Psychiatric Nursing

INTRODUCTION
Health- According to WHO:-

―Health is a state of complete physical, mental and social well-being and not merely the absence
of disease or infirmity‖.
Health is the level of functional or metabolic efficiency of a living organism. It is the ability of
individuals or communities to adapt and self manage, when facing physical mental or social challenges.
Disease: According to WHO:-

A DISEASE is a particular abnormal condition that negatively affects the structure or function of part or all of an
organism, and that is not due to any external injury. DISEASES are often construed as medical conditions that
are associated with specific symptoms and signs.
Psychiatry
It is a branch of medicine that deals with the diagnosis, treatment and prevention of mental,
emotional illness or abnormal behaviour.
Psychiatric Nursing/Mental Health Nursing

It deals with the promotion of mental health, prevention of mental illness, treatment and
rehabilitation of mentally ill individuals both in hospital and community.
Mental Health
Mental health general health Part Body, Mind Spirit
Environment Person
Mental Health
Environment Body, mind & spirit
 Mental Health includes our emotional, psychological and social well-being. It affects how we
think, feel and act. It also helps to determine how we handle stress, relate to others and make
choices.
 Mental health Individual Ability Life
Life situation Adjust
 The World Health organisation defines mental health as "a state of well-being in which the
individual realizes his or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or her community".
 Mental Health is not just the absence of mental illness.
 Mental health is important at every stage of life, from childhood and adolescenc through
adulthood.
Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mb. 7426955591, 7426955593 1
INTRODUCTION
Characteristics of Mentally Health Person

1. Mentally health person Comfortable feel
2. Mentally health person
3. Mentally health person is able to meet the basic demand of life
4. Reality orientation.
5. Self-awareness and self knowledge.
6. Self esteem and self acceptance
Mental illness
 Mental illness occurs when a state of physical, mental and social well being is disturbed.
 Any of various disorders in which a person's thoughts, emotions, or behaviour are so abnormal
as to cause suffering to himself, herself, or other people.
 Mental illness is a condition that affects a person's thinking feeling or mood, Such condition
may affect someone's ability to relude to other's and function each day, Each person will have
diffrent experiences, Even people with the same diagnosis.
Some Important Terms of Mental Health Nursing
1. Mind :- Mind is an abstract components which arises out from the central nervous system and
develops along with other developments in the human body.
Or
A set of cognitive faculties including consciousness, perception, thinking, judgement and
memory. It is the faculty of a human being's reasoning and thoughts. It holds the power of
imagination, recognition, and appreciation, and is responsible for processing feelings and
emotions,l resulting in attitudes and actions.
2. Personality:- Personality word Latin word persona derived
Personality Physical and mental qualities Individual

Individual
Or
It is a set of individual diffrence that are affected by the development of an individual: values,
atttitudes, personal memories, social relationships, habits and skills.
INTRODUCTION
Theories Of Personality
There are so many theories of personality. Main theories are-
A. Type theory
B. Psycho analytical theory.
A. Type theory:
It is oldest way to classify the personality. there are different classifications of personality on the
basis of physical characteristics & temperaments of an individual.
(i) Hippocrate:-
The earliest classification of personality was by Hippocrate
Hippocrate classify first time the people on the basis of physique & temperaments into four groups.
a) Sanguine : Sanguine type are those people who are confidant & cheerful in nature
b) Melancholic type: this type are those person who are with depressed mood, & sad in nature.
c) Chaleric : those person with hot temper, easily exited & physically strong.
d) Phlegmatic type: These person who are slow & sluggish.
(ii) Kretschemer:-
Kretchmer tried to classified the people on the basis of physical structure of body he classified in
four types.
a) Aesthenic type: Those person who are tall & thin with low muscles.
b) Athletic type: Those individuals who have muscular body, strong bone & powerful physically
desires & broad chest .
c) Pyknic type: Those individual who are short & fatty, outgoing in nature & popular in other
people.
d) Dysplastic : Those person who have mix types of above three characteristics .
(iii) SELDON (1942):-

Seledon classified the people‘s personality on the basis of physique into three categories.
a) Endomorphic :Endomorphic are those person who are fatty and massive development and short
with medium height.
b) Mesomorphic: Those persons who are powerful muscles & bones, and healthy.
c) Ectomorphic: Those persons who are thin & tall, weak in muscles & with less power.
(iv) Jung theory:-

Jung classified the peoples personality on the basis of psychological type
a) Introverted: Persons are more formal & less social in nature, slow in decision making process
& take longer time to put their decision into action.
b) Extroverted: Persons are outgoing, lovely, happy, more talkative & live in present, fast in
decision making and apply their decision quickly into action & they are more social & friendly.
INTRODUCTION
B. Psychoanalytic Theory:
Sigmund freud is founded father of psychoanalysis & developed a theory of psychoanalysis.
According to Sigmund freud personality is unconscious in nature & the motivation for the
personality development is also unconscious in nature.
According to this theory a large part of personality is unconscious freud compared the human
mind with an Ice berg.
 Psychoanalytic theory has three major parts:-
a) A theory of structure of personality - in which Id, ego, super ego are principle part.
b) A theory of personality dynamics- in which conscious & unconscious and semi concious are
major parts.
c) Theory of Psychosexual development
3. Behaviour:- Behaviour means all the covert and overt activities of human being that can be
observed. Or A response to a stimulus is known as behavior.
Or
The way in which one acts or conducts oneself espacially toward others.
Or
The way in which a person behave in response to a particular situation or stimulus.
Or
A Natural phenomenon work by which a person acts.
4. Psychopathology :- Psycho pathology refers to the study of the causes and nature of disease or
abnormal behaviour.
5. Insanity :- Insanity means that an individual is incompetent to manage his affairs and not able to
forsee the effect of his action.
6. Lunatic :- the person of an unsound mind. Or A person who is mentally ill.
 Historical Development of Psychiatry :-

The following categories of periods are identified historically.
a) Period of persecution :- period black spirit mental illness
treatment available
b) Period of segregation :- period mentally ill person Asylum ( )
Period treatment available Asylum
―Bethlem Asylum‖
c) Humanitarian period :- period Asylum physician mental
illness Interest general nurse psychiatric patient
d) Beginning of Scientific Attitude of period :- period (After 1856) mental patients
general patients treat
 Sigmund Freud Psycho Analysis
INTRODUCTION
 Mental Hospital
 In 1873, LINDA RICHARD the first American Psychiatric nurse graduated from
New England Hospital.
 In 1938, ECT Develop
 1946 Western countries Psychiatric Nursing Nursing Curriculum add
 Father of modern psychology-Wilhelm wundt"

 Father of modern psychiatry-philippe Pinel"
 First psychiatric nurse was johns Hopkins.
e) Period of prevention :- In the 20th century after 1960, the first world-wide Mental Health
Year was celebrated.
 Some Important Milestones of Psychiatry in India/World :-

 1773 The first mental hospital in the US was built in Williamsburg Virginia.
 1812 The first American textbook in Psychiatry was written by Benjamin Rush, who is referred
to as the father of American psychiatry.
 1952 Chlorpromazine was introduced (first Antipsychotic drug).
 1946 Health survey committee‘s report recommended preparation of Nursing personnel in
psychiatric Nursing, after this, the one year post certificate course in psychiatric Nursing was
started in 1956, in ―National Institute of Mental Health and Neuroscience‖ (NIMHANS)
 1986, The Indian nursing council (INC) made psychiatric Nursing a component of general
Nursing and midwifery course(GNM).
 In 1965, INC Include psychiatric NSG as a compulsory subject in B.Sc. Nursing.
 In 1975, psychiatric nursing M.Sc. Nursing course RAJKUMARI AMRIT KAUR (R.A.K.)
college of Nursing, New Delhi
 Misconception of Mental Health/MYTHS :-

1. Abnormal behaviour is bizarre.
2. Normal person Abnormal
3. Mental hospital Admit Patient general hospital Admit patient
4. Mental Health physical Health

5. India Mental Health prevalence
6. Mental illness
7. Mental illness Treatment available
8. Mental illness
9. Mental illness is caused by super natural powers.
INTRODUCTION
10. Mentally ill should only be treated in asylums.

11. Children don't experience mental health problems.
12. It is impossible to prevent mental illness.
ICD-XI
 18 twu] 2018 dks WHO us ICD 10 dks u, :i ICD 11 ds :i esa izLrqr fd;kA ICD (International
Classification of Disease)
 ;g classification leLr izdkj dh chekfj;ksa vkSj lEcfU/kr leL;kvksa dk oxhZdj.k gSA
 ICD – 11 ds vusd Hkkx gSa blesa pSIVj -F ekufld ,oa O;ogkfjd chekfj;ksa dks oxhZd`r djrk gSA
 Chapter V (F) esa 100 categories gSaA F00 – F99
 F00 – F09 :- Organic Mental Disorders.

 F10 – F19 :- Mental And Behavioral disorders due to psychoactive substances abuse.
 F20 – F29 :- Schizophrenia and Delusional disorder.
 F31 – F39 :- Mood (Affective) Disorders.
 F40 – F48 :- Neurotic disorder, somatoform disorder.
 F50 – F59 :- Behavior syndrome associated with physiological disturbance and physical factor.
E.g. eating, sexual and sleep disorders.
 F60 – F69 :- Personality disorders.
 F70 – F79 :- Mentally Retardation Mild, Moderate, severe, profound.
 F80 – F89 :- Disorder of Psychological development.
 E.g. language disorder.
 F90 – F98 :- Childhood and Adolescence disorders
 E.g. conduct disorder and TIC disorder.
 F99 :- Unspecified mental disorders.
ETIOLOGY/CAUSES OF MENTAL DISORDERS
 Etiology/Causes of Mental Disorders :- It is difficult to pin point one cause of mental

disorders.
1. Primary Cause :- It is a condition without which the disorder would not have occured e.g. head
injury lead to confusional state.
2. Predisposing Cause:- These factors makes the individual susceptible for a certain type of
mental illness.
E.g. genetic – chromsornal mutation
Rejection by parents is in the early age of the child.
3. Precipitatory Cause :- It is a condition that becomes too much for an individual to tolerate,
triggers to a maladaptive behavior.
E.g. – Death of the father of an Adoleseent boy may lead him into depression.
4. Perpectuating Factor :- These Factors are responsible for prolonging disease.
e.g. Isolation, Social withdrawl.
The Causes of mental disorders are categorized under three heading

1. Biological Factors :-
GENETIC CONSTITUTIONAL PHYSICAL PHYSICAL INFECTION

FACTORS FACTORS HANDICAP DEPRIVATION
Chromosomal Acc‖ To E.g. blindness, e.g. Mal nutrition Eg. Pediatric auto
Abnormality Personality body built Deadness & immune Neuro
(Increase/decrease) e.g. endomorphic → - These factors Sleep deprivation Psychiatic
e.g. down usually Usually affect Lead to mental disorder
Syndrome Susceptible for depression The self concept Retardation & (PANDA)
Or mongolisms. -Cyclothymic built for Of an individual mental associated with
BAD. Depression. streptococcus.
2. Psycho-Social Factors :-
Maternal Deprivation Pathogenic Family Pathogenic Inter Stress

e.g.- cPps dks eka dk I;kj Pattern Personal Relationship e.g.- failure in
Ugha feyukA e.g.- ekrk&firk dk cPps e.g.- marital Studies,
ds izfr T;knk strictness Disharmony or exam esa de
Over protection Broken homes Marks vkuk]
Of children. ekrk&firk vkSj cPpksa ds Job dk
relation [kjkc gksukA Uk feykuk ;k NwV
tkuk
ETIOLOGY/CAUSES OF MENTAL DISORDERS
3. Socio-Cultural Factors :-
War & Violence Economic and Employment Technological & Social

Problems Changes
e.g.  xjhc vkneh dk ?kj NksM+ nsuk
 dtkZ gksus ij person dk
Suicide djuk
(4) Other Factors:-
Drug abuse, disturbance in neurotransmeeter level in brain, endocrinal dysfunction, loss of loved
person, head injury, infections to brain, low I.Q.level etc.
CLINICAL MANIFESTATION OF MENTAL DISORDERS
Sign and Symptoms of Psychiatric Illness
Or
Deviation From Normal Behaviour
(Disturbance) (Disturbance) (Disturbance) (Disturbance) (Disturbance) (Disturbance) (Disturbance)

Disorder Disorder Disorder of Disorder of Disorder of Disorder of Disorder
of Of motor Perception Thought Affect Memory of
Consciousness Activities (Mood) & Attention
Intelligence
1. Disturbance of Consciousness :-
Consciousness & Surrounding Aware
stimuli alert
The State of being Aware of self and self surroundings and responding of stimuli.
Impairment of the ability to maintain awareness of self and enviorment and to respond to
enviormental stimuli are known as disorder's of consciousness. Consiousness disturbance
 Confusion :- Inability to think or reason in a focused, clear manner.

Disturbance of orientation of place,person and time with confused, puzzled and at times
surprised expression.
 Clouding of Consciousness (Brain fog / mental fog) :- person clear mindedness
Impaired
 Stupor :- person Activity Minimum level person motionless
mute , Respiration eye movement
 Coma :- prolong state of unconsciousness, person do not respond to a painfull stimuli.
Unconsciousness is the lack of appreciation of (or reaction to) a stimulus.
 Dream state :- An altered state of consciousness like a dream state.
 Somnolence :- Excessive day time sleeping by an individual.
 Coma Vigil:- coma in which eyes remain open.
2. Disorders / Disturbances of Motor Activity
Increase Activity Dysactivity Decrease Activity
Repetitions Automatic Negativism compulsion violence suicide

Behavior Behavior
(Stereotype Activity)
Echolalia Echopraxia
Position Movement Speech

1. Increase Activity :- Person dksbZ ,slh Activity djrk gSa tks uk rks Well organized gksrh gS vkSj uk gh
purposefull gksrh gSa e.g.- mania.
2. Decresed Activity :- Person Activity
Complete e.g. Depression.
3. Dys Activity :- Those psychomotor activities which are badly done, difficult or painfull
activities are called Dysactivities.
These are—
(A) Repetitious Activity :- The Activity is needless and purposeless. Person

Needless Activities Repeat Stereo Type Activity
(a) Stereotype position :- person repeatiously maintain a constant position, which may be
uncomfortable or comfortable.e.g.-catatonics stupor of schizophrenia that is also known
as catalepsy or waxy flexibility.
Cataplexy :- Temporary loss of muscle tone & weakness precipitate by a variety of
emotional state e.g. Death of close relative or love failure.
(b) Stereotype movement :- It is also known as mannerism.
e.g.- person & , &
saliva , schizphrenia patient &
(c) Stereotype Speech/Verbigeration :- Repeatation of words, phrases or sentences
e.g.- Question Repeat
(B) Automatism :- person activity conscious level

Automatism repetitious Echolalia Echopraxia
(a) Echolalia :- Person Repeat
Doctor to patient ―What is your name‖
Patient reply ―What is your name‖
(b) Echopraxia :- Person Activity Repeat
(C) Violence :- It is an aggressive behavior in which physical force is exerted. E.g. murder, rape,
war.
(D) Suicide :- Violence toward self may lead to suicide or ―an act of killing oneself‖.
(E) Compulsion:- uncontrollable impulse to perform an Act repeatedly or, an act which may look
unreasonable to the viewers and the individual himself it is called compulsion e.g. washing hand
repeatedly, checking the looked door at many time.
(F) Negativism :- person /patient, command oppose e.g. catatonic schizophrenia
space nsuk patient
3. Disorders / Disturbance of Perception :- Perception can be defined as whatever is

experienced by a person through various senses such as vision, Auditory, taste, olfactory, tactile.
There are two disorders of perception :-
(A) Illusion :- Illusion clear stimulus identified Illusion stimulus
present (misinterpretation of stimuli)
(B) Hallucination :- Hallucination is the perception of a stimulus in the absence of an actual
stimulus.
Hallucination actual stimulus Absent
Types of Hallucination :-
(a) Auditory Hallucination (Hallucination of Hearing):- e.g.
common in functional psychosis
(b) Visual Hallucination:- (Hallucination of sight) False visual perception, common in
organic psychosis.
(c) Olfactory Hallucination :- (Hallucination of smell) Common in organic brain syndrome
or in Aura of epilepsy. In this pt experience pleasant or unpleasant smell.
(d) Gustatory Hallucination :- (Hallucination of taste)
 common in organic brain syndrome.
 e.g. wrong taste feel
(e) Tactile Hallucination (Somatic Hallucination :- (Hallucination of Touch/haptic
hallucination)
 common in cocaine abuse called as cocaine bug.
 e.g. patient say same thing just like lice keep crawling on my arms.
4. Disorder of Thinking :- Thinking is a mental process which deal with ideas & thought
Formation Level Progression Level Content Level

(Association of thought)
Over Delusion Hypochondrias Obsession Phobia

Autistic Thinking
Valued -is
Or
Over
Determined
Ideas
Flight of Thought Thought Circum- Tengentiality Thought Incohrence

ideas Retardation Perseveration Stantiality Blocking
 Thought Formation :- Normal thought process involves imagination, co-ordination and

inferring resulting in formation of thought (idea).
 Thought Progression :- As an ideas are connected with other ideas, there is progression of
thought (association of thought).
 Content of thought :- The subject, importance, value or feeling attached to an idea is the
content of thought.
(a) Disorders of thought at formation level :-

(a) Autistic Thinking (Autism):- It is characterized by a withdrawl of the person into self
and into the fantasy world of his own creation, thinking that gratifies unfulfilled desire
but has no regard for reality.
(b) Disturbance of thought at progression level :-
(a) Flight of Ideas :- person/patient too quickly idea idea shift
(rapid verbalization so that there is a shifting from one idea to another)
e.g. to patient
pt to Nurse
 Sometimes, the rapid flow of thought is expressed in words that are similar in sound that is
called clang association. E.g. BAT CAT RAT HAT NAT PAT CHAT.
 Loosening of association :- Flow of thought is rapid, quickly shift from one idea to another
which are illogical or in infocused very common in schizophrenia.
e.g. , ,
(b) Thoughty Retardation :- In this, the initiation and movement of thought are show e.g.
patient
(c) Thought Perseveration :- psycho pathological repeatation of the same word or idea in
response to different questions.
E.g. – Nurse :- who is our first prime minister, patient-NEHRU
Nurse :- who is our present prime minister, patient-NEHRU
Nurse :- who is our present chief minister, patient-NEHRU
(d) Circumstantiality :- patient Question &
Question patient has reached to the target answer at last.
(e) Tangentiality :- patient Question Topic
Question patient NEVER reaches to the target
answer.
(f) Incoherence :- patient Question Ir-relevant
(g) Thought blocking :- There is a sudden cessation of thought in the midst of a sentence,
unconscious in origin.
C. Disturbance of thought at content level :-

