poor performance at work
Stage II: Middle Stage (2 to 12 years)

 Progressive memory loss

 Hesitates in response to questions
 Has difficulty in following simple instructions
 Irritable, anxious
 Wandering
 Neglects personal hygiene
 Social isolation
Stage III: Final Stage (up to a year)

 Marked loss of weight because of inadequate intake of food

 Unable to communicate
  Does not recognize family
 Incontinence of urine and feces
 Loses the ability to stand and walk
 Death is usually caused by aspiration pneumonia

Q19. Define Vascular dementia

Ans : Definition

Vascular dementia is a condition characterized by an irreversible alteration in brain

function that results from damage or destruction of brain tissue such as blood
clots that block small vessels in the brain .

Treatment

 Carotid endarterectomy

 Drug such as Aspirin

 UNIT VIII & IX

NEUROTIC AND SUBSTANCE USE DISORDERS

Q1. Define Panic attacks with its characteristics features

Ans : Definition

Panic attacks are relatively short lived period of anxiety or fear which are
accompanied by somatic symptoms like palpitations and Tachypnea .

Features : are

 Palpitations

 Sweating

 Trembling or shaking

 Shortness of breath

 Chest pain
  Feeling dizzy

 Fear of dying

Q2. Define Hypochondriasis

Ans : Definition

Hypochondriasis is defined as a persistent preoccupation with a fear or belief of

having a serious disease despite repeated medical reassurance .

Features of hypochondriasis : Are

o Complete physical examination and investigations do not show

presence of any significant abnormality.
o The fear or belief persists despite assurance to the contrary by
showing normal reports to the patient.
o A preoccupation with medical terms and syndromes is quite common.

Q3. What are the types of somatoform disorders

Ans : These disorders are characterized by repeated presentation with physical

symptoms which do not have any physical basis.

Types : are

a. Somatization disorder

b. Hypochondriasis

c. Somatoform autonomic dysfunction

d. Persistant somatoform pain disorder

Q4. List down the types of anxiety disorders

Ans : Anxiety disorders are common conditions that have disturbances in

perception of fear as the characteristic feature .

Types of Anxiety Disorders : are

 Generalized anxiety disorders

 Obsessive compulsive disorder

 Phobia

 Panic disorder

 Post traumatic stress disorder

Q5. Differentiate Panic anxiety and generalized anxiety disorders.

Ans :

Panic Anxiety disorder Generalized Anxiety disorder

Panic disorder is characterized by
anxiety which is intermittent and
unrelated to particular
circumstances.
Generalized anxiety disorders are
those in which anxiety is unvarying
and persistent (unlike phobic anxiety
disorders where anxiety is
intermittent and occurs only in the
presence of a particular stimulus).

Q6. Enlist the symptoms of Opioid use disorders

Ans : The most common use of opioids are morphine and heroin.

Symptoms : are

a. Acute Intoxication : It is characterized by apathy , bradycardia , hypotension ,

respiratory depression .

b. Withdrawal syndrome : Watery eyes , running nose , yawning , loss of

appetite , irritability , tremors , sweating , cramps , nausea , diarrhea ,
insomnia.
Q7. Explain the procedure of Disulfiram therapy

Ans : Disulfiram therapy is used for the treatment of alcohol dependence

syndrome

 The dose of disulfiram is taken before bedtime to avoid drowsiness

 Patient should carry a warning card detailing the forbidden alcohol

containing articles , effects and emergency treatment .

 The usual dose of disulfiram is 250 – 500 mg/ day .

Q8. Define Aversion therapy

Ans : Aversion therapy is method of behavior therapy used for the treatment of
conditions which are pleasant but undesirable.

The principle is the pairing of the pleasant stimulus ( Alcohol ) with an unpleasant
response ( Electrical stimulus ) .

Eg: Alcohol dependence , Transvestism & Homosexuality .

Q9. Mention withdrawal symptoms in alcoholic patients

Ans : Symptoms : are

 Mild tremors

 Nausea

 Vomiting

 Weakness

 Irritability

 Insomnia and anxiety

Disturbance in following three

 Delirium tremens

 Alcoholic seizures
  Alcoholic hallucinations

Q10. Explain the types of Phobia

Ans : A phobia is an unreasonable fear of a specific object, activity or situation.

This irrational fear is characterized by various features.

Types of Phobia

 Simple phobia
 Social phobia
 Agoraphobia

Simple phobias are common in childhood. By early teenage, most of these fears
are lost, but a few persist till adult life.