(a) Over Valued or Over Determined Ideas :- When there is too much value or importance
attached to an idea, person connect extreme feeling or importance to an idea which directly
reflects his inner need. False belief maintained with less than delusional thinking.
(b) Delusion :- Delusion is defined as a false fixed belief, not in according with one‘s
intelligence, sociocultural and educational background.
Persistent and unshakable belief or ideas are known as delusion.
 Types of Delusion :-
(i) Delusion of grandiosity :- Exaggerated conception of one‘s importance. In this patient has
false belief that he has more power.e.g. common in mania.
(ii) Delusion of Persecution :-It is very common form of delusion in Psychosis, commonly in
paranoid schizophrenia. Delusion patient believe Family member
Friends,
(iii) Delusion of reference :- (Ideas of reference) patient believe
(iv) Delusin of guilt :- Commonly seen in depression. patient self-critical

for e.g. extra marital relation.
(v) Delusion of control (Ideas of control) :- patient /
/ & mind control
(vi) Delusion of worthlessness and poverty :- Common in depression. In this, patient feels that
he/she is useless and worthless in the world.
(vii) Delusion of self-Accusation :- Common in depression. patient, Neglect
(viii) Nihilistic delusion:- False Feeling that self other or world for Non existant.
(c) Hypochondriasis :- In this, patient has an exaggerated concern over his bodily health. He
has false believe for his health and feels ill without any actual medical basis or pathology.
(d) Obsession :- The unwelcome ideas comes in the patient‘s mind, the patient try to remove
these idea from his mind without any success. These unwelcome ideas or thoughts are called
obsession. E.g.
(e) Phobia :- Phobia is an exaggerated pathological fear of s specific type of stimulus or
situation or activity.
D. Other disorder of thinking :-

 Neologism :- patient word create
 Word salad :- e.g. – , , sky
 Derailment :- Sudden or gradual deviation in track of thought without blocking e.g.-
 Thought broadcasting :- patient
 Thought Insertion :- Person thinks that some thought not his own but inserted in mind by
outside agent.
 Thought withdrawl:- patient thinks that patient‘s thoughts are withdrawl by some one else.
5. Disordes of Emotions :-
Emotion:- A complex feeling state with a psychic, somatic and behavioral component. It May
be expressed by facial expression, gesture, posture and speech.e.g. fear, anger, Wonder, grief,
joy, love, hate etc.
Affect and mood are used to explain the emotional condition of an individual.
Affect :- Affect can be defined as the individual‘s inner feelings at a given moment.
Mood :- Pervasive/sustained/prolonged emotion.
Euthymic Mood :- Normal range of mood

Dysthmic mood:- an unpleasant mood.
Disorders of AFFECT / Mood
Pleasurable AFFECT Unpleasurable AFFECT Other AFFECT
Euphoria Elation Exaltation Ecstasy Depression Grief
Inappropriate Bluted Labile FLAT Apathy Anxiety Ambivance Mood Depersonalis-

AFFECT AFFECT AFFECT AFFECT swing -ation
Panic agitation aggression derealisation alexithymia anhedonia
i. Euphoria :- Pleasurable affect in which the person gets a feeling of well being.
ii. Elation :- Moderate elevation of mood with increase psychomotor activities and biological
drives.
iii. Exaltation :- Elation + Delusion of grandeusity.
iv. Ecstasy :- Very severe elevation of mood. In this patient feels detached from the world and
has often a feeling that he is re-born.
v. Depression :- decrease psychomotor activity, poverty of ideas & sadness of mood.
vi. Grief :- Sadness which is appropriate to real loss & self-limiting or may lead to serious
impairment of activities.
vii. Inappropriate Affect :- The patient smiles when situation demands seriousness. Or patient
cries or sad when situation demands a happiness.
viii. Blunted Affect :- Severe reduction in intensity of affect.
ix. Flat Affect :- Absence or nearly absence of affective expression.
x. Labile Affect :- Rapid & abrupt change in emotional feelings, unrelated to external stimuli.
xi. Apathy :- Absence of affect. In this patient‘s face show an emptiness of expression.
xii. Anxiety :- Anxiety is an unpleasurable reaction to an unreal or imagined danger.
xiii. Fear :- Fear is a reaction to a real or threatened situation.
xiv. Panic :- It is a state of extreme, acute, intense anxiety associated with disorganization of
personalities.
xv. Agitation :- Anxiety with severe motor restlessness.
xvi. Ambivalence :- In this individual has two contradictory ideas or feelings at the same time
toward the same person or object e.g. child having the feeling of both love & hate towards
the parents.
xvii. Aggression :- Forceful goal directed action that may be verbal or physical.
xviii. Depersonalization :- In this, feeling of unreality concerning oneself or one‘s environment.
E.g. pt say- my brain is dead or stop working.
xix. Derealization :- Feeling of reality of external world is temporarily changed or lost,
distortion of relationship so that environment becomes unfamiliar to him e.g.
xx. Mood Swings :- Changing of mood between two extreme feeling e.g. a period of euphoria
and depression.
xxi. Alexithymia :- inability to describe one‘s own emotions or moods.
xxii. Anhedonia- it is an inability to experience pleasure from activities usually found enjoyable.
6. Disorders of Memory :-
 Memory means power to remembering.
 Memory is the process in which information is encoded, stored and retrieved.
 Memory process includes.
a) Ability to attend to stimulus.
b) Register the stimulus.
c) Ability to recall or reproduce the stimulus.
Types of Memory
Immediate Memory Recent Memory Remote Memory

time e.g. e.g.
memory Hospital admit
(i) Hypermnesia :- Excessive retention of memory. common in paranoid schizophrenia and in

manic state.
(ii) Amnesia :- Complete or partial loss of memory.
a. Retrograde Amnesia :- it is the inability to retrieve information that was acquired
before a particular date, usually the date of an accident or operation.
b. Anterograde Amnesia :- inability to transfer new information from the short term store
into the long term. People with this type of Amnesia cannot remember thing for long
period of time.
c. Circumscribed Amnesia :- Forgetting some group of events which usually have strong
emotional reasons.
(iii)Paramnesia :- It is a false recollection of memory where the patient talks about, those events
which never took place or gives a false colorings to those that did happen.
a. Confabulation:- unconscious filling of gaps in memory by imagined or untrue
experience that patient believes but that has no basis in fact.
b. Dejavu :- A sense of familiarly with unfamiliar circumstances/situations.
c. Jamisvu :-It is a false feeling of unfamiliar with familiar situation or real situation.
7. DISORDER OF ATTENTION :-
 Attention :- It means focusing of sense organ towards a particular stimulus.

 Concentration :- It means ability to focus attention for longer time.
 Distractibility :- It is disorder of attention in which inability to concentration or focus attention,
the patient gives attention to every things which is happen, with the result his attention passes
very rapidly from one object to another.
 Insight :- It is the awareness of one‘s own mental condition ,if person is not aware about her
own mental illness, it is called absent of insight. E.g. common in psychosis, if patient know
about his mental illness it is called ―present‖ of Insight. E.g. – common in Neurosis.
 Judgment :- It is the capacity to draw correct or incorrect conclusions from material acquired by
experience.
MENTAL STATUS EXAMINATION
THE MENTAL STATUS EXAMINATION
1. Appearance (observed)
2. Behavior (observed)
3. Attitude (observed)
4. Level of Consciousness (observed)
5. Orientation (inquired)
6. Speech and Language (observed)
7. Mood (inquired)
8. Affect (observed)
9. Thought Process/Form (observed/inquired)
10. Thought Content (observed/inquired)
11. Suicidality and Homicidality (inquired)
12. Insight and Judgment (observed/inquired)
13. Attention Span (observed/inquired)
14. Memory (observed/inquired)
15. Intellectual Functioning (observed/inquired)
 Components of the Mental Status Examination

I. Appearance (Observed) - Possible descriptors:
 Gait, posture, clothes, grooming.
II. Behavior (Observed) - Possible descriptors:
 Mannerisms, gestures, psychomotor activity, expression, eye contact, ability to
follow commands/requests, compulsions.
III. Attitude (Observed) - Possible descriptors:
 Cooperative, hostile, open, secretive, evasive, suspicious, apathetic, easily distracted,
focused, defensive.
IV. Level of Consciousness (Observed) - Possible descriptors:
 Vigilant, alert, drowsy, lethargic, stuporous, asleep, comatose, confused, fluctuating.
V. Orientation (Inquired) – Possible questions for patient:
 ―What is your full name?‖
 ―Where are we at (floor, building, city, county, and state)?‖
 ―What is the full date today (date, month, year, day of the week, and season of the
year)?‖
 ―How would you describe the situation we are in?‖
VI. Speech and Language (Observed)

A. Quantity - Possible descriptors:
 Talkative, spontaneous, expansive, paucity, poverty.
B. Rate - Possible descriptors:
 Fast, slow, normal, pressured.
C. Volume (Tone) - Possible descriptors:
 Loud, soft, monotone, weak, strong.
D. Fluency and Rhythm - Possible descriptors:
 Slurred, clear, with appropriately placed inflections, hesitant, with good articulation,
aphasic.
VII. Mood (Inquired): A sustained state of inner feeling – Possible questions for patient:
 ―How are your spirits?‖
 ―How are you feeling?‖
 ―Have you been discouraged/depressed/low/blue lately?‖
 ―Have you been energized/elated/high/out of control lately?‖
 ―Have you been angry/irritable/edgy lately?‖
VIII. Affect (Observed): An observed expression of inner feeling. - Possible descriptors:
 Appropriateness to situation, consistency with mood, congruency with thought content.
 Fluctuations: Labile, even.
 Range: Broad, restricted. • Intensity: Blunted, flat, normal intensity.
 Quality: Sad, angry, hostile, indifferent, euthymic, dysphoric, detached, elated,
euphoric, anxious, animated, irritable.
IX. Thought Processes or Thought Form (Inquired/Observed): logic, relevance,
organization, flow and coherence of thought in response to general questioning during the
interview. - Possible descriptors:
 Linear, goal-directed, circumstantial, tangential, loose associations, incoherent,
evasive, racing, blocking, perseveration, neologisms.
X. Thought Content (Inquired/Observed) – Possible questions for patient:
 ―What do you think about when you are sad/angry?‖
 ―What‘s been on your mind lately?‖
 ―Do you find yourself ruminating about things?‖
 ―Are there thoughts or images that you have a really difficult time getting out of your
head?‖
 ―Are you worried/scared/frightened about something or other?‖
 ―Do you have personal beliefs that are not shared by others?‖ (Delusions are fixed,
false, unshared beliefs.)
 ―Do you ever feel detached/removed/changed/different from others around you?‖
 ―Do things seem unnatural/unreal to you?‖
 ―What do you think about the reports in papers such as The National Enquirer?‖
 ―Do you think someone or some group intend to harm you in some way?‖
 [In response to something the patient says] ―What do you think they meant by that?‖
 ―Does it ever seem like people are stealing your thoughts, or perhaps inserting
thoughts into your head? Does it ever seem like your own thoughts are broadcast out
loud?‖
 ―Do you ever see (visual), hear (auditory), smell (olfactory), taste (gustatory), and
feel (tactile) things that are not really there, such as voices or visions?‖
(Hallucinations are false perceptions)
 ―Do you sometimes misinterpret real things that are around you, such as muffled
noises or shadows?‖ (Illusions are misinterpreted perceptions)
XI. Suicidality and Homicidality

A. Suicidality – Possible questions for patient:
 ―Do you ever feel that life isn‘t worth living? Or that you would just as soon be
dead?‖
 ―Have you ever thought of doing away with yourself? If so, how?‖
 ―What would happen after you were dead?‖
B. Homicidality – Possible questions for patient:
 ―Do you think about hurting others or getting even with people who have
wronged you?‖
 ―Have you had desires to hurt others? If so, how?‖
XII. Insight and Judgment (Inquired/Observed) – Possible questions for patient:
 ―What brings you here today?‖
 ―What seems to be the problem?‖
 ―What do you think is causing your problems?‖
 ―How do you understand your problems?‖
 ―How would you describe your role in this situation?‖
 ―Do you think that these thoughts, moods, perceptions, are abnormal?‖
 ―How do you plan to get help for this problem?‖
 ―What will you do when _____________ occurs?‖
 ―How will you manage if ____________ happens?‖
 ―If you found a stamped, addressed envelope on the street, what would you do with
it?‖
 ―If you were in a movie theater and smelled smoke, what would you do?‖
XIII. Attention (Inquired/Observed) - Possible descriptors:
 Attend, concentration, distractibility.
A. Digit Span (forward and reverse) - Suggested patient instructions:
• ―I will recite a series of numbers to you, and then I will ask you to repeat them to me,
first forwards and then backwards.‖ [Begin with 3 numbers – not consecutive numbers,
and advance to 7-8 numbered sequence.]
B. Spelling Backwards - Suggested patient instructions:
 ―Spell the word ‗world.‘ Now spell the word ‗world‘ backwards.‖
C. Calculations - Suggested patient instructions:
 (Serial 7‘s) ―Starting with 100, subtract 7 from 100, and then keep subtracting 7 from
that number as far as you can go.‖
 (Serial 3‘s) ―Starting with 20, subtract 3 from 20, and then keep subtracting 3 from
that number as far as you can go.‖ [Monitor for speed, accuracy, effort required, and
monitor patient reactions to the request]
―Add these numbers: (15 + 12 + 7)‖ • ―Multiply these numbers: (25 x 6)‖
―If something costs 78 cents and you give the cashier one dollar, how much
change should you get back?‖
XIV. Memory (Inquired)
A. Recent Memory – Possible questions for patient:
 ―What is my name?‖
 ―What medications did you take today?‖
 ―What time was your appointment with me for today?‖
B. Remote Memory – Possible questions for patient:
 ―Where were you when President Kennedy was shot?‖ (For patients over 40)
 ―What is your Social Security number?‖
 ―What were the dates of your graduation from high school, college, graduate
school?‖
 ―When and where did you get married?‖
C. Immediate Memory (also see XIII.-A. above) and New Learning - Suggested patient
instructions:
 ―I am going to ask you to remember three words (color, object, animal – e.g.,
blue, table, and horse) and I will ask you to repeat them to me in 5 minutes.
Please repeat them now after me: blue, table, and horse.‖ – 5 minutes elapse –
―What were those three words I asked you to remember?‖ [Monitor accuracy of
response, awareness of whether responses are correct, tendency to confabulate or
substitute other words, ability to correct themselves with category clue and
multiple choice].
XV. Intellectual (Inquired/Observed)
A. Information and Vocabulary - Suggested patient instructions:
 ―Name the last 5 presidents.‖ (Clinton, Bush, Reagan, Carter, Ford, Nixon, …)
 ―Name 5 of the largest cities in the country.‖ (New York City, Los Angeles,
Chicago, Houston, Philadelphia)
 ―Name the current president, vice president, governor, and mayor.‖ (Bill Clinton,
Al Gore, George Ryan, Richard M. Daley)
B. Vocabulary - Possible descriptors:
 Grade school level, high school level, fluent, consistent with education.
C. Abstraction - Possible questions for patient:
1. Similarities – ―How are the following items similar?‖
 ―an apple and an orange‖ (round ~concrete, fruit ~abstract)
 ―a chair and a table‖ (made of wood ~concrete, furniture ~abstract)
 ―a watch and a ruler‖ (measurement instruments ~abstract)
2. Proverbs – ―How would you describe the meaning of the following sayings?‖
 ―People living in glass houses should not throw stones.‖
 ―A bird in the hand is worth two in the bush.‖
 ―You shouldn‘t cry over spilt milk.‖
 ―Two heads are better than one.‖

MINI MENTAL STATUS EXAMINATION
The MMSE is a brief, quantitative measure of cognitive status in adults. It can be used to screen
for cognitive impairment, to estimate the severity of cognitive impairment at a given point in time, to
follow the course of cognitive changes in an individual over time, and to document an individual's
response to treatment.
WHAT IS THE MMSE TEST?

The MMSE test can be used by clinicians to help diagnose dementia and to help assess its progression
and severity.
It consists of a series of questions and tests, each of which scores points if answered correctly.
The MMSE tests a number of different mental abilities, including a person's memory, attention and
language.
MMSE is only one part of assessment for dementia. Clinicians will consider a person's MMSE score
alongside their history, symptoms, a physical exam and the results of other tests, possibly including
brain scans.
The MMSE can also be used to assess changes in a person who has already been diagnosed with
dementia. It can help to give an indication of how severe a person's symptoms are and how quickly their
dementia is progressing.
Again, results should be considered alongside other measures of how the person is coping together with
clinical judgment.
ELECTRO-CONVULSIVE THERAPY [ECT]
 Convulsive therapy was introduced in 1934 by Ladislas J. Meduma, induced Seziures (first with
camphor and than metrazol (cardiazol).
 Ladislas meduna is thought to be the father of convvlsive therapy.
 sakel Insulin shock treatment
 The ECT procedore was first conducted in 1938. by Cerletti and Bini.
Insulin shock treatment :-
A Injection of large Dose of Insulin To Patient Hypoglycemia in patient
Patient wake up glucose IV Then coma state for three

within 10 to 20 hour after Injection
minutes
 ugo carletti lucino Bini ª (EST/ECT)

 Definition :- It is the painless from of electric therapy in which electric current is applied for a
fraction of a second through electrodes placed on the temporal region to produce two stage
seizures or convulsion (Tonic and clonic stage). Psychetric treatment in which seziures are
electrically induced in patients to provide relief from Psychetric illness.
 TECHNIQUES / METHODS OF GIVING ECT :-
1. Direct ECT :- In this atropine Sulphate (salivary secretion ) is given

subcutaneously 0.6 mg to 1.0 mg half an hour before procedure. Then ECT is given for 0.5-1.5 sec.
2. Modified / Indirect ECT :-

In this –
Atropin Anaesthetize agent Muscle Relaxant o2 Inhalation
sulphate Thiopental Na succinylcholine by mask
before ½ hour 5 to 10 ml. + 0.3 ml to 0.5 ml + (to reduce
of ECT (4-6mg/kg) IV IV hypoxia to brain)
(0.3-0.6 mg) (anticonvulsant// anxiolytic affect) (To prevent complication)
(e.g.Fracture)
(0.5-1.5 mg/kg)
Then ECT given
 Types of ECT :-
1. Unilateral ECT :- (Benefit – post – convulsive confusion & amnesia )
Placement of Electrodes :- one electrode on non-dominant side of temporal region & second is
placed on non-dominant centroparietal Region.
2. Bilateral ECT :- (commonly used ECT)
Two electrode on Bi temporal region.
 Amount of Current :-
 70 to 130 volts (Average-110 Volts)
 200 to 1600 milliamphers (Alternative Current)
 Time – 0.6 to 1 second. (Average 0.6 sec.)
 Seizure production :- (Grand mal seizure)

 Tonic phase (Muscle contraetion) – Duration – 10 seconds
 Clonic phase (Movement/convulsion) – Duration – 25 to 30 seconds.
 Indication of ECT :-
i. Major depressions (Endogenous Depression)
ii. Psychotic depression (Schizoaffective disorder)
iii. Post Partum Depression
iv. Manic phase in (MDP/BAD)
v. Catatonic Stupor and Excitement.
vi. Suicidal thought and suicidal attempts.
vii. Paranoid schizophrenia.
 Ect Treatment Is Not Effective In :-

 Reactive Depression (Neurotic Depression/exogenous depression)
 Neurosis, Hysteria, Hypochondriasis, Drug Dependence .
 Schizophrenia – Simple and Hebephrenic.
 Contraindication of ECT :-
 Increased intra cranial pressure due to tumour, hemorrhage, hematomas.
 Acute myocardial infarction, Hypertension.
 Cardiac disease, thrombophlebitis, bleeding disorders.
 Pregnancy, Fracture, Retinal Detachment, Glaucoma.
 Number And Frequency of ECT Treatment :-
 Three time in a weak.
 Five to ten ECT for BAD/MDP.
 20-25 may required for chronic schizophrenic patients.
 Complication of ECT :-
 Retrograde Amnesia & Confusion.
 Fracture & dislocation of jaw. Fracture of femur & humorous.,Fracture of vertebre III ,IV
,Vth are common.
 Apnea ,headache, backache, injury to mouth & tongue. ECT doesnot cause any Brain
damage.
 Stuns or Subshock :-
 It occur due to an insufficient current application to the patient which does not result in a full
convulsive stage.
 NURSING CARE :-
S. BEFORE ECT DURING ECT AFTER ECT

No.
1. All investigation e.g. Supine position. Vital sign should be
ECG, all blood Checked
Investigation x-ray Air way clearance
Maintain and monitor
respiratory status (Because
succinylcholine is given)
2. Written consent A small pillow is placed Provide side Lying
Family member under the lumber curve. Position to patient.
3. PT should be kept NBM Mouth gag between teeth Re-oriented to patient.
4. Remove all metallic Support shouders, arm Note any injury mark on
Articles & artificial tlghtly, Restrain thigh. The patient‘s body.
Dentures.
5. Empty bowel & bladder. Oxygenation By mask

6. Loosen the tight Medications :- After one hour patient
Cloths. - Anesthetic agent Should be provided
Muscle Relaxant Breakfast.
7. Medication atropine - Observation of allow the patient for daily

Sulphate seizure. activity of living.
8. Benzodiazepine / barbiturate -
and lithium should be
stopped before CT.
PSYCHO-PHARMACOLOGY
Drug :-
ACCn to W.H.O. A Drug is an any substance that, when taken into the living organism, may
modify one or more of its functions.
Or
A drug is any substance othger than food, that when inhaled, injected, smoked, consumed,
absorbed via a patch on the skin or dissolved under the tongue causes a physiological change in the
body.
 Agonist :- Drug that activate receptors.
 Antagonists :- Drugs that blocks receptors.
 Psycho-pharmacology :- It is the study of Drug used to treat psychiatric disorders.
 Psycho tropic Drug :- Medications that affect psychic function, behavior or experience are
called psychotropic medications.
Medication :-
It is a chemical substance used to treat, cure, prevent or diagnose a disease or to prmote
well being.
Classification :-
1. Antipsychotic Drugs
2. Anti depressant Drugs.
3. Anti manic Drugs
4. Anti parkinsonian/Anti EPS Drugs
5. Anti Anxiety Drugs / sedatives / Hypnotic/anxiolytics
1. Anti Psychotic Drugs
 major Tranquilizer, Neuroleptic Drug

 Drugs psychotic symptoms treat use anti psychotic Drug
 Common Indications :-
-Delirium, Delusion, - Schizophrenia, Hallucinations - Paranoid disorders
-Dementia - & Mania -Some time in
-depression -Neurotic Disorder
 Mode of Action :- Function Anti-dopaminergic CNS Dopamine
receptor Block D2 Blocker Drug
PSYCHO-PHARMACOLOGY
Contraindication :- Children under three year of age,Comatose patient ,Bone marrow
Depression,Pregnancy and lactation ,These Drugs are cautionally used in epilepsy, Parkinson‘s disease
& peptie ulcer.
CLASSIFICATION OF ANTIPSYCHOTIE DRUGS :-
1. TYPICAL OR TRADITIONAL ANTIPSYCHOTIC DRUG:-

 chlorpromazine,haloperidol
 Trifluparazine,triflupromazine.
 These drug are commonly used to treat the positive symptoms of schizophrenia.
2. ATYPICAL ANTIPSYCHOTIC DRUGS (NEWER DRUG) :-

 e.g. clozapine, Resperidone, olanzapine.
 Olenzepine & Resperidone & Clozapine Newer Antipsychotic Drugs
 Clozapine Drug Agranulocytosis (granulopenia) use Weekly,
TLC, DLC (Blood Investigation)
 Chlorpromazine old Anti psychotic Drug
 Haloperidol Drug:- EPS Clozapine EPS
SIDE EFFECTS OF ANTI PSYCHOTIC DRUG :-

Dry mouth,Impotency, Urinary retention ,Constipation,Weight gain (maximum with
olanzapine),Jaundice ,Contact-dermatitis,Agranulocytosis(maximum – Due to Clozapine)
 Extra Pyramidal Side Effects (Extra pyramidal symptoms/EPS)

(a) Pseudo-parkinsonism :- (parkinsonism like symptorns)
 It occurs in 40% of the patient presenting EPS. Common symptoms-
 Muscle rigidity,Drooling ,Slurred speech,Mask like face,Weakness & fatigue
(b) Akathesia (Most common form of EPS) :-
 It occurs in 50% of all patients presenting EPS.
 In this, strong urge to move ( )
 It is also called ―Walking & Talkies‖.
(c)Dystonia :-
 It occur in 6% of Total EPS.
 Common symptoms include.
 Rapidly developing contraction of muscles of the tongue, Jaw, and neck (torticollis) and
extra ocular muscles.
 Combined torticolis ( side ) and extra ocular spasm (
/eye looks upward )result in an oculogypic crisis.,It gives a painful and a
frightening experience to patient.
PSYCHO-PHARMACOLOGY
(d) Tardive Dyskinesia (It may be Ir - reversible in some patient) :-
 It occur in 3% of total EPS.
 It is characterized by involuntary rhythmic stereotype movements. e.g. protrusion of tongue,
chewing movements.,Involuntary movement of Extremities.
(e) Neuroleptie malignant syndrome (NMS):-
 Very rare but fetal,Common symptoms include-
 Hyperpyrexia, severe muscle rigidity, Leukocytosis, altered consciousness, change in Blood
pressure, elevated creatinine kinase, reduce iron plasma level, electrolyte abnormalities.
 Note :-
 Antipsychotic Drugs use Alcohol smoking, , coffee, cold drinks etc.
Antipsychotic Drug effect
 Anti psychotics Antacid Anti psychotic Drug
Absorption
 Withdrawal symptom:-
 Nausea, anorexia.
 Emesis
 Diarrhea
 Rhinorrhea
 Diaphoresis
 Myalgia
 Anxiety
 Restlessness
 Insomnia
 Withdrawal effect may occur when switching a person from one anti-psychotic to another.
2. ANTI EPS /ANTI PARKINSION AGENTS
 EPS Drug.
1. Anti Cholinergic :- These Drug blocks secretions. E.g. Benztropine, Trihexyphenidyl

Hydrochloride, procyclidine.
2. Anti Histamine :- Same effect as Anti cholinergic e.g. – Diphenhydradramine.
3. Dopamine Drugs :- These are dopamine releasing drug From CNS. E.g. L-dopa,
Carbidopa.
PSYCHO-PHARMACOLOGY
3. ANTI DEPRESSANT AGENTS
Mood elevator Thymoleptics

 Indications :-
 Grief Reaction and Pathological grief.,Major Depression
 Panic Anxiety disorder and generalized Anxiety Disorder,phobic anxiety disorder.
 These drugs are also used in childhood disorders such as Enuresis, somnambulism, OCN,
Addiction dependence.
 Mechanism of Action :-
 Drug brain Neurotransmitter such as serotonin Nor-epinephrine etc.
level Depressed mood
 Classification of Antidepressant Drugs:-
1. Tri-cyclic Antidepressant Drug :- e.g. Amitryptyline, Imipramine,
2. Tri-imipramine,clomipramine.
3. Mono-Amine oxidase Inhibitors (MAOI’S):- e.g. IsoCarboxazid, Phenelazine.
4. Selective serotonin re-uptake Inhibitors (SSRI’S):- e.g. fluxetine, Sertraline, fluoxamine.
 Contraindication of Drugs :-
Myocardial infarction ,Other cardiac disease ,Narrow Angle glaucoma
 Note :-
ECG should be monitored before starting the Antidepressant Drug.
The Anti depressant Drug should not taken with the food which contain excess of tyramine
amino acid such as beer, chocolate, coffee, banana, pickle. Because due to Drug in-traction, it causes
following symptoms.
Occipital headache, Photophobia ,Vomiting ,Excessive sweating (Hypertensive crisis).
4. ANTI-MANIC DRUGS
 mood stabilizing agent

Indications :-
 Acute mania,,Schizoaffective Disorder,Bipolar mood disorder (BAD).
 Mechanism of Action :- Drugs Brain Neurotransmitter such as, Serotonin, Nor-
epinephrine, level
Anti Manic Agents :-
 Lithium carbonate is the drug of choice in mania (600-1200 mg/day) and BPD.
 Carbamazepine, and sodium valporate are also used as Anti manic agents/mood stabilizer.
PSYCHO-PHARMACOLOGY
 Instruction During Lithium Therapy (precaution):-

 80% Lithium Re-absorption kidney PCT Lithium renal impairment
patient use
 Patient with sodium depletion or receiving diuretics should not use Lithium.
 Other Contraindications:- Cardio-vascular problems, Pregnant women (first trimester),
Hypothyroidism.
 Lithium therapy use
Lithium Retention
 Lithium therapy caffeine, Alcohol, Beverages
 Intake-out put chart maintain Fluid intake
Lithium toxicity
 Lithium (due to metallic taste) gastro-Intestinal
Irritation
 blood Lithium level
Therapeutie Serum Lithium level :- 0.6 – 1.2 mEq/L
 Lithium toxicity:-
When blood level os lit reach about 2.0 mEq/L it is known as Lithium toxicity. Symptom occurs
are-
 Anorexia, Nausea, Vomating
 Tremor (commonest side effect).
 Muscular weakness.
 Cogwheel rigidity (mild)
 Seizures
 Poly uria
 Hypokalaemia
 T-wave depression.
5. ANTI ANXIETY DRUGS

 These Drugs are also called minor Tranquilizer, Anxiolytics or Hypnotics or sedatives.
 These Drugs are used to relieve mild, moderate and severe Anxiety and induce sleep.
PSYCHO-PHARMACOLOGY
 Indications :-
 Generalised Anxiety Disorder (GAD),Panic Anxiety Disorder(PAD),Phobia
 OCN (Obsession Compulsion Neurosis),Insomnia,Enuresis,Night mares, Somnambulism.
 These Drugs are also used in various psychotic disorders to induce sleep.
 Mechanism of Action :-
 Anxiolytic Drugs Brain GABA (Gamma – Amino Butyric Acid)
GABA Inhibitory, Neurotransmitter Neuronal activity
Anxiety level
 Classification of Anxiolytics:-
a) Barbiturates :- e.g. – Amobarbital, Phenobarbital, sodium thiopental.
b) Non-Barbiturates Anxiolytics :-
 Quinazolines :- e.g. – methaqualone.
 Chloral Derivatives: - Chloral Hydrate.
 Monoureides: - e.g. Paraldehyde.
 Benzodiazepines e.g. – chlordiazepoxide(Librium) ,Diazepam, clonazepam, Lorazepam,
Temazepam, Alprazolam, midzolam,ettizolam.
 Common side effects :-

Nausea,Vomiting ,Weakness /fatigue ,Blurred vision,Drowsiness & Body ache.
 Withdrawal symptoms of Anxiolytics :-

 Anxiety
 Insomania
 Postural Hypotension
 Nausea, Vomitting
 Tremor
 Restlessness
 Blurred vision
 Seizures
 Delirium.
PSYCHO-PHARMACOLOGY
 Special Points About Anxiolytics Drugs :- (During use)

 Anxiolytics long time use person physical / psychological
dependence
 Hypotension use
 Anxiolytic Drugs use , Alcohol, caffeine Avoid
 Anxiolytic Drug Anti depressant Drug use
 Anxiolytic Drugs long time use
 Abrupt withdrawl of barbiturate/anxiolytics may cause seizure.
 Anxiolytic Drugs use long-time drive
 Antidot of benzodiazepine:-flumezenil.
PSYCHO-THERAPY
 Psychotherapy is a therapeutic relationship which is estabilished between the patient and

therapist.
 The purpose of Psychotherapy is to modify, remove or reduce the factors causing a disturbed
behavior or to help the patient to grow and develop coping mechanism to face the problems in
future and improve in social functioning.
 Indications:-
 Neurotic disorders :- Anxiety, Phobia, Hysteria, OCN.(very useful)
 Psychotic disorder :- As a Adjuvant therapy (Not very useful).
 Alcoholism and other Psychoactive Substance Abuse disorders.
 Personality disorders
 Childhood disorders.
 Psycho somatic illness.
 Sexual disorders.
 Other‘s :- Anorexia, Nervosa, Bulimia Nervosa, sleep disorders.
 Contraindication :-
 Manic patients.
 Organic mental illness :- Delirium, Dementia.
 Antisocial personality disorder & unmotivated patient.
 Demerites Of Psychotherapy:
The psychotherapy is not much effective in the patient ,whose insight is absent (psychotic pts),
Low I.Q. level‘s persons.,Un co-operative patients
It require lot of time, money or energy.
Types / Techniques Of Psycho-social Therapy
Individual Behavioral Inter Group other Psycho-

Psychotherapy Psychotherapy Personal Psycho- social therapy
Psychotherapy therapy
I. Individual Psychotherapy :- Psychotherapy time Psychotherapy
type
1. Psycho – Analysis therapy :- Sigmund Freud
(i) Theory of mind :- levels

(ii) Theory of Structure of mind (structure of personality.
(iii)Theory of Ego :- Defense Mechanism
(iv) Theory of Psycho - Sexual Development
(v) Theory of Dream :-
Freud Dream ―Royal Road to conscious‖
PSYCHO-THERAPY
 Techniques of Psycho Analysis (By Freud) :-

 Free Association :-
Repressed desires Catharis
 Dream Analysis :- lkexzh -

lkexzh ,
 Interpretation and Re-education :-

 Transference :- Terminal phase,
2. Hypnosis :- .
 Hypnosis Hypnos sleep.
 Hypnosis Braid
 Hypnosis is an artificially induced state in which the person is relaxed and suggestible.
The relaxation is guided by the therapist, it means for entering an altered state of consciousness
and in this state using visualization and suggestion to bring about desired changes in behavior
and thinking.
 Hypnosis Peripheral awareness
 Indications :-
 Hysteria
 Childhood disorder
 Psycho-somatic disorders.
3. Abreaction Therapy :-
 Abreaction therapy Hypnosis Psycho-Analysis
 Abreaction therapy is a process by which repressed material, particularly a pain full experience
or conflict is brought back to consciousness then it relieves from conscious level.
 This therapy is most useful in post traumatic stress disorder.
 Abreaction therapy can be done with the use of medication thiopental sodium.
4. Supportive Psychotherapy :-
 It is a form of ―Surface therapy‖.
 In this, the therapist helps the patient to relieve emotional distress and symptoms without
probing into the post or attempting to change in the basic personality of the individual.
 The various techniques of supportive psychotherapy are –
PSYCHO-THERAPY
a) Mental Ventilation :-
 It is a free expression of feeling or emotions.
 In this, the Pt is allowed to talk freely whatever comes to his mind.
b) Environment Modification:-
 condition Environment e.g. A manic Pt
Non-stimulating environment A depressive Pt Socialist
c) Persuasion :-
 Process Therapist
Advice Behavior modification
d) Re-education and Re-assurance :-

 Therapy self confidence e.g. ―
‖
e) Explanation / Suggestion :-

II. Behaviour Therapy :-

It is the form of Psychotherapy which focuses on modifying faulty behavior rather than basic
changes in the personality by applying Basic learning techniques.
 Indication :-
 Neurosis (Anxiety, Phobia, OCN, Hysteria)
 Sexual disorder
 Childhood disorders (Nail biting, Thumb sucking)
 Eating disorders (Anorexia Nervosa, Bulimia Nervosa)
 Psychosomatic disorder
 Psycho – Active substance Abuse & Alcoholic Dependent disorders
 Types of Behavior therapy :-

1. Systemic Desensitization :-
 Mainly used in phobia and OCN
 It is a form of behavior therapy to reduce or eliminate fear or Anxiety.
 It is developed by J. Wolpe.
PSYCHO-THERAPY
 There are three steps in the therapy :-
(i) The patient is trained in deep muscle Relaxation.
(ii) The Anxiety or fear provoking situations are placed from the strongest to weakest order
(Hierarchy formation).
(iii) Systemic Desensitization :-

 S.D.I. : (Imagination)- Anxiety fear situation
 S.D.R. (Reality):- Anxiety situation reality
e.g. - Road cross
2. Flooding (Implosive Therapy) :-

 Commonly used in Anxiety or Phobia.
 In this therapy An Individual or patient is exposed directly to a maximum Intensity fear
producing situation either in Imagination or in real life.
 In this, at last, the patient gradually feels that no actual danger in this situation.
 It is just opposite to systemic desensitization e.g. A person has developed intense phobia of a
lizard then during a psychotherapy session suddenly the therapist put a rubberized lizard on a
table in front of patient.
3. Aversion Therapy :-
 Mainly used in Alcohol dependence
 Child psychiatric disorders
 It is a form of behavior therapy in which the patient is conditioned to avoid an
undesirable behavior or symptoms by associating them with painful or unpleasant
stimulus.
 E.g. (i) Putting a bitter taste(unpleasurable stimulus) on nails or tongue for nail biting in
children / adults.
(ii) Disulfirum therapy in Alcoholism:-

Alcohol + Disulfirum Acetaldehyde Co2 + H2o
Acetate
Cause
Nausea, Vomiting, Headache, Sweating, hypotension
(iii) Thumb sucking low voltage electric current pairing
PSYCHO-THERAPY
4. Assertiveness Training :-
 Technique Role playing
 therapy
 therapy modeling or Role playing
 therapy usually Endomorphic personality / Shy person
Conditioning Procedure For Increasing Wanted Behaviour

OR
Decreasing/eliminating A Undesired Behaviour
(A) Positive Reinforcement :-

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 (positive stimulus) for doing homework (behavior).
 The little boy receives $5.00 (positive stimulus) for every A he earns on his report card
(behavior).
 A father gives his daughter candy (positive stimulus) for cleaning up toys (behavior).
(B) Negative Reinforcement :- Techniques Negative

reinforcement A response or behavior is strengthened by stopping, removing or
avoiding a negative outcome or aversive stimulus. e.g. On Monday morning a person leave the
house early in order to avoid getting stuck in traffic and being late (aversive stimulus) for class.
(C) Modelling :- Techniques observational learning e.g.-

(wearing cloth by seeing other patient)
(D) Token Economy :-

 positive reinforcement
 Token Token
, special diet
(E) Time-out :- e.g. – Home work
(F) Punishment :- patient / person faulty behavior
PSYCHO-THERAPY
(G) Satiation :- Techniques Undesired Behaviour
5.Response Shaping :-
 therapy usually mentally Retarded therapy
step wise
 E.g. M.R. child
e.g. ,
6. Relaxation Techniques :-
 These Techniques are commonly used to reduce Anxiety. E.g. –
(a) Meditation:-
(b) Bio Feed back- it is the use of Instrumentation to become aware of process in the body that
usually go unnoticed and to help bring them under voluntary control. E.g. B.P., Heart rate,
Muscular tension, temperature.
(c) Cognitive therapy / Cognitive Behaviour therapy (CBT):-
 Cognitive therapy is a Psychotherapeatic Approach based on the idea that behavior is secondary
to thinking.
 It focuses on how patients think about themselves and their world, make changes in current way
of thinking and behavior.
 It is the best therapy for the patient of phobia, OCN, Anorexia Nervosa, Bullimia Nervosa.
III. Interpersonal Therapy :-

Interpersonal therapy is a type of Psychotherapy in which there is emphasis on the interpersonal
relationship of the various person involved such as husband, wife and one or more parties.
a) Marietal Therapy:- This Psychotherapy is directed at improving a disturbed marital

relationship.
b) Family Therapy :- It is a form of group Psychotherapy in which family is a therapeutic unit.