Social phobia: It is an irrational fear of performing activities in the presence of

other people or interacting with others.

Agoraphobia: It is characterized by an irrational fear of being in places away from

the familiar setting of home, in crowds, or in situations that the patient cannot
leave easily.

Q11. Describe agoraphobia

Ans : Agoraphobia: It is characterized by an irrational fear of being in places away

from the familiar setting of home, in crowds, or in situations that the patient
cannot leave easily.

Signs and 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 .

Q12. Define obsessive compulsive disorder

Ans : Obsessive-compulsive disorder is a state in which "the outstanding
symptom is a feeling of subjective compulsion-which must be resisted-to carry
out some action, to dwell on an idea, to recall an experience, or ruminate on an
abstract topic.

Clinical Features

 Obsessional thoughts

 Obsessional images

 Obsessional ruminations

Q13. Explain exposure and response prevention technique in obsessive

compulsive disorder .
Ans : Exposure and response prevention

 This is vivo exposure procedure combined with response prevention

techniques.

 For example, compulsive hand washers are encouraged to touch

contaminated objects and then refrain from washing in order to break the
negative reinforcement chain.

Q14. Explain thought stoppage in obsessive compulsive disorder .

Ans : Thought stoppage

Thought stopping is a technique to help an individual to learn to stop thinking

unwanted thoughts.

Following are the steps in thought stopping:

 Sit in a comfortable chair, bring to mind the unwanted thought concentrating

on only one thought per procedure .

 As soon as the thought forms, give the command 'Stop!'

 Follow this with calm and deliberate relaxation of muscles and diversion of
thought to something pleasant .

 Repeat the procedure to bring the unwanted thought under control.

Q15. Enlist the symptoms of Post traumatic stress disorder

Ans : Post-traumatic stress disorder is of a reaction to extreme stressors such as

floods, earthquakes, war, rape or serious physical assault .

Signs and symptoms of PTSD

 Intense feeling of fear and dread following traumatic event

 Mental reruns of the event (flashbacks)

 Emotional numbness following the event » Avoidance of people, places or

things associated with events

 Insomnia, recurring distressing dreams,

 Increased vigilance or watchfulness

 Startles easily

 Depression

 Irritability and aggressiveness

 Impaired social or work functioning difficulty in interpersonal relationships

Q16. Enlist the types of dissociative disorder

Ans : The dissociative disorders are described as a disturbance in the ordinarily

organized functions of the conscious awareness, memory and identity .

Common clinical types

 Dissociative amnesia

 Dissociative fugue

 Dissociative identity disorder

  Trauce and possession disorders

 Other dissociative disorders

Q17. Explain dissociative fugue

Ans : Psychogenic fugue is a sudden, unexpected travel away from home or

workplace, with the assumption of a new identity and an inability to recall the past.

 The onset is sudden, often in the presence of severe stress.

 Following recovery there is no recollection of the events that took place

during the fugue .

 The course is typically a few hours to days and sometimes months.

Q18. Define conversion disorder and enlist the types

Ans : Definition

Conversion disorder is characterized by the presence of one or more symptoms

suggesting the presence of a neurological disorder that cannot be explained by
any known neurological or medical disorder.

Types : are

a. Dissociative motor disorder

b. Dissociative convulsions

c. Dissociative anesthesia.

Q19. Explain dissociative identity disorder

Ans : Dissociative Identity Disorder (Multiple Personality Disorder)

 In this disorder, the person is dominated by two or more personalities of

which only one is manifest at a time.

 Usually one personality is not aware of the existence of the other

personalities .

 Each personality has a full range of higher mental functions and performs
 complex behavior patterns.

Q20. Enlist the symptoms of Korsakoff’s syndrome

Ans : Korsakoff's syndrome is a alcohol induced amnesia disorder .

 The prominent symptom in Korsakoff's syndrome is gross memory

disturbance.

Other symptoms include:

 Disorientation

 Confabulation:

 Poor attention span and distractibility

 Impairment of insight

Q21. What are the types of somatoform disorders

Ans : These disorders are characterized by repeated presentation with physical

symptoms which do not have any physical basis.

Types : are

a. Somatization disorder

b. Hypochondriasis

c. Somatoform autonomic dysfunction

d. Persistant somatoform pain disorder

Q22. Enlist the characteristics of wernicke’s syndrome

Ans : Wernicke's syndrome is an alcohol induced amnestic disorder.

Characteristics : are
  Prominent cerebellar ataxia,

 Palsy of the 6th cranial nerve,

 Peripheral neuropathy

 Mental confusion.