The objective of family therapy is not merely to improve relationship but to modify home
influences that contributes to the disorder of one or more family members.
IV. Group therapy :-

 It is a form of Psychotherapy in which a group of pt is provided Psychotherapy by a group of
Psychiatrist or therapist as well as the patients intract with each other & help in problem
solving.
 It is very useful for the depressive patient and patient of PASAD.
PSYCHO-THERAPY
 Descrition and Advantages of Group therapy :-
1. Less time consuming, at a time Psychotherapy is given to about 6-10 pts.
2. session of Psychotherapy are held once in a week.
3. Duration of session longer than individual psychotherapy (1 to 2 hours).
 Steps of Group therapy :-

1. Pre-introduction phase :- Physical set up, place, time, group member, goal of therapy etc.
2. Initial / Orientation phase :- group members Therpaist

3. Working Phase :- Most important phase of group therapy. group members
Psychotherapy
4. Termination Phase :-
 Phase
 Problems arising during this phase Anxiety, Dependency of patient on therapist.
 Demerits of Group therapy :-

privacy explain
Self help group:- eg. Alcholics Anonymous
V. Other Psychosocial Therapy :-

(1) Milieu Therapy :- (Therapeutic Community)
 Milieu means Environment or setting.
 Therapeutic milieu means providing a healthy environment which helps in the recovery
of a patient.
 Therapeutic community is a term applied by the English psychiatris ―Maxwell Jones‖
(1953) to a mental hospital that utilizes therapy in this approach, the entire environment
of a mental hospital or a Psychiatric ward is organized in such a way to achieve the aim
of promoting recovery in the patient and preventing complication which may occur due
to stay in the hospital.
 Milieu therapy or Therapeutic community approach attempt to make the maximum use
of
(i) the social system and its constituents (e.g. patient, his relative and neighbours)
(ii) personnal of the hospital community (e.g. psychiatrist, nurse, psychologist, social
worker, other patients) to modify the patient‘s behavior so that he may manage his life
and his personal relationship in a more constructive manner.
PSYCHO-THERAPY
(2) Attitude Therapy :-
Attitude therapy is a form of milieu therapy in which all staff members assume a
consistent, prescribed attitude designed to be therapeutic towards patients.
(3) Occupational Therapy :-

 Any Activity (mental or physical) which contributes to the recovery & rehabilitation of
mentally ill is known as occupational therapy.
 Any goal directed activity meaningful to the individual providing feed back to him about
his worth & value as an individual & about his Inter relatedness to other.
 Occupation therapy is a type of Rehabilitation technique.
 Types of Activity in Occupational therapy :-

 Craft work,Needle & tailoring work, Basket making, Carpentry, Gardening, Painting
 Mat-weaving ( ), Weaving ( ), chair caning,, Wood work ,Cooking.
(4) Music Therapy :-

It is the functional application of music towards the attainment of special therapeutic goal.
(5) Dance Therapy :-
It is the Psycho therapeutic use of movement which furthers the emotional and physical
integration of the individual.
(6) Recreational Therapy:-
It is a planned Therapeutic activity that enables people with limitations to engage in
recreational experiences. Such as-play activity, games, looking a pictures, reading etc.
DEFENCE MECHANISM
Defence Mechanism dk iz;ksx loZizFke Ýk;M us fd;k FkkA
 Mental Mechanism Adjustment dk ,d rjhdk gSA ftlds }kjk O;fDr fdlh ifjfLfFkfr ds dkj.k mRiUu ruko
dks de djrk gS ;k lekIr djrk gSA
 Defense mechanisms are one way of looking at how people defend themselves from a full
awareness of unpleasant thoughts, feelings and behaviors
Classification :-
1. Compensation :- ¼{kfriwfrZ½
- ;fn O;fDr ,d fn’kk esa fo’ks"k deh dk vuqHko djs rks og nwljh fn’kk esa bldh iwfrZ djus dk iz;kl djrk gSA
a) ijh{kk esa Qsy [ksy esa vkxsA
b) dkyhnkl vui<+ ij egku dfo
c) yMdh dq:i@dkyh gSA ij i<+kbZ esa gksf’k;kj gSA
2. Substitution :- ¼izfrLFkkiu½
O;fDRk viuh {kerk ls vf/kd Åapk y{; fu/kkZfjr djs] vlQy gks tk, rks nwljk y{; pqu ysA
e.g. M.B.B.S. uk lgh] Nsg gh lghA
3. Sublimation :- (mUu;u)
- izsj.kk dh ’kfDr dks mlds lkekU; y{;ksa ls gVkdj mUur y{;ksa esa yxk nsukA e.g.-
i) egkdfo rqylhnkl iRuh ls vVwV izse iRuh ds dgus ij jkeHkDr cu x,A
ii) ,d izseh viuh izsfedk ds fo;ksx esa vPNk dfo cu ldrk gSA
iii) ,d vfookfgr L=h ulZjh Ldwy esa v/;kfidk cudj viuh nfer ekr`Ro izsj.kk dks vfHkO;Dr djrh gSA
4. Rationalization :- ¼;qfDrdj.k½
 blesa O;fDr vPNs rdZ nsdj vius }kjk fd, x, dk;Z dks mfpr Bgjkus dk iz;kl djrk gSA
 e.g. fo|kFkhZ ijh{kk esa Qsy] Teacher dks nks"k
 ckbd ugha gS dgrk gS dksSu risk ysA
 L=h T;knk shoping djsA diM+s lLrs gSa cktkj esa lsy yxh gSA
 vkylh O;fDr iSlk ugha dekrkA dgrk gSA iSlk lkjh fcekfj;ksa dh tM+ gSA
5. Repression :- ¼neu½
 bls selective forgetting Hkh dgk tkrk gSA blesa vokafNr vkSj nq[knk;d fopkj] izo`fr;ksa vkSj Le`fr;ksa psru eu ls
vpsru eu esa /kdsy nh tkrh gSA
 e.g. - ,d fo|kFkhZ Hk;adj ,DlhMs.M dj nsrk gSA vkSj og bl Le`fr :i ls Hkwy tkrk gSA
6. Denial ([k.M+u):- Plain ordinary Rejection

 O;fDr tc dHkh Hkh fo"ke ifjfLFkfr dk lkeuk djrk gS rks dqN le; rd fd, x, [k.M+u ls mlds eu dks ml
okLrfodrk dks ekuus gsrq rS;kjh dk le; fey tkrk gSA
 E.g. M.I. okyk ejht viuh fcekjh dks lgh ugha ekurkA
 o`) O;fDr ;g ugha ekurs fd mudh ’kkfjfjd vkSj ekufld ’kfDr {kh.k gksrh tk jgh gSA
 ?kj esa fdlh dh e`R;q gks tkus ij dqN fnuksa rd [kkus dh table ij ml e`r O;fDr dk LFkku [kkyh NksM+k tkrk gSA
DEFENCE MECHANISM
7. Identification :- ¼rknkO;;½
 bl Defense Mechanism esa O;fDr viuk O;ogkj ,viuh fdz;kvksa ,oa vius vkidks fdlh vU; O;fDr ds vuqlkj
cukus dk iz;kl djrk gSA
 E.g. – ;qok yksx ghjks vkSj ghjksbZu dh udy djrs gSA
 ,d yM+dh Hospital esa Admit gksus ds ckn ulZ ;k MkDVj cuuk pkgrh gSA
8. Transference :- ¼LFkkukUrj.k½
 blesa O;fDr }kjk ,d O;fDr dk izfr:i fdlh vU; O;fDr ds :i esa ns[krk gSA
 e.g. - vLirky esa HkrhZ o`) O;fDr ulZ dks viuh csVh ds :i esa ns[krk gSaA
9. Suppression ¼’keu½ :-
 O;fDr tku cw>dj vius nq[kn vuqHkoksa dks Hkwyus dk iz;kl djrk gSA ;g Hkh selective forgetting dk gh ,d izdkj
gSA
 E.g. ,d fo|kFkhZ ijh{kk ls igys vius fe= ds lkFk >M+i dks ijh{kk ds nkSjku tkucw>dj Hkwyus dh dksf’k’k djrk gSA
10. Displacement (foLFkkiu) :-
 bl Defense Mechanism esa fdlh O;fDr dh emotional Feeling fdlh nwljs O;fDr, object ¼tks fd de
[krjukd gks½ ij displace gks tkrh Gsa
 e.g. O;fDr }kjk vkfQl dk xqLlk ?kj ij wife ij mrkjukA
 fo|kFkhZ }kjk Teacher dh MkWaV dk xqLlk vius NksVs HkkbZ ij mrkjukA
11. Withdrawl (izR;kgkj):-
tc dHkh O;fDr dks fdlh vlQyrk dk Hk; gksrk gS rks og withdrawl dk lgkjk ysrk gSA vkSj og dfBu
ifjfLFkfr;ksa ls Hkkxus dk iz;kl djrk gSA
12. Projection (iz{ksi.k) :- ([kqn dh deh ij nwljksa dks nks"k nsuk)
 E.g. ,d ulZ tks clinical field esa fuiw.k ugha gSa] og vU; ij Bhd ls dke u djus dk vkjksi yxk ldrh gSA
 dqN ifr&iRuh vius ifjokj ds lq[k ,oa vkuUn ds vHkko ds fy, vius cPpksa dks nks"k nsrs gSA
13. Regression (izfrxeu):-
 bls Flight to childhood Hkh dgk tkrk gSA
 blesa O;fDr vius ls de voLFkk ds O;fDr dh rjg O;ogkj djrk gSA
 e.g. dfBu ifjfLFkfr esa vxwBk pwluk ,oa uk[kwu dkVukA
 O;Ld voLFkk esa Temper Tantrum dk izn’kZu djukA
14.Fixation (fLFkfjdj.k):-
 blesa O;fDr O;Ld gksus ds ckotwn vifjiDo cuk jgrk gS vkSj mldk O;fDrRo ,d fodkl fcUnq ij vkdj fLFkj gks
tkrk gSA
 e.g. Thumb suking in Adult age.
15. Reaction Formation :- ¼izfrfdz;k fuekZ.k½
 blesa Unacceptable real feeling dks repressed fd;k tkrk gS vkSj Acceptable opposite feeling dks
expressed fd;k tkrk gSA
 E.g. ,d woman tks Actually viuh mother-in law dks ukilUn djrh gSA exj vkSj O;fDr;ksa ds lkeus lkl dk
vR;f/kd vknj ,oa ns[kHkky djrh gSA
DEFENCE MECHANISM
16. Fantasy (dYiuk rjax):-

 euq"; esa fd’kksjkoLFkk (13-19 years) esa Day – Dreaming dh izo`fr vf/kd gksrh gS bl voLFkk esa fur ubZ
leL;k,a mRiUu gksrh gS tc O;fDr bu leL;kvksa dks okLrfod :i ls ugha lqy>k ikrs rks Fantasy dk lgkjk ysrs
gSA
 e.g. ,d vikfg.k O;fDr ns[krk gS fd og ,d izfl) f[kykM+h cu x;k gSA ,d O;fDr tks vLirky esa yEcs le; ls
HkrhZ gSa og dYiuk dj ldrk gS fd og Bhd gks tk,xk rks mlds thou esa vusd lq[kn ?kVuk, ?kfVr gksxhA
17. Intellectualization:
A form of isolation; concentrating on the intellectual components of a situation so as to
distance oneself from the associated anxiety-provoking emotions; separation of emotion from ideas;
thinking about wishes in formal, affectively bland terms and not acting on them; avoiding unacceptable
emotions by focusing on the intellectual aspects.
18 .Conversion
The expression of an intrapsychic conflict as a physical symptom; some examples include
blindness, deafness, paralysis, or numbness. This phenomenon is sometimes called hysteria.
19. Introjection:
Identifying with some idea or object so deeply that it becomes a part of that person. For
example, introjection occurs when we take on attributes of other people who seem better able to cope
with the situation than we do.
20. Dissociation:
People who use dissociation as a defense mechanism tend to momentarily lose their connection to
the world around them. They may feel separated from the outside world, as though they exist in another
realm. Dissociation often helps people to cope with uncomfortable situations by ‗removing‘ themselves
from them. The may enter a state of daydreaming, staring into space and letting their mind wander until
someone nudges them, prompting them to acknowledge reality once more.
 Freud theory of Personality Development:-

 Sigmund Freud us bl fl)kUr dks izLrqr fd;kA
 ;g eq[;:i personality ds nks igyw dk o.kZu djrk gSA
(i). Subsystem of Personality :- (structure of personality/mind) blds vUrxZr QzkbM bldks rhu Hkkxksa esa ckVk
gSA
a) Id: ;g LokFkhZ] LodsfUnzr] uncorsious state vkSj primary thinking process ij vk/kkfjr gSA ;g oks fopkj
tks fdlh oLrq dks ns[kus ij loZizFke vkrs gSA ;g fdlh Hkh bPNk ds rqjUr lUrqf"V ij tksj nsrk gSA
 Id is the primary source of psychic energy, it is present at the time of birth. It is
biological in nature. It can not delay gratification so it is childish in nature. It seeks
immediate gratification.
 Id operates on the pleasure principle. It is unaware about social norms, cultural
values, ethics, wrong or right, & good or bad.
DEFENCE MECHANISM
b) Ego: bls self Hkh dgrs gSA ;g Id ij fu;U=.k djrk gSA bls secondary thinking process Hkh dgk tkrk
gSA
 Ego bPNkiwfrZ gsrq lgh le; o lgh ifjfLFkfr ij tksj nsrk gSA
 ;g Id vkSj Super ego ds e/; lUrqyu LFkkfir djrk gSA
 Ego is that part of personality by which we represent ourselves. Ego is conscious the
nature. Ego is based on reality principle.
 It awares about social value, cultural norms, ethics, social values etc. Ego is a
decision making component.
 It can delay gratification & can create appropriate conditions to achieve something.
Personality make up is depend on the ego strength.
c) Super Ego: bls Higher self Hkh dgk tkrk gSA

 Super ego is judicial branch of personality. Super ego works for morals, social
norms, ethics. Super ego works against Id.
 Super ego consists mainly prohibitions learned from parents, elders and other
authorities.
 blds fodkl ij cPpksa ds ekrk&firk /keZ egRoiw.kZ O;fDr;ksa o ifjos’k dk izHkko iM+rk gSA ;g lgh vkSj
xyr dk fu/kkZj.k djrk gSA
 ;g eu dk Super consious Hkkx gSA
E.g. :- 13 o"khZ; cPpk jkg pyrs ,d ?kj esa isM+ ij ids ve:n ns[krk gSA
 Id :- ve:n [kkus dh rqjUr bPNk
 Ego :- ve:n pksjh djus ds fy, mi;qDr le;
 Super ego :- pksjh ugha djus dh lykg nsrk gSA
(ii) A theory of Personality dynamics: In this theory he gave three concept of mind.
 Conscious
 Sub Conscious
 Unconscious
 Conscious : It is a part by which individual aware about his own self.
 Unconscious: unconscious is a big store house of memories, in this individual is not aware
about himself but it play a important role in the behavior & personality development.
 Subconscious: Subconscious is between the conscious and unconscious mind.
PSYCHOSEXUL STAGES OF DEVELOPMENT
PSYCHOSEXUAL STAGES OF DEVELOPMENT
According to the famous psychoanalyst Sigmund Freud, children go through a series of
psychosexual stages that lead to the development of the adult personality. His theory described how
personality developed over the course of childhood. While the theory is well-known in psychology, it
has always been quite controversial, both during Freud's time and in modern psychology.
PSYCHOSEXUAL STAGES OF DEVELOPMENT

Oral Stage ( 0 – 1 year old ) – Child derives pleasure from oral activities, such as sucking and tasting.
Successful fulfillment of the infant‘s feeding needs and proper weaning may result in the establishment
of trust. Too much or, conversely, too little gratification can bring about an oral fixation for the adult
individual, represented by a preoccupation with oral activities such as drinking alcohol, smoking, over
eating, or nail biting.
Anal Stage ( 2 – 3 years old ) – The main source of gratification is the ability to control bladder
movement and the elimination or retention of feces. A positive and appropriate experience revolving
around toilet training can encourage competence, creativity and productivity in individuals. Contrarily,
anal fixations can translate to obsession with perfection, extreme cleanliness, and control or the opposite
which is messiness and disorganization in adulthood.
Phallic Stage ( 3 – 6 years old ) – The focus of pleasure is the genitals. Boys start to perceive their
fathers as rivals for their mother‘s affections while girls feel similarly toward their mother. Fear of
punishment can lead to repression of feelings felt toward the opposite sex parent. Fixation at this stage
may bring about sexual deviancy or weak sexual identity.
Latency Period ( 6 years to puberty ) – At this stage, sexual urges are repressed and the individual
spends most of his time interacting with same sex peers, engaging in hobbies and acquiring skills.
Genital Stage ( puberty onward ) – Focus is on the sexual urges that are reawakened and are directed
toward opposite sex peers, with genitals as the primary source of pleasure. Individuals who completed
the earlier stages successfully become well-adjusted, caring and secure individuals.
MENTAL DISORDERS
Indian Classification System of Psychiatric illness :-
(Neki, Wig, Singer, Verma) ICD-8 Modify mental
illness classify
MENTAL illness (Mental Disorders)
Psychotic Disorder Neurosis Special Disorder

e.g. e.g.
-Anxiety -Childhood disorder
Functional (Mood) Organic -OCN -Personality Disorder
Psychotic Affective Psychotic -Phobia -Psycho Active
Disorder Psychotic Disorder -Neurotic Depression Substance
Disorder -Hysteria Abuse Disorder
Schizophrenia -Delirium -Mental
-Mania(BAD) -Dementia Retardation
-Depression Conversion Dissociation -Sexual Disorder
Disorder Disorder -Psychosomatic
Disorder
Psychosis :-
 It is a group of major mental illness (Disorder)
 Majority of patient in psychiatric hospital suffer from psychosis.
 In the psychosis, there is a major disturbances in the personality and mental process of an
individual.
 Person looses insight and Judgement.
 There is a gross disturbance of various mental functions such as thinking, emotions and
perception.
 Delusion & Hallucination are commonly present in the psychosis.
ORGANIC MENTAL DISORDERS
 Organic psychosis involves impairment of brain tissue function due to head injury, toxic
conditions, cerebral arteriosclerosis, Brain tumor, degeneration of brain tissue.
 Organic psychosis is clinically characterized by mild to severe impairment of consciousness,
memory, orientation, intelligence, Judgement and emotions.
Types of Organic Psychosis :-

1. Delirium (Acute Brain syndrome)
2. Dementia (Chronic Brain syndrome)
Delirium
(Acute Brain syndrome)
 Delirium is the commonest organic mental disorder seen in clinical practice.

 5-15% of all patients in medical and surgical units are estimated to develop delirium at some
time in their lives.
 The percentage is higher in post-operative patients.
 Delirium is also called Acute confusional states, Acute organic reaction, toxic psychosis.
 It is a state of clouded of consciousness in which attention can not be sustained, environment is
wrongly perceived & disturbance of thinking are present.
 It is acute in onset.
Etiology / Causes :-
1) Metabolic Causes :- Hypoxia, Hypoglycemia, fluid and electrolyte imbalance, metabolic
acidosis, Hypovolemia, shock, High grade fever.
2) Endo-crinal :- Hypo or Hyper – Thyroidism, pitutarism, Adrenalism.
3) Nutrient Deficiency :- Vit- B1, B2, B6, B12 , protein deficiency.
4) Brain related causes:- Epilepsy, Head injury, Cerebro vascular Accident (stroke) Intracranial
infections such as meningitis,encephalitis.
5) Drugs / Toxins :- Alcohol, sedatives, Anti convulsant, Heavy metal.
6) Severe infections :-
 Septicemia
 Endocarditis , pneumonia
7) Post – operatively :-
 One of the important causes of delirium, namely post cardiac surgery.
Clinical features :-
Clouding of consciousness, Disorientation (most commonly in time than in place),Decrease
Attention span and distractibility, Slurring of speech, sometime illusion & visual Hallucination.,
Disturabance of sleep-wake cycle :- most commonly insomnia at night with day time drowsiness.,
Diurnal variation is marked usually with worsening of symptoms in the evening and night (called sun-
downing).
Psychological symptoms includes, Anxiety, agitation etc, Physical symptoms Includes :-

Tremors Urinary incontinence, Tachycardia, Indigestion, Ataxia.
Diagnosis :-
 Depend mainly upon the clinical features.
 Duration of episode is less than 6 month.
Other Investigations :-
 CBC, Urinanalysis, Serum Hormones level, Liver function test, ABGs Analysis
 Chest x-ray, CSF Examination, CT Scan and MRI, Electro- encephalography.
 VIT B1 and B12 level, blood ammonia level.
 MENTAL STATUS EXAMINATION.
Management :-
1. Management of delirium depend upon the causative factor.
 E.g. 25% Dextrose in Hypoglycemia.
 O2 Administration in Hypoxia
 Thiamine deficiency – 100mg vitamine B1.
 IV fluid for fluid & electrolyte balance.
2. IF Psychotic feature are present, then administer Antipsychotic Drug and other Anxiolytics/
sedative to reduce insomnia & induce sleep. E.g.
 Haloperidol, Chlorpromazine, Resperidone
 Sedative :- such as lorazepalm.
3. Provision of diet high in calory and protein
4. T3 and T4 in Hypothroidism.
5. Anti Hypertensive in Hypertension.
6. Other Psychosocial therapy :-

 Occupational therapy
 Recreational therapy
 Family therapy.
Dementia
(Chronic Brain Syndrome)
 DEMENTIA is a chronic organic mental disorder, characterized by impairment of memory,

impairment of intellectual functions and deterioration of personality with lack of personal care.
With out impairment of consiousness.
Etiology :-
1. Perenchymatous brain disease:- (Degenerative brain disorders)
 Alzheimer's disease - commonest form of degenerative disorder.
 Parkinson‘s disease.
 Huntington‘s chorea.
2. Vascular Dementia :-
 Essential Hypertension
 Cerebro vascular accidents.
 Multi infarct cerebral dementia.
3. Toxic Dementia :-
 Bromide Intoxication
 Heavy metals, Alcohol
 Carbon – monoxide
(i) Endocrinal
(ii) Metabolic Just like Delirium.
(iii)Brain related factors
(iv) Deficiency Dementias
Types of Dementia :-
1. Alzheimer‘s Dementia :- commonest type
2. Multi-infarct Dementia :- second commonest type
3. Hypothyrold Dementia.
4. AIDs Dementia Complex.
Clinical Features :-
 Onset of clinical features of disease are gradual (more than 6 month)
 Memory impairment (mainly immediatc and recent )
 Impairment of Intellectual functions, Poor personal Hygiene
 Aphasia ( lnability to communicate or speak)
 Apraxia (Impairment of motor Activity or loss of under standing for the use of things/ loss of
ability to execute or carry out learned purposefull movement)
 Ataxia (Impairment of motor-Activity co-ordination).
 Agnosia(inability to understand sensory impression)
 Visual Hallucination & some time delusion may also present.
Diagnosis :-
 Depends upon the clinical features
 Other Investigation are same just like Delirium.
Management :-
Depends upon the causative factors.
 Hormonal therapy in Endocrinal Abnormalities
 Anti Hypertensive Drug in Hypertension
 Rivastigmine, donepezil and Galantamine in Alzheimer (Anti Alzheimer Drugs).
 Anti Psychotic e.g. Haloperidol, Resperidone.
 Anxiolyties or sedatives – Lorazepalm, Alperazolam.
Psychotherapy :-
 Cognitive Behavior therapy
 Occupational therapy
 Family therapy
 Recreational therapy.
Difference b/w Delirium and Dementia
1. Causes Due to any other Medical Due to mainly Degenerative
illness or Alcohol Intoxication disease of brain e.g.
or post operatively. Alzheimers disease parkinsons
disease.
2. Onset Acute Chronic (gradual)
3. Duration For few day or few week More than six months
4. Course Reversible Ir-reversible
5. Clinical features Cloudiness of consciousness Consciousness is not impaired
(i)Consiousness
(ii)Disorientation Commonly present Not present
(iii)Attention Distractibility are commonly Attention is not affected.
present, pt cannot sustain
attention for long time.
(iv) Memory Slight impairment in memory Gross Impairment mainly in

immediate memory.
(v) Sleep-wake cycle Severly impaired Normal

(vi) Diurnal Variation in Present symptoms become Not present
Clinical features (Sun- severe after evening.
downing)
(vii) Delusion Delusion may be present Rarely present
(viii) Hallucination Usually present Rarely present
SCHIZOPHRENIA
Schizophrenia:- xzhd world (eu esa njkj)

 Schizo :- Split (njkj)
 Phrenic :- mind
 Schizophrenia uke Eugen bleular us fn;kA
 1896 esa emil krapelin us Shizophrenia dks dementia Praecox uke fn;Ka
Defination:-
Schizophrenia refer‘s to a group of mental illness characterized by a specific Psychological
symptoms leading to disorganization of the personality of an individual.
The symptoms of schizophrenia chiefly interfare with the patient‘s thinking, emotions and
Behaviour in a characterstic way.
According to American Psychiatric Association ―A group of disorders manifested by
characterstic disturbance of thinking mood and behavior‖.
Disturbance in thinking is marked by alteration of concept formation which lead to
misinterpretation of reality and some time to delusion and hallucination.
Mood changes include ambivalence, constricted and inappropriate emotional responsiveness and
loss of empathy with other.
Behaviour may be withdrawn, regressive and bizarre.
Etiology or Causes :-
There is no definite etiology of schizophrenia probably. Several factors contribute to the
development of illness. Such as-
 Biological Factors :-
 Psychosocial Factors:-
 Socio-cultureal Factors :-.
 Other Factors :-
a) Intelligence :- People with low I.Q. are more predisposing to schizophrenia.
b) Social Isolation:-
c) Over crowdy areas :-
d) Endocrine, biochemical, Dopaminergic(increase dopamine level) & Chollinergic
neurotransmitter system disturbances.
e) Organic Factors :- Infection, poison and trauma.
f) Vit – Deficiency :- B1, B6, B12 and ViT-C.
g) Precipitatory factors:-
h) Physical and Psychological stress.
 Pregnancy & child birth.,Psycho active substance abuse disorder.
SCHIZOPHRENIA
Clinical Menifestation :-
They are classified as-
I. Primary and secondary symptoms (According to Bleuler)
II. Positive and Negative symptoms (ACCn to recent concept)
I. Primary and secondary symptoms
A. Primary / Fundamental Symptoms :- Which are present to some extent in every case of
schizophrenia. ( 4A Symtoms )
a) Associative Disturbance or Looseness :- Pattern of spontaneous speech.
b) Autims :- One of the most classical feature.
c) Affect Inappropriate :-
d) Ambivalence :-
B. Secondary Symptoms / Accessory Symtoms :- Which may or may not be present.

a) Disorder of Perception :-
(i) Hallucination :- Auditory are most common, other type may also be present.
(ii) Illusion :- Rope ( ) is perceived as snake.
b) Disorder of thought :-
(i) Thought Insertion, Thought withdrawl, thought broadcasting, word salad, incoherence.
(ii) Delusion :- Delusion of persecution, ideas of control and ideas of reference,
depersonalization, Neologism and mutism.
c) Disorder of Activity :-
 Negativism and Automatism
 Stereo type speech, echololia and Verbigeration
 Stereo type activity, echopraxia, Mennerism
d) Deteriorated Apearance and Manner :-
 Schizophrenic patients have to the reminded of bath, wash and shave and other routine
activities.
e) Disturbance in Attention :- The pt is not able to hold attention for a long time. He/she lives in
his own autistic world.
f) Insight in Schizophrenic :- It is affected severly in schizophrenia.
II. Positive and Negative Symptoms of Schizophrenia :-
ACCn to recent concept :-
A. Positive Symptoms :- (Additional behavior)
a) Delusion
b) Hallucination
c) Bizarre behavior
d) Grandiosity
e) Hostility
f) Aggression
g) Suspiciousness, Excitement
SCHIZOPHRENIA
B. Negative Symptoms :- Deficit of behavior.

a) Apathy
b) Avolition(lack of motivation)
c) Emotional blunting
d) Social withdrawl
e) Thought blockng.
f) Mutism
g) Alogia (Lack of Speech)
h) Artificial gestures
i) Hopelessness
j) Reduced Attention
k) Sucidal tendencies.
l) Anhedonia :-
Classification / Types of Schizophrenia :-

Classification of schizophrenia is not static. There is overlapping of symptomatology broadly two
groups are recognized.
a) Typical :- (a) Simple (b) Hebephrenic (c) Catatonic (d) Paranoid (e) Undifferentiated or mixed
type.
b) Atypical :- (a) Juvenile and childhood (b) Late schizophrenia (c) Schizoaffective Psychosis (d)
Psuedoneurotic (e) Latent (f) Residual.
The Type of Schizophrenic disorders ACCn to ICD – 10:-

F20 – 0 Paranoid Schizophrenia
F20 – 1 Hebephrenic Schizophrenia
F20 - 2 Catatonic Schizophrenia
F20 - 3 Undifferentiated Schizophrenia
F20 - 4 Post Schizophrenic depression
F20 - 5 Residual Schizophrenia
F20 - 6 Simple Schizophrenia
F20 - 8 Other Schizophrenia
F20 - 9 Schizophrenia Unspecified.
1. Simple Schizophrenia :- (F20 - 6)

 It commonly occur at the age of 15-20 years (during adolescence).
 Onset of disease is gradual.
 More common in male than in females, social withdrawl, blunt emotions.
 Disturbance of affect is most marked (Lack of intrest in human relation, emotion & Activity)
 Thinking and behavior disturbance are also present.
 Delusion and hallucination are rare.
 Prognosis is not good, ECT is not effective.
SCHIZOPHRENIA
2. Hebephrenic Schizophrenia :- (Disorganized Schizophrenia F20 – 1)
 It occur around the age of 20 to 25 year.
 Onset is gradual
 Thinking disturbance is most marked.
 Hallucination (visual) & Delusion present.
 Prognosis is not good. ECT is not effective.
 Behaviour of hebephrenic schizophrenia is indicated as ―silly‖ behavior (Childish
behavior/regressive behavior). E.g. the Pt urinates and defecats in the bed.
 Eats with fingers, masturbates openly, Resist wearing clothes.
3. Catatonic Type :- (F20 - 2)

 It commonly occur at the age of 25-35 years.
 Onset is acute / sudden.
 Marked disturbance in thinking, behavior and affect.
 Prognosis is good but recurrences are common. ECT is very effective.
 Catatonic patient present two main type of clinical picture.
4. Catatonic Stupor :-
 It follow Depression & Apathy
 The Pt become uncommunicative characterized by falling intrest, preoccupation in his own
thought, emotional, poverty of ideas and dreaminess.
 Mute, stupours and mask like face.
 Catalepsy or waxy flexibility is present.
 Negativism and somatie disturbances are present.
 The Pt refuse to ear occasionally.
 Dribbling of saliva from angular region.
 Involuntary passes urine and stool in the bed.
 The pt do not show avoiding sign to painful stimuli.
5. Catatonic excitment :-
 The Pt may behave in a wild and quite unpredictable manner.
 He show an aggressive motor activity which is not accompanied by an emotional expression.
 The pt may suddenly attack to anybody standing near by‘ Break and destroy articles, tear clothes
and remain nude.
 Flow of speech from mutism to flight of ideas.
 Negativism, Halluciantion, sleeplessness and dehydration are present.
 Homosexual prone and assaultive.
 The pt is not consistently joyful as in the case of mania.
SCHIZOPHRENIA
6. Paranoid Schizophrenia :- (F20 - 0)
 This is the most common type of Schizophrenia Psychosis.
 The onset is gradual most of time, acute may also be present.
 It usually occur after 30 year of age.
 These patient are extremely suspicious.
 Delusions of persecution, reference, Delusion of control are marked in them.
 Hypochondnal delusions are also present.
 Hallucination are very common, the pt hallucinate threatening voices, warning voices, and
voices directing him what to do.
 Poor IPR and withdrawn from other..
7. Childhood or Juvenile :-
 Usually occur at 5 to 10 year (childhood) and 12 to 14 yrs (Juvenile).
 Onset is acute or gradual
 Prognosis is not good.
 Preoccupation with fantasy withdrawn and atypical behavior.
8. Late Schizophrenia :-
 It occur around the age of 40 yrs. With the symptom of Schizophrenia.
9. Schizo Affective Schizophrenia :-

 It is associated with the symptoms of depression & mania.
10. Psuedo neurotic Schizophrenia :-

 It is associated & symptoms of neurotic illness like Anxiety, Phobia, OCN and hysteria.
11. Latent Schizophrenia :-

It is characterized by various symptoms of schizophrenia but lack of full intensity of symptoms.
12. Residual Schizophrenia:-

It is a chronic form of Schizophrenia in which symptoms persist after acute phase, but patient
can do his routine work as he has attained ―Social recovery‖.
13. Undifferentiated :-
The various symptoms of Schizophrenia cannot be grouped into one of the above types.
Management of Schizophrenia :-
The selection and method of treatment will depend on the type of schizophrenia, The patient‖ s
presenting and predominant symptoms. The approach to treatment is as follows:-
SCHIZOPHRENIC DISORDERS
1. Electro- Convulsive therapy :- About 10-12 E.C.T. spread over a period of 4 to 6 weeks.
Indications :-
(i) Catatonic or paranoid Schizophrenia
(ii) Stupor, excitment or violent behavior of the patient.
(iii) Associated symptoms of depression or mania.
(iv) Suicidal and homicidal tendencies
(v) Patient not responding to other treatments.
2.Pharmacological MGT :-
 Antipsychotic drugs such as clozopine, Resperidone, Haloperidol and chlorpromazine .
 Antiparkinsonism drugs may be given to reduce the risk of Extra pyramidal symptoms (side
effect of Antipsychotic drug)
 Anxiolytics/sedatives-lorazepam, clonazepam,alperazolam.
3.Psychotherapy :-
 Supportive or Superficial Psychotherapy are given to the Schizophrenia patient.
 Such as-Individual therapy, Occupation, therapy Group, therapy Art, therapy Music therapy,
Recreational therapy, Milieu therapy (therapeutic environment).
4. Family-Psycho Education :-
 About the disease and its nature.
MOOD DISORDERS
Mood Disorders:-
Definition :-
Affective disorders are illness in which and mood change is the primary and dominant feature,
mood change is associated with characteristics changes in thinking, attitute and behavior.
Classification of Mood disorders
Manic Depressive Psychosis (MDP) Major depressive disorder (MDD)
Manic type Depressive type circular type
 Unipolar Disorder :- Only attack / recurrent episode of Depression.