Q23. List down the commonly used Psychotropic substances

Ans : Psychotropic substances are drugs that cause change in mood , awareness ,
thoughts , feelings or behavior .

Example of Psychotropic substances

 Alcohol

 Opioids

 Cannabis

 Cocaine

 Amphetamines

 Hallucinogens

 Nicotine

Q24. Define obsessional thoughts . List the common types of obsessional

thoughts content .

Ans : Obsessional thoughts are words, ideas and beliefs that intrude forcibly into
the patient's mind.

 They are usually unpleasant and shocking to the patient and may be
obscene or blasphemous .

Common types of obsessive thought content

 Contamination
 Repeated doubts
  Orderliness
 Impulses
 Sexual imagery

Q25. Define alcoholic anonymous group

Ans : Introduction

This is a self help organization founded in USA by two alcoholic men

Definition

 Alcoholic anonymous considers alcoholism as a physical , mental and

spiritual disease , a progressive one , which can be arrested but not cured .

 It remains the most well known program for helping people with alcoholism

 The organization works on the firm belief that abstinence must be complete .

Q26. Define Simple phobia with examples

Ans : Simple phobia is an irrational fear of performing activities in the presence of

other people or interacting with others .

Examples of Simple Phobia : are

 Acrophobia- fear of heights

 Hematophobia- fear of the sight of blood

 Claustrophobia- fear of closed spaces

 Gamophobia- fear of marriage

 Insectophobia- fear of insects

 AIDS phobia- fear of AIDS

 Zoophobia- fear of animals

 Microphobia- fear of germs

  Brontophobia- fear of thunder

 Algophobia- fear of pain

UNIT XIV

LEGAL ISSUES IN MENTAL HEALTH NURSING

Q1. Define Parole

Ans : Definition

Parole is the permission given to mentally ill patients to go home for performing
certain rituals or attend certain family functions .

Relatives are clearly instructed about the purpose for which the patient is being
sent home and when he should be brought back .

Q2. Explain about leave of absence

Ans : Leave of absence means , when mentally ill patients are detained in a
hospital , they may be given time limited leave , to leave the hospital with
permission to visit family members .

On application by relative or others to the medical officer should sign it .

The leave of absence may be granted for maximum 60 days .

Q3. Enlist the legal responsibilities of a mental health nurse.

Ans : Nurse must be aware of

 Both the laws in the state in which they practice

 Patient’s rights ‘

 Criminal and civil responsibilities of mentally ill patients

 Legal documentation

Nurse should

 Protect the patient’s rights

 Keep legal records safely

 Maintain confidentiality of patient information

 Take informed consent from patient / relatives for any procedure

Q4. Enlist the types of admission in a psychiatric hospital

Ans : Chapter IV deals with procedures for admission in psychiatric hospital .

Types of Admission : are

 a. Admission on Voluntary basis

b. Admission under special circumstances

c. Admission under Authority or order

 Reception order on application

 Reception order on production of a mentally ill person before

magistrate

 Reception order after inquest

 Admission and detention of a mentally ill prisoner .

Q5. Enlist the types of discharge in a psychiatric hospital

Ans : Chapter V deals with the procedure to be followed for the discharge of
mentally ill persons from a mental hospital .

Types of Discharge : are

a. Discharge of a patient admitted on voluntary basis

b. Discharge of a patient admitted under special circumstances

c. Discharge of a patient admitted on reception order

d. Discharge of a patient admitted by police

Q6. List down the objectives of Mental Health Act

Ans : Indian mental health act was drafted by the parliament in 1987.

Objectives : are

a. To regulate admission in to psychiatric hospitals.

b. To protect society from the presence of mentally ill persons

c. To protect citizens from being detained in psychiatric hospitals

d. To establish central and state authorities for mental health services

e. To regulate maintenance charges of psychiatric hospitals

Q7. Explain Nursing Malpractice

Ans : Malpractice involves the failure of professionals to provide proper and

competent care that is given by the members of their profession , resulting in
harm to the patient .

Example of Malpractice

 The nurse performed the duty negligently

 The damages were suffered by the plaintiff as a result

 Damages were substantial

Q8. Describe informed consent

Ans : Informed consent is more than simply getting a patient to sign a written
consent form for any medical interventions .

Informed consent include

 The patient diagnosis if known

 Nature and purpose of treatment

 Alternate treatment procedures

 Mode of administering the treatment

Q9. Describe admission on reception order

Ans : Any mentally ill person can be admitted in psychiatric hospital based on
order passed by the court of law or approved authority .