 Bipolar Disorder :- Alternate episode of mania & Depression.
 Bipolar Ist :- Episode of severe mania and severe Depression.
 Bipolar IInd :- Alternate episode of Hypomania and severe Depression.
Classification ACCn to ICD – 10

 F30 — Manic episode.
 F31 — Bipolar Affective disorder.
 F32 — Depressive episodes.
 F33 — Recurrent depressive disorders.
 F34 — Persistent mood (Affective) disorders.
 F38 — Other mood (Affective) disorders.
 F39 — Unspecified mood (Affective) disorders
1. Manic Episode (F30) :-

The life time risk of manic episode is about 0.8 to 1%. The Episode lasting usually 3-4 months
followed by complete clinical recovery. The future episodes can be either manic, depressive or mixed.
The characteristics feature of manic episode is-
 Elated / Expansive mood, Increase Psychomotor activity, Increase speech (Tone, volume,
pressure) and thought disturbance (Flight of ideas).
2. Depressive Episode :- (F32)
 The life time risk of depression in male is – 8 – 12% and in female is 20- 26%.
 The characteristics features of Depressive episode is Sadness of mood, poverty of ides,
Decrease Psychomotor Activity, present of Psychotic feature (Delusion & Hallucination) and
disturbance in Biological functions, and suicidal ideation & attempt.
MOOD DISORDERS
1. Bipolar mood (Affective) Disorder :-(F 31)
 This disorder, earlier known as Manic depressive psychosis (MDP). This is characterized by
recurrent episodes of mania and depression (Mood swing) in the same patient at different times.
BAD (MDP-D) Mania

Normal Normal Normal Normal Normal
Depression Depression Deprerssion Depression
BAD (MDP-M)
Mania Mania Mania
Normal Normal Normal Normal Normal
Depression
2. Recurrent Depressive Episodes :- (F33)

 This disorder is characterized by recurrent (at least two) depressive Episode (Unipolar
depression).
3. Persistent Mood Disorders :- (F34)
 This disorders are characterized by persistent mood symptoms which last for more than 2 years.
 If the symptoms consist of persistent mild depression, the disorder is called as Dysthymia.
 If the symptoms consist of persistent Instability of mood between mild depression and mild
elation, the disorder is called as cyclothymia.
 (Cyclothymia is a form of bipolar disorder, consisting of recurrent hypomanic and dysthymic episodes,
but no full manic episodes or full major depressive episodes)
4. Other Mood Disorders :- (F38)
 This category includes the diagnosis of mixed Affective episode.
BIPOLAR AFFECTIVE DISORDER (Manic Depressive Psychosis)
 BAD(MDP) is characterized by recurrent episode of mania and depression in the same patient at
different times.
FACT ABOUT BAD AND MDD :-
 Incident Range :- The incidence range of BAD is 3 to 4 patients per 1,000 population.
 Sex :- The male / Female Incidence of BAD is 3: 2
 But Female esa Depression dh lEHkkouk male dh rqyuk esa nqxuh gksrh gSA
 Social Class :- It is thought that BAD occurs among people in high social class comparatively.
 Marital Status :- Depression dh lEHkkouk married people dh rqyuk esa Seperated or Divorced
people esa vf/kd gksrh gSA
 Professionals :- BAD is four times more in professionals than Non-professionals.
 Age :- BAD may commonly occur between the age of 20 to 35 years. Depression usually occur
between 35 to 50 years.
MOOD DISORDERS
Etiology / Causes / Risk Factors

1. Gentic Predisposition :-
 Pwfa d lkekU; population esa BAD dh laHkkouk 1-2% gksrh gSa ijUrq parents ls mudh lUrku esa mood disorder
dh transfer gksus dh laHkkouk 10 ls 15 xq.kk rd c<+ tkrh gSaA
2. Neurotransmitter :-
Due to Increase / Decrease of Neurotransmitters such as – serotonine, Nor-epinephrine. IN
Depression these Neurotransmitter are decrease and IN Mania these neurotransmitter are increased.
3. Constitutional factors:-
 Depression is common Melencholic or Endomorphic personality.
 BAD is more common in Cyclothymic personality.
4. Endocrinal:- Hypo / Hyper secretion of Endocrine glands.
5. Physiological Factors :-
 e.g. – Alcohol, Sedatives, Amphetamine, gluco-corticoids, or use of propranolol.
 Disease conditions such as stroke, Encepnalitis, T.B, Heart disease.
6. Psychological Factors :-
 Stress, loss of loved person, loss of self-esteem, failure in exam.
(i) MANIC EPISODES

It is characterized by triad of features such as- Elevation of Mood., Flight of Ideas, Increase
Psychomotor activity.
Features:-
1. Expansive Mood or Irritable Mood or Elevated Mood :-
 The elevated mood can pass through following four stages on the severity of manic episode-
A. Euphoria (Mild elevation of mood – stage I Mania) :-
 This is also called Hypomania
 An increase sense of Psychological well being and happiness.
 Person have high self confidence and look like a intelligent person.
B. Elation (Moderate elevation of mood – stage II Mania):-
 Sense of well being with increase psychomotor activity.
 Person viuh vkykspukvksa dks lgu ugha dj ikrk gSaA
C. Exaltation (severe mood elevation – stage III severe mania):-
 Elation + Delusion of grandiosity
D. Ecstasy (very severe elevation of mood (state ivth):-
 This is also called delirious or stuporous manic phase.
 In this person have extreme feeling that he is reborn.
MOOD DISORDERS
2. Increase Psychomotor Activity
 Increase Activeness, Restlessness , Busyness, Abnormal Attention.
3. Speech and thought disorders :-
 Increase Tone, volume and pressure (TVP) of speech., More talkative, big talk., Flight of ideas.,
Playful language, Hypermnesia, ,Delusion of grandiosity, Distractibility.
 Hallucination of auditory and visual often with religious content can occur .e.g. Hkxoku esjs lkeus
vkrs gSa vkSj eq>ls ckrs djrs gSaA
4. Other Features :-
 Loss of appetite, lack of sleep, increase interest in sexual activity, Increase demand of money by
patient, loss of body weight, Impaired Judgment, family disturbance.
(ii) Depressive Episode
 The episode is mostly characterized by triad of symptoms. These are –Sadness of mood Poverty
of ideas, Decrease Psychomotor Activity.
(i) Depressed Mood :- Depressive mood dks fuEu rhu izdkj ls classified fd;k x;k gSA
a. Mild depression :-
 Highly attentive, Highly sensitive to criticism.
 Low self-confidence, lack of interest in routine activity.
b. Acute / Severe depression :-
 Fixed head, loss of facial expression(apathy), become suspicious in nature ,Delusion of
guilt, delusion of self accusation. lack of interest in social activities.
c. Depressive stupor :- Intense form of depression.
 Anhedonia, Lack of all physical and mental activity of patient., Stupor
 Delusion of Nihilism, Auditory Hallucination.
(ii) Depressive Ideation :-
 Thought retardation(poverty of ideas), Reduced Judgment Capacity
 Marked Negatives ideas, Helplessness, Hopelessness., Worthlessness
 Suicidal ideation
(iii) Decrease Psychomotor Activity :-
 Less energy level, memory loss, loss of concentration.
 Restlessness, Decrease Daily routine activity.
(iv) Physical symptoms :-Fatigue, Insomnia, Weight loss, Perspiration, Decrease libido, chest pain,
palpitation, Abdominal discomfort, Constipation.
(v) Speech:- reduce Tone, volume and pressure of speech.
(vi) Suicide and Suicidal Ideation :- There is risk of suicide in every depressed patient with suicidal
Ideation.
MOOD DISORDERS
MANAGEMENT :
(1.) Electroconvulsive therapy :-
- Usually used for major Depression & Recurrent depression.
- 6-8 ECT –
3 In first week
2 In second week
1 In third week
(2.) Drug therapy :-
a) Antidepressants :- Tricyclic Antidepressant, SSRI‘s, MAOIs
b) Lithium therapy :- Lithium has traditionally been the Drug of choice for the treatment of manic
episode (Acute phase) as well as for prevention of further episodes in bipolar mood disorder.
c) Other mood Stabilizers :- Sodium valproate, Carbamazapine.
d) Antipsychotics :- e.g. Olenzapine, Resperidone, Chlorpromazine commonly used when
Psychotic (hallucination and delusion) features are present.
(3.) Diet therapy :-
- High protein and high Carbohydrate Diet.
(4.) Psychosocial treatment :-
 Cognitive behavior therapy.
 Interpersonal therapy:- family therapy & marietal therapy.
 Psycho Analytic Psychotherapy
 Behaviour therapy
 Group therapy
 Some Other Types of Depression :-

1. Post partum Depression :- it is an intense, sustained and sometimes disabling depression experienced by
women after giving birth. Postpartum depression, which affects 10–15% of women, typically sets in within three
months of labor, and lasts as long as three months. It is quite common for women to experience a short-term
feeling of tiredness and sadness in the first few weeks after giving birth; however, postpartum depression is
different because it can cause significant hardship and impaired functioning at home, work, or school as well as,
possibly, difficulty in relationships with family members, spouses, or friends, or even problems bonding with the
newborn. In the treatment of postpartum major depressive disorders and other unipolar depressions in women
who are breastfeeding, nortriptyline, paroxetine(Paxil), and sertraline are in general considered to be the
preferred medications.
2. Mixed Anxiety – Depressive Disorders :-
 This disorder is characterized by presence of depressive and Anxiety symptoms which result in
significant distress or disability in the person.
3. Masked Depression :-The depressive mood is not easily apparent and is usually hidden behind the
somatic symptoms.
4. Agitated Depression :-This is a type of severe depression with marked motor restlessness or
Agitation. (Increase PMA)
5. Seasonal mood disorder :-This is either a bipolar mood disorder or recurrent depressive episode
which tends to occur in the same season on each occasion. It is more commonly seen in women.This is
thought to be due to changes in the length of the day and its effect on Hypothalamus.
MOOD DISORDERS
6.Neurotic Depression :-
- Neurotic depression is usually characterized by the following features
i) Presence of mild to moderate depression.
ii) Depressive symptoms usually occur in response to a stressful situation but are often quite
S.No. FEATURES Endogenous Depression Exogenous Depression
1. Synonym bls Biological and psychotic Depression dgk tkrk bls Reactive ,oe~ Neurotic
gSaA depression dgk tkrk gSaA
2. Genesis Mainly due to Biological and personality related Mainly due to environmental
causes. causes.
3. Severity Very severe. Less severe.
4. Sleep pattern nsj jkr vfunzk O;fDr le; ij lksrk gS ,oa lcqg 3&4 cts izkjfEHkd vfunzk O;fDr nsj jkr rd lks ugha
tkx tkrk gSaA ikrk gSaA
5. Psychotic Feature Delusion (Nihilism)& Hallucination are mainly Not usually presents.
presents.
6. Treatment ECT, Anti-depressant drugs. Psychotherapy, antidepressant

drugs.
disproportionate to the severity of stress.

iii) Other neurotic symptoms like Anxiety, OCN and phobic symptoms are often present.
iv) Preoccupation with the stressful condition is common.
S. No. Features Organic Psychosis Functional Psychosis

1. Causes Impairment of brain tissue function due to Caused by
head injury, toxic conditions brain tumors, Biological Factor
systemic infections, and degenerative Psychosocial Factor
disorder of brain. Socio-cultural Factor.
2. Disturbance of Common Very rare
consciousness
3. Disturbance of Present Markedly affected
Memory, orientation
& Intelligence
4. Hallucination Usually visual Usually auditory
5. Physical Exam Feature of systemic disease or brain disease No abnormality which can explain
reveals mental illness.
6. Laboratory & Help in determining the etiological factor No specific abnormality are found
Radiological Exam responsible for psychosis & help in in these examination.
management of disease.
7. Treatment Depending upon the causative factor. ECT

Drug therapy
Psychotherapy
NEUROSIS
Neurosis:-
The term Neurosis is defined as –
i) The presence of a symptoms or group of symptoms which cause subjective distress to the
patient.
ii) Insight is present.
iii) The personality and behavior are relatively preserved and not usually grossly disturbed.
iv) The contact with reality is present.
v) There is an absence of organic causative factors.
The disorders in Neurosis are –

1. Anxiety disorder (Generalized Anxiety disorder)
2. Panic Anxiety disorder
3. Phobic Anxiety disorder
4. Obsessive – compulsive disorder (OCD/ OCN)
5. Dissociation – conversion disorder (DCD /HYSTERIA)
6. Reaction to severe stress and post traumatic stress disorder
7. Psycho – somatic disorder
8. Hypochondriasis
Etiology / Causative Factors of Neurosis :-
(i) Genetic
(ii) Neurotransmitter :- e.g. Anxiety esa GABA dk level de gks tkrk gSaA
(iii)Drug Induced Neurosis :- dqN fo’ks"k Drug ds yxkrkj Infusion / Inhalation ls Anxiety gks ldrh gSaA
e.g. – Infusion of sodium lactate, Inhalation of 5% co2, Nor-Adrenergic agents.
(iv) Organic brain disorders :- e.g. Head injury, Encephalitis.
(v) Life threatening disorder:-heart disease, HIV, cancer.
(vi) Psychological causes :-
 Psychic conflict , Individual susceptibility (Anxious personality, obsessive personality)
 Excessive stress, Low I.Q. Level, Environmental causes
ANXIETY DISORDERS
Anxiety Disorders
 It is a psychoneurotic disorder characterized by a state of apprehension or unease or nervousness
or unpleasant reaction arising out of anticipation of an imaginary danger.
 Anxiety is a commonest psychiatric symptom in clinical practice, normal Anxiety becomes
pathological when it causes significant subjective distress or impairment in routine functioning
of an individual.
 Anxiety is mainly classified under two group :-
1. Generalized Anxiety Disorder(GAD):- Anxiety is a mood. When it becomes a mental disorder,

that is, characterized by excessive, uncontrollable and often irrational worry about everyday
things that is disproportionate to the actual source of worry, it is diagnosed as generalized
anxiety disorder (GAD).
2. Panic Anxiety Disorder(PAD):- very severe acute episode of anxiety..
1. Generalised Anxiety Disorder (GAD) :-

 It is most common type of Anxiety disorder.
 The onset is gradual but long lasting (more than 6 month)
 Female are more affected than male (2:1)
 Usual age 30-40 year (third decade of life)
2. Panic Anxiety Disorder (PAD) :-
 The onset is Acute, the episode of panic attack lasts for 20-30 minutes, Anxiety mRiUu gksus ds 10
feuV i’pkr~ pje~ ij gksrh gSaA
 Main characterstic of panic attacks are –
 Lo;a ij fu;a=.k esa deh] Excessive perspiration, shortness of breathing.
 nkSjs ds nkSjku person vdsyk jgus ls Mjrk gSa], panic attack ds nkSjku person dks yxrk gS f d og ikxy gks
tk,xk ;k mldk Heart Fail gks tk,xk ;k og ej tk,xk ;k mldh fljnnZ ds dkj.k Brain dh uls QV tk,xhA
 At that time , the personality of individual is disturbed.
(i) Physical / Physiological Symptoms :-:- Tremors, Headache fearful facial expressions.
 Palpitation, chest pain, fainting (cSgks’kh), Tachypnoea, Dyspnoea
 Dry mouth, Abdominal pain, Dysphasia, Constipation, Nausea and vomiting
 frequency and urgency of micturation, Decrease sexual desire.
 Cold extremities, Numbness, fatigue.
(ii) Psychological Features :-
Poor concentration, Distractibility, Hyper arousal (tYnh gh mRrsftr gks tkuk)
 Insomnia , Increase sensitivity to Noise, Fearfulness , Irritability
 Feeling of impending doom/Disaster (ikxy gksus dk Mj] ejus dk Mj] fny dk nkSjk iMsxk] ne ?kqV
tk,xk)
 Worthlessness
 Perceptual symptoms :- Derealization, Depersonalization.
ANXIETY DISORDERS
 Role of GABA in Anxiety Production :-
 GABA (Gamma Amino Butyric Acid) is the most prevalent inhibitory Neurotransmitter in the
central Nervous system.
 It has been suggested that an alteration (Decrease) in GABA levels may lead to production of
clinical Anxiety.
MANAGEMENT :-
1. Drug therapy :- Anxiolytics (Benzodiazepine)
 Diazepam, Lorazepam, Oxazepam, Ettizolam, chlordiazepoxide, buspirone.
2. Antidepressant:-sertraline, fluxetine,, fluoxamine, escitalopram , paroxetine , citalopram,
imipramine, clomipramine, and phenalezine.
3. Some time B-Blocker Drug may be used- such as Propranolol , Atenolol
4. Psychotherapy :-
 Supportive Psychotherapy.
 Caffeine elimination.
 Parentral anxiety management.
 Relaxation Techniques (Yago, Meditation, Progression relaxation techniques).
 Group Psychotherapy
 Cognitive Behaviour therapy
 Some time Hypnosis and Abreaction therapy.
cMs liuksa dks ikus okys gj O;fDr dks lQyrk]

vkSj vlQyrk ds dbZ iM+koksa ls xqtjuk iM+rk gSA
 igys yksx etkd mM+k,axs]
 fQj yksx lkFk NksM+xs]a
 fQj fojks/k djsx
a sA
fQj ogh yksx dgsx a s ge rks igys ls gh tkurs Fks
fd rqe ,d u ,d fnu rqe dqN cM+k djksxsA
PHOBIC-ANXIETY DISORDERS
Phobic-Anxiety Disorders
 Phobia word dh mRifr ,d xzhd word ―Phobos‖ ls gqbZ gSa bldk vFkZ gSa & Mj (Fear)
 Phobia is defined as an irrational fear of a specific object, situation or activity, often leading to
persistent avoidance of the feared object, situation or activity.
 Characteristics of phobia :-
i) Presence of fear of an object, situation or activity.
ii) The fear is out of proportion to the dangerousness perceived.
iii) Insight is present
iv) Patient is unable to control the fear and is very distressed by it.
v) This leads to persistent avoidance of the particular object, situation or activity.
The Common Types of Phobias are :-
1. Agoraphobia :- (Fear of open place)
 This is the examples of Irrational Fear of situation.
 It is the commonest type of phobia encountered in clinical practice.
 bl izdkj ds Phobia esa O;fDr fdlh Public place (places away from the familiar setting or home)
ij vdsys gksus ls Mjrk gS tgkWa mls fdlh vU; O;fDr dh rqjUr lgk;rk miyC/k ugha gSaA
 e.g. xqQk esa tkus ls Mj
 iqy ij gksus dk Mj
 cl LVS.M] jsYos LVs’ku vkfn ij vdsys tkus ls Mj
 ;g iq:"kksa dh rqyuk esa efgykvksa esa vf/kd gksrk gSaA
2. Social Phobia :-
 This is an example of irrational fear of activities. blesa O;fDr fdlh lkewfgd lekjksg esa cksyus ;k ,sls
vU; dk;Z djus ls Mjrk gS ftlesa fd mldh vkykspuk dh tk ldrh gSaA
 blesa O;fDr social activities esa Hkkx ugha ysrk gsSA
 bls izdkj ds ―Phobia‖ esa O;fDr vius dk;ksZ dh vkykspuk ds izfr vR;Ur laosnu’kkhy gksrk gSaA
 e.g. public performance dk Mj (stage performance)
 vusd yksxksa ds chp esa fy[krs le; Mjuk (pSd sign djrs le; Mjuk)
 public lavatory esa urinate djus ls Mjuk (Shy bladder)
3. Simple (specific phobia) :- This is an example of irrational fear of object or situation or animal.
E.g.
 Insectophobia = Fear of insects
 Acrophobia = mpkbZ ls Mjuk (fear of high places)
 Zoophobia = Fear of Animals
 Xenophobia = Fear of strangers
 Algophobia = Fear of pain
 Claustrophobia = Fear of closed places
 Hydrophobia = Fear of water
 Achulophobia = Fear of drak places.
 Aichmophobia = fear of sharp or pointed objects (such as a needle or knife)
 Gamophobia = fear of marriage, commitment
 Nosocomephobia = fear of hospitals
 Nosophobia = fear of contracting a disease
 Trypanophobia, belonephobia, enetophobia – fear of needles or injections
PHOBIC-ANXIETY DISORDERS
 Phobic Anxiety Disorder esa person, phobic agent dk lkeuk djus ij usually Anxiety ds features
show gksrs gSA
 E.g.- Dyspnoea, Tachycardia, Palpitation, increase Respiration rate, Dry mouth.
Management :-
1. Psychotherapy :-
 Cognitive behavior therapy
 Behaviour therapy e.g.- Systematic Desensitization, flooding, positive and negative
reinforcement.
 Rexaxation techniques such as yoga, meditation.
2. Drug therapy :-
 Anxiolytics / Antipanic
 e.g.
 Clonazepam , Lorazepam, Ettizolam.
Some time Antidepressant may be used-

e.g. :- Sertraline, fluxetine, fluoxamine, clomipramine, Imipramine.
3. Defense Mechenism :- Used by the Pt of phobia is Denial, Displacement, projection,

Intellectualisation.
j[k gkSalyk oksa eatj Hkh vk;sxk]

I;kls ds ikl pydj leanj Hkh vk;sxkA
Fkddj uk cSB] ,s eafty ds eqlkfQj]
eafty Hkh feysxh vkSj thus dk etk Hkh vk;sxkA
OBSESSIVE-COMPULSIVE NEUROSIS
Obsession :-These are persistent recurrence of unwelcome ideas & impulses. They enter the
individual‘s mind again and again in a stereotype form, person does not enjoy by getting these ideas,
they appear senseless to the individual. The person tries to remove these ideas from the mind without
any success. It is a THOUGHT disorder.
Some common obsessions are : - e.g
 Contamination obsessions (xUnxh dk fopkj):- Fear of being contaminated by germs or dirt or
contaminating others.
 Sexual obsessions:- Intrusive sexually explicit or violent thoughts and images
 Aggressive obsession (vkdzke.k fopkj) :- Fear of causing harm to yourself or others.
 Order and symmetry: the idea that everything must line up “just right. ( gj oLrq dks lgh txg j[kus dk
fopkj (common in females)
 xyfr;kWa djus dk fopkj @ Hk;
 Religious obsession :-Excessive focus on religious or moral ideas.
 Saving obsession.
Compulsion :-
 Compulsions are repetitive, stereotype act which must be performed by individual to relieve
tension/anxiety even though they are recognized senseless by the individual.
 It is a form of behavior which usually follow obsessions. It is a disorder of ACTIVITY.
o Some common compulsions are :-
 Hand washing (ckj-ckj gkFk /kksuk) :- Spending a lot of time washing or cleaning.
 ckj-ckj fxuuk (counting) and checking:- Excessive double-checking of things, such as locks,
appliances, and switches.
 ckj-ckj QOokjksa Luku

 ckj-ckj ckgj >kWaduk] ;k dgh >kWd
a uk
 ckyksa esa ckj-ckj da/kh djuk , nkarksa esa ckj-ckj cq’k djuk]
 ckj-ckj ,d gh ckr fy[kuk vkSj feVkuk
 fyQkQs dks Mkd ls Hkstus ls iwoZ ckj-ckj [kksydj ns[kuk
 fdlh pht dh ckj-ckj tkWap djuk njokts] rkys] fctyh ds Lohp] ikuh dh VwVh] xSl dk cuZjA(Checkers)
 dwMk dpjk Qsdus ls iwoZ ckj-ckj tkWapuk fd dksbZ dke dh pht rks ugha jg xbZA
 gj ,d oLrq dks pkgs og dke dh gks vFkok ugha gks tek djrs jguk vkSj mldks ckgj Qsdus dh bPNk ykus esa ck/;rk
gksukA Accumulating “junk” such as old newspapers or empty food containers.
 fdlh ls Lohd`fr ;k fQj ls ijke’kZ vkSj ckj-ckj vkKk ysuk fd vkius tks dgk ;k fd;k og lgh gS vFkok ughaA
OBSESSIVE-COMPULSIVE NEUROSIS
Common Facts About OCN :-
1. Prevalence of OCN in general population is 2 to 3%
2. More common in 20-30 years of age.
3. Unmarried have more risk than married
1. Pure Obsessions
2. Pure Compulsive Act
3. Mixed Obsession Thought And Compulsive Act
e.g. – Washers, checkers, Counters.
Other feature associated with disorder are-
 Anxiety , Depression, Time consumption
 Marked slowness in day to day Activity.
Management :-
1. Psychotherapy :-
(A) Behavior therapy
i) Systemic Desensitization
ii) Modeling
iii) Aversion therapy
iv) Response shaping
(B) Supportive Psychotherapy
(C) Group therapy
(D) Family therapy
(E) Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD)
 (ERP)Exposure and Response prevention:- it involves repeated exposure to the source of your
obsession. Then you are asked to refrain from the compulsive behavior you‘d usually perform to
reduce your anxiety. For example, if you are a compulsive hand washer, you might be asked to
touch the door handle in a public restroom and then be prevented from washing. As you sit with
the anxiety, the urge to wash your hands will gradually begin to go away on its own. In this way,
you learn that you don‘t need the ritual to get rid of your anxiety—that you have some control
over your obsessive thoughts and compulsive behaviors.
2. Drug therapy :- Anxiolytic Drug – e.g. Alprazoloam, Clonazepalm. Anti depressant and some
time Antipsychotic may be used.
3. ECT :- In severe form of OCD(aggressive OCN), ECT may be used.
4. Defense Mechenism :- Used by the Pt of OCN is Undoing, Reaction formation.
HYSTERIA (DCD)
Hysteria is a neurotic disorder characterized by suggestability, emotional outbursts, histrionic

behavior (Attention seeking behavior), repressed Anxiety and transformation of an unconscious
conflict or anxiety into physical symptoms such as paralysis, blindness and loss of sensation.
DISSOCIATIVE REACTION
(euksfoPNsnu izfrfdz;k)
 Dissociative Reaction esa O;fDr dh ekufld fdz;kvksa tSls –consciousness, memory, Identity and
cognition etc vkfn esa vpkud ls ;k /khjs-/khjs Dissociation (fo[kaMu) gks tkrk gS vkSj O;fDr viuh thou
?kVukvksa ,oa okrkoj.k ls Dissociate gks tkrk gSA
Facts About Dissociative Reaction :-

1. Onset is usually sudden.
2. Ekkufld izfdz;kvksa esa gksus okyh xMcMh usually vLFkk;h (Temporary) gksrh gSaA
3. There is a clear relationship between stressor (ruko mRiUu djus okys dkjd) and the onset of the
illness.
4. blds dkj.kksa dk dksbZ Hkh 'kkjhfjd vk/kkj ugha gksrk gSA
5. Dissociation ls O;fDr dks Primary and secondary ykHk (gain) gksrk gSA
Primary gain: - the patient gets reliefs from Anxiety by not going through the threatening
situation e.g.- not going for an interview
Secondary gain: - by getting sympathy and attention from other.
Etiology / Causes :- (Dissociation – Conversion Disorder / DCD).

1. Genetics :- ;fn parents esa Dissociative disorder gSa rks mldh lUrku esa bldh laHkkouk 20% gksrh gSA
2. Pshcho-Dynamic Causes :- bl theory ds vuqlkj Histrionic personality ds O;fDr rukoiw.kZ voLFkk esa
bl izdkj dk O;ogkj iznf’kZr djrs gS tks yksxksa dk /;ku vkdf"kZd djrk gSA
3. Mal-Adaptive learning :-
 cpiu esa lkekU;r% cPps vius ekrk firk dk /;ku vkdf"kZd djus gsrq ;k lgkuqHkwfr izkIr djus gsrq ,d chekj dh Hkkafr
O;ogkj djrs gS ,oa ldkjkRed ifj.kke feyus ij bldks ckj- ckj nksgjkrs gS ;gh izo`fr Hkfo"; esa DCD dk dkj.k
curh gSA
 izk; ,slk ns[kk tkrk gS fd tc O;fDr vius thou dh leL;kvksa dks gy djus esa vlQy gks tkrk gSa ;k tc mUgsa bu
leL;kvksa dk lkeuk djus esa vR;f/kd fpUrk ;k Hk; yxus yxrk gS rc muesa bl izdkj ds (DCD) dqN y{k.k mRiUu
gks tkrs gS ftlls og viuh dfBukbZ dk vLFkk;h gy fudky ysrs gSaA the person who have poor coping skill.
 vDlj DCD efgykvksa esa T;knk gksrk gS l;qDr ifjokjksa esa (In Indian Culture) tgkWa ifjokj dh efgykvksa esa viuh
Hkkoukvksa dks O;Dr djus dh vktknh ugha gksrh rc muds eu esa ,d ruko iSnk gks tkrk gSA tc ;g ruko] ftldk fd
HkkoukRed :I ls izn’kZu ugha gks ikrk] jksxh ds Unconsious mind esa pyk tkrk gSa rks og Hkfo"; esa DCD ds :i
esa ckgj fudyrk Gsa
Clinical Features of Dissociative Reaction :-

1. Dissociative Amnesia/psychogenic Amnesia :- (Dissociative Memory Disorder)
 This is most common clinical type of dissociative disorder.
 It is characterized by a sudden inability to recall important personal information particularly
concerning stressful or traumatic life events. E.g. Circumscribed Amnesia.
HYSTERIA (DCD)
2. Dissociative Fugue :- (Psychogenic Fugue)

 bl izdkj ds dissociation dk eq[; y{k.k gS & O;fDr dk vpkud] fcuk fdlh iwoZ lwpuk ds ?kj NksM+dj Hkkx tkukA
blds lkFk og vius thou dh iqjkuh ?kVukvksa dks ;kn djus esa vleFkZ jgrk gSa ,oa viuh ubZ igpku (New
Identity) ds lkFk thou dh ubZ ’kq:vkr djrk gSaA
 The onset is usually sudden, often in the presence of severe stress.
 The characteristic feature is the assumption of a purposeful new identity with absence of
awareness of amnesia.
3. Multiple personality :- (Dissociative Identity disorder)
 In this disorder, the person is dominated by two or more personalities, of which only one is
being manifested at a time.
 Each personality has a full range of higher mental functions and performs complex behavior
patterns.
 One personality is not aware of the existence of the other personality there are amnesic
barriers between personalities.
 Both the onset and termination of control of each personality is sudden.
4. Depersonalization :-
 blesa O;fDr dks ckj&ckj ;k LFkk;h :i ls ;g eglwl gksrk gS fd mldk viuh ekufld fdz;kvksa ls lecU/k fcPNsn gks
x;k gS vkSj og ,d out sider (n’kZd) dh rjg viuh ;k vU; person dh ekufld izfdz;kvksa dks ns[k ldrk gSaA
5. Dissociative Trance and Possession :-
 Trance and possession disorders (Possession hysteria) are characterized by the control of
person‘s personality by a ―spirit‖ during the episodes.
 Usually the person is aware of existence of the other (possessor).
 This disorder is very common seen in Indian societies.
6. Other Dissociative Disorders :-
 Ganser syndrome (Hysterical pseudo dementia) is characterized by ―Approximate Answer‖.
 The answer given by a person is wrong but shows that the person understands the nature of
question asked.
 For e.g. when asked the color of a red pen, the patient call it blue.
 When asked a person to add three and three, patient might answer seven, and when asked to add
four and five, the patient might answer ten. Each answer is one greater than the correct answer.
7. Somnambulism:-sleep walking disorder.
CONVERSION DISORDER (HYSTERIA)
 It is a psychoneurotic disorder characterized by conversion of Psychological conflict or anxiety

or psychological symptoms into the physical symptoms without any organic basis e.g. paralysis,
blindness and aphonia.
HYSTERIA (DCD)
Fact About Conversion Disorder :-
 Onset is Acute
 Development of symptoms usually in the presence of a significant psychological stressor.
 A clear temporal relationship between stressor and development of symptoms.
 'kq:vkr esa O;fDr tku cw>dj conversion process djrk gSa ysfdu ckn esa ;g vuSfPNd :i ls gksus yxrh gS ,oa
Disorder dk :i /kkj.k dj ysrk gSA bl izdkj ds conversion disorder ls Hkh O;fDr dks nks ykHk gksrs gSA
 Primary gain :- to resolve self‘s Internal psychic conflict or anxiety or stress.
 Secondary gain :- blesa O;fDr vU; yksxksa ls lgkuqHkwfr ,oa Lusg dh izkfIr djrk gSA
 Usual age is 20 to 30 year.
 Low I.Q. level person are more affected.
 More common in unmarried/Divorced than married.
 Usually common in Hysterical personality.
 LA BELLE INDIFFERENCE are present in conversion disorder.
The symptoms are
(1.) Motor Symptoms :-
(a) Akinesia :- Voluntary muscle ds ,d group esa movement loss (paralysis) gks tkrk gSA
e.g. – Monoplegia - ,d gkFk ;k ,d ikWoa dh ekalisf’k;kW dk;Z ugha djrhA
Hemiplegia - bls ’kjhj dh ,d rjQ ¼nk,a ;k cka,½ Hkkx ds gkFk ,oa iSj dh muscle dk;Z ugha djrh gSA
Paraplegia :- blesa nksuksa iSjksa dh muscles dk;Z ugha djrh gSA
Quadriplegia:-paralysis of muscle of both limb and hand.
(b) Hyperkinesias :- Voluntary muscles ds movement c<+ tkrs gSA
e.g. – Tremors,
Chore form movements ¼u`R; dh rjg gkoHkko½
Staggering Gait ¼pyrs le; yM[kMkrs gq, pyuk½
(2.) Sensory Symptoms :-
 Anesthesia (loss of sensation)
 Hypothesis (Decrease feeling of sensation)
 Hyperesthesia (Increase feeling of sensation)
 All sensory modalities like touch, pain, temperature and senses, are affected at the same
level.
 Loss of vibration senses.
(3.) Visceral Symptoms :-
 A feeling of lumb in throat (Globous Hysterics)
 Nausea, vomiting & chocking sensation.
(4.) Hysterical Fits :- (Psuedo-convulsion)
 It is characterized by presence of convulsive movements and partial loss of consciousness.
 blesa euksoSKkfud ruko ,oa Anxiety ’kkfjfjd y{k.kksa tSls convulsion bR;kfn esa :ikUrfjr gks tkrk gSA
 fgLVhfj;k ds nkSjs ,oa convulsive fit esa cgqr vUrj gksrk gS tks fd fuEu izdkj gSA
 ;g lkekU;r% lqjf{kr LFkkuksa ij gh vkrs gSA
 ―AURA‖ vuqifLFkr gksrk gSA uhan ds le; dHkh ugha gksrsA
 Time duration -20-800 seconds.
HYSTERIA (DCD)
 blesa flj dks side to side ?kqek;k tk ldrk gSA
 thHk dk dguk ;k pksV dk yxuk lkekU;r% vuqifLFkr gksrk gSA
 Fits ds nkSjku ,oa ckn esa EEG lkekU; gksrh gSA
 Post – convulsive Amnesia, urinary Incontinence vuqifLFkr gksrk gSA
 Fits ls igys ruko ges’kk mifLFkr gksrk gSA
MANAGEMENT OF DCD (Hysteria) :-

1. Behaviour Therapy :-
 bl Disorder (DCD) esa O;fDr dks dHkh chekj uk le>k tk,A
 strong suggestions ¼dM+k:[k viukuk pkfg,½ nsus pkfg,A (high suggestibility ds dkj.k)
2. Aversion Therapy :-
E.g. nkSj (Hysterical fits) ds nkSjku gYds electrical shock ;k Liquor Ammonia lq/kkukA
3. Abreaction Therapy :-
4. Other Therapy :-
 Supportive psychotherapy
 ejht dks rukoiw.kZ okrkoj.k ls isolate djukA
 Placebo theray :- ’kkfjfjd y{k.kksa dks nwj djus gsrq ejht dks Distill water dk IM injection nsukA
 Family therapy
 DRUGS:- anxiolytics and antidepressant.
Hypochondriasis
 fdlh Hkh O;fDr dk iw.kZr LoLFk gksus ds ckotwn bl pre-occupation ls xzflr gksuk fd mls ,d ;k ,d ls
vf/kd xaHkhj chekjh gS] Hypochondriasis dgykrk gSA(THOUGHT DISORDER)
 vU; Neurotic disorder dh rjg bldk dkj.k Hkh Psychological stress gksrk gSA
 blesa ejht ckj&ckj lEiw.kZ 'kkfjfjd tkWp a gsrq vLirky tkrk gS ysfdu tkWap ls fdlh Hkh 'kkfjfjd chekjh dk
Diagnosis ugha gksrk gSA
 ckj&ckj tkap dh udkjkRed fjiksVZ feyus ds ckotwn mls ;g eglwl gksrk gS fd mls dksbZ vlk/; jksx gSA
 blesa ejht dks fofHkUu chekfj;ksa ds y{k.kksa ds ckjs esa viw.kZ tkudkjh gksrh gS vkSj blh v/kwjh tkudkjh ds vk/kkj
ij og ;g fu.kZ; ysrk gS fd mls vo’; gh dksbZ chekjh gSA
Management :-
 bldk management Hkh DCD dh rjg gh gSA
Neurasthenia
The disorder is characterized by –
1. Either persisting and distressing complaints of increased fatigue after mental effort or persistent
and distressing complaints of bodily weakness and exhaustion after minimal effort.
2. At least two of the following :- Feeling of muscular aches and pains, dizziness, tension,
headaches, sleep disturbances, inability to relax, irritability and dyspepsia.
SOMATOFORM DISORDERS
 The patient has repeated presentation of physical symptoms with a persistent request for medical
investigation inspite of repeated negative findings and re-assurance by doctor that the symptoms
have no physical basis. Patient converts his psychological symptoms into the physical
symptoms.
e.g. pain in abdomen.
Types of Somatoform Disorders :-

(1.) Body Dysmorphic Disorders :- These patient are pre-occupying in imagined defect in
appearance specially facial problem. They usually go to dermatologist or plastic surgeon with
complaints of face. It may start from adolescence & persist for several year.
(2.) Hypochondriasis :-
(3.) Conversion Disorders :-
(4.) Somatoform Pain Disorder :- Patient complain of severe prolonge pain without any organic
pathology.
REACTION TO STRESS AND STRESS DISORDER
These category consists of those disorders which are temporally related to an exceptionally stress full
life-events and a significant life change. There are-
(1.) Acute Stress Reaction :- Due to presence of stressor (e.g. death of a loved one, rape etc.). The
symptoms includes – Anxiety, depression, Anger, Over activity, or withdrawl.
Treatment :- Removal of the patient from stress full environment and helping the patient to ―pass
through‖ the stress full experience. Anxiolytics or sedative may be used.
(2.) Post – Traumatic Stress Disorder (PTSD) :-