Admission on Reception order having 4 categories

 Reception order on application

 Reception order on production of a mentally ill person before

magistrate

 Reception order after inquest

  Admission and detention of a mentally ill prisoner .

Q11. Explain Mc Naughten ‘s rule

Ans : According to section 84 of the Indian Penal code of 1860 , nothing is an

offence which is done by a person who is unsoundness of mind at the time of
doing.

M Naughten rule

a. The first rule states that the individual at the time of the crime did not ,
know the nature and quality of act .

b. The second states that if he did not know what he was doing , he did not
know that it was wrong .

c. These 2 rules are called the nature and quality rule and right from wrong test.

Q12. Explain testamentary capacity

Ans : As per the Indian Succession Act , testamentary capacity of the mental
ability of a person is a pre- condition for making valid will .

 The testator must be a major , free from coercion , understanding and

displaying soundness of mind .

 At times , doctors and nurses are called upon to witness the will of an ailing
person.

 Under such circumstances , the doctor tests the testator for orientation ,
concentration and memory .

Q13. Enlist the rights of mentally ill

Ans : Rights of Mentally ill

a. The right to wear their own clothes

b. The right to have space for private use

c. The right to keep and use their own personal possessions

d. The right to spend a sum of their money for their own expenses

e. The right to see visitors every day

 f. The right to hold civil service status

g. The right to refuse electroconvulsive therapy

Q14. Describe Durham ‘s rule

Ans : An accused person is not criminally responsible , if his unlawful act is the
product of mental disease or mental defect .

In this , the causal connection between the mental abnormality and the alleged
crime should be established .

It is sometime called the product rule .

Q15. Describe Product rule

Ans : An accused person is not criminally responsible , if his unlawful act is the
product of mental disease or mental defect .

In this , the causal connection between the mental abnormality and the alleged
crime should be established .

Q16. Enlist the civil responsibilities of a mentally ill person

Ans : Civil responsibilities : are

a. Management of Property

b. Marriage

c. Testamentary capacity

d. Right to vote
 UNIT X

Patient with Personality , Sexual and Eating disorders

Q1. Define Narcisstic personality disorder

Ans : Definition

 This disorder consists of an extreme sense of arrogance , entitlement and

self importance.

 Narcissistic Personality disorder are driven by their self love and take
advantage of others or fail to have empathy for them .

Signs & Symptoms

 Inflated sense of self Importance

 Attention seeking , dramatic behavior

  Lack of empathy

 Arrogance

Q2. List down the features of Sociopathic personality

Ans : Sociopathic is characterized by antisocial behavior that violates other rights .

Features : are

 Failure to sustain relationship

 Disregard for the feelings of others

 Impulsive actions

 Low tolerance to frustration

 Lack of guilt

 Tendency to cause violence

Q3. Define gender identity disorder and its types

Ans : In these disorders , the sense of one’s masculinity or femininity is disturbed .

They include

 Transsexualism

 Gender identity disorder of childhood

 Dual role transvestism

 Intersexuality

Q4. List down the characteristics of bulimia nervosa

Ans : Bulimia nervosa is a eating disorders.

Features : are

 Frequent binging

 Feelings of guilt

 Humiliation

 Depression

 Self –Condemnation

Q5. Define Pedophilia

Ans : It is characterized by persistent or recurrent involvement of an adult in

sexual activity with prepuberal children .

Q6. Differentiate sexual sadism and masochism

Ans :

Sexual sadism Masochism

The person is sexually aroused by Here the person is sexually aroused
physical and psychological by physical or psychological
humiliation , suffering or injury of the humiliation or injury inflicted on self
sexual partner . by others .
Q7. Differentiate transexualism and transvestism

Ans :

Transsexualism Transvestism

There is a persistent and significant Sexual arousal occurs by wearing

sense of discomfort regarding one’s clothes of the opposite sex .
anatomic sex and a feeling that it is
inappropriate to one’s perceived
gender.

Q8. Enlist the complications of anorexia nervosa

Ans : Anorexia nervosa is a eating disorders.

Complications : are

 Increased susceptibility to infection

 Hypoalbuminemia

 Chronic inflammatory bowel disease

 Esophageal erosion

 Amenorrhea

Q9. Define Voyeurism

Ans : This is a persistent or recurrent tendency to observe unsuspecting persons

naked ( usually of the other sex ) and engaged in sexual activity .