 This disorder arises as a delayed response to an exceptionally stress full event or situation which
is likely to cause pervasive distress in ―Almost any person‖ (e.g. disaster, war, rape, serious
accident).
 The symptoms of PTSD may develop, after period of latency, with in six months after the stress
or may be delayed beyond this period.
 PTSD is characterized by recurrent and recollection of the stressful event, either in flash-backs
(images, thoughts or perceptions) and or in dreams.
 The other important clinical features of PTSD include partial amnesia for some aspects of the
stressful event, feeling of numbness and Anhedonia (inability to experience pleasure).
Treatment :-
1. Prevention
2. Disaster management
3. Supportive psychotherapy
4. Antidepressant and anxiolyties may be used.
SOMATOFORM DISORDERS
PSYCHO – SOMATIC DISORDERS

It is defined as those physical disorders which are either initiated or exacerbated by the presence
of meaningful psychosocial environmental stressor.
Process of development of Psychosomatic illness :-

Emotional/(Psychological) Environmental stress/Anxiety / conflict
Disturbance in Hypothalamic function
Abnormality in autonomic nervous system functioning
Structural & Physiological (functional) changes in organs of body.
Causes somatic illness.
 Types or Examples of Psycho-somatic illness :-

1. Effect On Cardio-vascular System :-
 Essential Hypertension, Arteriosclerosis, Myocardial Infarction.
2. Effect On Digestive System :-
 Peptic ulcer, obesity, ulcerative colitis, Anorexia nervosa, irritable bowel syndrome.
3. Effect On Endocrinal System :-
 Diabetes mellitus, Hyperthyroidism, Amenorrhea, Menorrhagia.
4. Effect On Musculo Skeletal System :-Rheumatiod Arthritis
5. Effect On Respiratory System :- Asthma, Rhinitis
6. Effect On Skin :-
 Urticaria, Neurodermatitis, Psoriasis.
Seven Most Common Examples of Psychosomatic illness :-

1. Bronchial Asthma
2. Essential Hypertension
3. Ulcerative colitis
4. Peptic ulcer
5. Neuro-dermatitis
6. Thyrotoxicosis
7. Rheumatoid Arthritis
Management :-
1. Treatment of the physical symptoms.
2. Relaxation Techniques :- Yoga, Meditation, progression Relaxation techniques.
3. Group Psychotherapy
4. Drug therapy :- Anxiolytics e.g. Clonazepalm, Lorazepalm
Antideprassant :- Sertraline, Fluxetine.
SLEEP DISORDERS
Sleep Disorders
 Nearly 1/3 of human life is spent in sleep.
 The sleep disorders are divided in 2 sub types :-
I. Dyssomnias :-
a) Insomnia
b) Hypersomnia
c) Disorders of sleep-wake schedule
II. Parasomnias :-
a) Sleep walking disorder (Somnambulism)
b) Night mares
c) Sleep terrors or night terrors
d) Sleep related Enuresis (bed wetting)
e) Bruxism (teeth-grinding)
f) Somniloquy(sleep taiking)
1.Dyssomnias :-
 These are characterized by disturbances in the amount, quality or timing of sleep. These are
commonest disorders of sleep.
a) Insomnia :- It is also known as the disorder of Initiation and or Maintenance of sleep
(DIMS). Insomnia is very common, nearly 15-30% of genral population.
E.g. –Frequent awakening during the night.
– Early morning awakening.
b) Hypersomnia :- It is also know as Disorder of Excessive Somnolence (DOES).
E.g. –Excessive Day time sleepiness.
– Sleep drunkenness (person needs much more time to awaken and during this period is
confused or disoriented)
c) Disorders of sleep-wake Schedule :-
-This is characterized by a disturbance in the timing of sleep. The person with this
disorder is not able to sleep when he wishes.
2. Parasomnias :-
 Parasomnias are dysfunctions or episodic nocturnal events occurring with sleep.
a) Sleep walking disorder (Somnambulism) :-
b) Sleep terrors or Night terrors (Pavor Nocturnus) :-The patient suddenly gets-up screaming with
autonomic arousal (Tachycardia, sweating). He may be difficult to recall the episode on
awakening.
c) Night Mares (Dream-Anxiety Disorder) :-
i. -It is characterized by fearful dreams occurring most commonly in the last one-
third of night sleep.
d) Sleep related Enuresis (bed wetting) :-
e) Bruxism (Teeth Grinding) :-The patient has an involuntary and forceful grinding of teeth during
sleep.
f) Sleep Talking (Somniloquy) :-
g) Other Sleeping Disorders :- Nocturnal Angina, nocturnal Asthma, Nocturnal seizure.
SLEEP DISORDERS
HABIT AND IMPULSE DISORDERS

1) Pathological Gambling :- Characterized by two or more episodes of gambling per year which
have no profitable outcome.
2) Pathological Fire Setting (Pyromania) :- Characterized by two or more act of fire-setting
without an apparent motive. Intense urge to set fire to objects with a feeling of tension before the
act and a sense of relief afterwards.
3) Klepto mania (Pathological Stealing) :-
 Characterized by two or more thefts, in which there is stealing without apparent motive of
personal gain or gain for another person.
4) Trichotillomania :- (Compulsive hair-pulling) :-
 Intense urge to pull out hair with mounting tension before the act a sense of relief atterwards.
5)Dipsomania:- compulsive drinking of Alcohol.
Management :-
 Aversion therapy
 Cognitive behavior therapy
 Individual psychotherapy.
PSYCHOACTIVE SUBSTANCE ABUSE DISORDER
Psychoactive Substance Abuse Disorders
Substance :- The term substance is used in reference to any Drug, medication or toxin that shares the
potential for abuse.
Drug :- ACCn to W.H.O. A Drug is an any substance that, when taken into the living organism, may
modify one or more of its functions.
Psychoactive Drug :- og Drug tks efLr"dh; dk;ksZ dks izHkkfor djrh Gsa
Drug Tolerance :- Drug Tolerance ,d voLFkk gS ftlesa vkS"kf/k ds okafNr izHkko dks mRiUu djus ds fy,] igys ls dgh
vf/kd ek=k esa ml Drug dks ysuk iM+rk gSA
Drug Withdrawl:- ;g ,d severe condition gS tks fdlh psychoactive Drug Intake vpkud jksd nsus ls mRiUu
gksrh gSA ;g voLFkk dqN le; rd jgrh gS iqu% ml Drug dks ysus ij withdrawl state (symptoms) Lor% gh lekIr gks
tkrh gSA
Drug Intoxication :- ;g ,d substance specific syndrome gS tks fd fdlh Drug ysus ds rqjUr i’pkr~ ifjyf{kr
gksrh gSaA Drug Intoxication dks O;fDr ds abnormal behavior ,o Psychological and physical changes ads }kjk
igpkuk tkrk gSaA
Drug Addiction :- It is a physiological and psychological dependence on Drug of abuse that affect the
central nervous system in such a way that withdrawl symptoms are experienced when the substance is
discontinued.
Drug Dependence / Substance Dependence :-
 ;g ,d Psychic state gksrh gS tks fdlh ,d Drug ds fujUrj iz;ksx ls mRiUu gksrh gS blds charactersties fuEu
gS
(i) O;fDr iw.kZ :i ls Drug ij fuHkZj gks tkrk gSSA
(ii) fu;fer vUrjky (Periodically) ij mldks og Drug ysuk t:jh gksrk gSA
(iii) O;fDr ml Drug ds Psychic effect dks enjoy djus ds fy, vFkok vius mental discomfort dks de djus
ds fy, og Drug ysrk gSA
(iv) Drug tolerance Hkh mifLFkr gks ldrh gSA
(v) Drug dks Discontinue djus ij withdrawl symptoms, present gksrs gSA
Drug Abuse / Substance Abuse :-
 fdlh Drug dk Pathological use djuk tks person dh social, familiar ,oa occupational functioning dks
Impair djrh gS ,oa ftlds symptoms 12 eghus esa fuEu izdkj ls show gksrs gSA
(i) O;fDr lkekftd Hkwfedk dks Bhd ls ugha fuHkk ikrkA
(ii) O;fDr Criminal behavior show djrk gSA
(iii) O;fDr vius dke (occupation) ij ugha tk ikrk ;k school miss djrk gSA
(iv) Familiar, social vkSj occupational leL;kvksa ds ckotwn Drug dk fujUrj mi;ksx djrk gSA
Etiological Factors In Psychoactive Substance Abuse :-

1. Biological Factors :- E.g. family history
2. Socio – cultural Factors :-
3. Psychological Factors :- e.g. – Depression, poor coping skills.
4. Cultural factor.
5. Pharmacological Factors :-
Commonly Abused Substances / Drugs
OPOIDS Sedative and Stimulants Hallucinogens Minor

Depressants Traquilizers
(1) OPOIDS :-
 Narcotics are referred to as ―hard stuff‖ by drug abusers. Narcotics Analgesics are drugs that are
Highly addictive. These Drugs-
 Alleviate Physical Pain
 Induce relaxation
 Produce euphoria (Sense of well being)
 Alleviate Anxiety and tension.
These Drugs can be classified as-
1. Opium and its derivates such as opium, morphine, heroin, codeine (Brown sugar, Junk, Smack,
chase)
2. Synthetic Narcotics such as methadone.
 Opoid and its products are obtained from ―papaver somniferum‖.
 The most important dependence producing derivatives are morphine and heroin.
Acute Intoxication :-
 This is characterized by Apathy, bradycardia, Hypotension, slow respiration rate, cold body and
pin point pupils.
Withdrawl Symptoms :-
The onset of withdrawl symptoms, occur typically within 12-24 hours, has a peak within 24-48
hours and symptoms subside within 7-10 days of the last dose of opoids.
Symptoms includes – Lacrimation (Discharge of water from eyes). Rhinorrhoea, sweating,
Tachycardia, muscle cramps, Nausea, vomiting, anorexia,Insomnia, raised body temperature, severe
Anxiety, and yawning (on involuntary opening of mouth).
Management :-
1. Treatment of opoid overdose :- an overdose of opoid can be treated with opoid antagonists e.g.
naloxone, Naltrexone I.V. 2 mg.
2. Detoxification :-
 Use of substitution drug like methadone
 Clonidine
 Narcotic Antagonist- Naltrexone.
3. Care / Symptomatics Management During Withdrawl Symptoms e.g.chlordiazepoxide.
4. Psycho-social therapy :- e.g. group therapy (Narcotics Anonymous)
5. SELF controlling skills.
(2) SEDATIVE /DEPRESSANTS :-
 bl izdkj dh Drug, central Nervous system ds function dks slow-down / Depress djrh gSA
 E.g. sedatives — Barbiturates —e.g. Phenobarbital, Amobarbital
 Ethyl Alcohol— it is a CNS Depressant.
(3) STIMULANTS :-
- Stimulants are drugs which stimulate the CNS. These Drugs are …
i) Amphetamines :- These group of Drug increase a feeling of Alertness of and confidence, a
decrease Feeling of fatigue, user can stay awake for a long period. E.g.- phenyl ethylamine
stimulants
ii) Cocaine :- It causes an euphoric state for four to six hours, bring self confidence and increase
flow of ideas, pressure of speech and activity. During the period of stimulation a person may
have an increased capacity to work.
 Tactile Hallucination are common among cocaine users.
Stimulants are used both individually and clinically for therapeutic purposes in the treatment of a
number of indications, including the following:
 To counteract lethargy and fatigue throughout the day while at work or while doing other
activities
 To reduce sleepiness and to keep the person awake when necessary,
 To decrease appetite and promote weight loss, as well as to treat obesity
 To improve concentration and focus while at work or school, especially for those with
attentional disorders such as ADHD. Commonly used drugs are:- substituted phenethylamines,
amphetamine, methylphenidate .
 Occasionally, used to treat clinical depression, in particular, non-typical depression
and treatment-resistant depression
(4) HALLUCINOGENS :-
 bUgsa Mind expansion Drug Hkh dgk tkrk gSA
 These Drugs Dramatically affect perception, emotions and mental process. They Disturb
sensory perception and can cause Hallucinations.
 E.g.(i) Cannabis products :- These are obtained from the hemp plant ―SAVITA INDICA‖.
E.g. Ganja, Charas (Hashish), Bhang, Marijuana.
 (ii) LSD (Lysergic Acid Diethylamide):- It is most important abusive Drug which cause
visual Hallucination. It is colorless, odorless and tasteless Drug.
(5) MINOR TRANQUILIZERS :-

 Minor tranquilizers leads to drug abuse.
 E.g. Librium (chlordiazepaxide) and Diazepam, lorazepam, clonazepam.
 These Drugs alleviate tension and anxiety. They also induce relaxation and sleep.
 Antidot of benzodiazepine:-flumezenil.
 Abrupt withdrawl of barbiturate/anxiolytics may cause seizure
ALCOHOLISM (ALCOHOL ABUSE DISORDER)
Alcoholism (Alcohol Abuse Disorders)
Definition :- Alcoholism ,d euksjksx gS tks vR;f/kd ek=k esa ,Ydksgksy ihus ls gksrk gSA blds dkj.k O;fDr ,YdksgkWy ij
’kkfjfjd ,oa ekufld :i ls vkfJr gks tkrk gS ,oa O;fDr ds LokLF; ij blds O;kid udkjkREd izHkko ifjyf{kr gksrs gSA
Charactersties of Alcohol Dependency :-
 O;fDr ds fy, fu;fer vUrjky (periodically) ij ,sYdksgksy ysuk vR;Ur vko’;d gks tkrk gSA
 O;fDRk dks Lo;a viuh Alcohol ihus dh vknr dks fu;af=r djuk dfBu gks tkrk gS og pkgdj Hkh viuh bl vknr
dks NksM+ ugha ldrkA
 ;fn O;fDr ds }kjk dqN fnuksa rd Alcohol ihuk jksd fn;k tk, rks severe withdrawl symptoms fn[kkbZ nsrs
gSA
 /khjs&/khjs O;fDr esa ,sYdksgkWy ds izfr tolerance mRiUu gks tkrh gSaA
 O;fDr Social functioning vkSj euksja tu dks Avoid djrk gSA
 O;fDr Lo;a ds LokLF; vius ifjokj ,oa lkekftd leca/kksa ij Alcohol dk udkjkRed izHkko gksus ds ckotwn Hkh viuh
bl vknr dks tkjh j[krk gsSA
Clinical pattern of Alcoholism :-

1. Alcohol Intoxication :- bles Alcohol ds dkj.k O;fDr ds cksyus ,oe~ O;ogkj ds e/; lketL; izHkfor gksrk
gSA
2. Episode Excessive Drinking :- bldk vFkZ gS Intoxication dk episode ds :i esa gksuk ¼tSls o"kZ esa pkj
ckj½ bu episode dh yEckbZ dqN ?k.Vks]a dqN fnuksa ;k dqN lIrkg gks ldrh gSaA
3. Habitual Excessive Drinking :- blesa izfro"kZ gksus okys Intoxication episode dh la[;k 4 ls c<+dj 12
izfro"kZ gks tkrh gS ,oa Alcoholism ,d vknr dk :i ys ysrk gSA
4. Alcohol Addiction :- bl voLFkk esa O;fDr iw.kZ 'kkfjfjd ,oa ekufld :i ls ,sYdksgksy ij vkfJr gks tkrk gSA
vxj og dqN fnuksa ds fy, Alcohol ugha ysrk gS rks mldks severe withdrawl symptoms iznf’kZr gksrs gSA
Etiology or Causes :-
Same as in psychoactive substance abuse disorder causes.
 /khjs&/khjs ,sYdksgksy dh ek=k ,oa vko`fr dk c<+ukA
 ?kjsyw fgalk
 ,sYdksgksy NksM+us esa vleFkZrk
 Self centeredness
 Emotional blunting
 Decrease Attention and concentration
 Forgetfulness
 Anxiety
 Staggering Gait
 cksyrs le; gdykuk
 Impotency
 Dipsomania (compulsive-drinking)
Complication of Alcoholism :-
 Physical Complications
 Psychological Complication
 Social complication
1. Physical Complication:-
 Fatty liver
 Liver cirrhosis
 Hepatitis
 Gastritis
 Peptic ulcer
 Pancreatitis
2. Psychological Complication :-
(i) Delirium Tremens :- It is a syndrome characterized by
 Cloudiness of consciousness with disorientation in time & place
 Poor attention span / Distractibility
 Visual, Auditory or tactile Hallucination.
 Inability to recognize objects or carryout simple commands.
(ii) Alcoholic Seizures (rum fits) :-
 10% Alcoholic vkfJr ejhtksa esa Tonic-clonic seizures ik;s tkrs gSaA lkekU;r% ;g Alcohol dh Hkkjh
ek=k ihus ds 12-48 ?k.Vksa ckn izdV gksrs gSA
(iii) Alcoholic Hallucination :-
 Alcohol dh fu;fer vknr ds ckn ;fn ejht dqN fnuksa rd ,sYdksgksy ugha(withdrawl) ysrk gSa rks bl
fLFkr esa Visual Hallucination lokZf/kd lkekU; y{k.k izdV gksrk gSA
(iv) Wernicke’s encephalopathy / syndrome :-
 It is mainly due to the thiamine deficiency. Common symptoms are-Ataxia, Fluctuating
state of consciousness diplopia, Nystagmus, and opthalmoplegia (paralysis of ocular
muscles. Memory disturbances, poor attention span and distractibility.
(v) Korsakoff’s Syndrome / Encephalopathy :-
 Clinically, korsakoff‘s psychosis presents as an amnestic syndrome characterized by gross
memory disturbance with confabulation. Other signs are :-
 Physical sign :- peripheral Neuropathy, Muscular weakness.
 Psychological sign :- Amnesia (common), disorientation, apathy, mistaken identities,
confabulation, visual Hallucination.
(vi) Social Complication :-
 nq?kZVuk,a ,Family problems, Divorce, Occupational problems, Economical problems.
Withdrawl Symptoms of Alcoholism :-
 Insomnia, Sweating, poor Apetite, tremor, convulsion, Hallucination and confusion,
hypertension.
 These symptoms are usually present at 7-10 day after abrupt withdrawl from alcohol.
Diagnosis :-
 Clinical Feature, Complication ,oa ejht ,oa family members dh History ds vk/kkj ij Diagnosis
gksrk gSA
 blds vykok jDr dh tkWap ls bldh xaHkhjrk dk ekiu fd;k tkrk Gsa
jDr esa ,sYdksgksy dh lkUnzrk Indication
80 mg % (per 100 ml blood) Legal limit for driving
80-100 mg% Severe Intoxication
200-300mg% Dangerous
>400 mg% Death
Blood esa ik;k tkus okyk Gamma XyqVkby VªkUlQsjst (GGT) dk level alcoholism ds Laboratory
marker dh rjg dk;Z djrk gSA
Treatment / Management :-
1. Motivation of patient for self control :-
2. Detoxification :-
 ,sYdksgksy dh Intake dks vpkud jksd nsuA
 During the withdrawl period (7-10 day after withdrawl from Alcohol) the Anxiolytics or
sedative may be used such as Diazepam, chlordiazepoxide.
 Vitamine therapy :- large dose of thiamine and nicotinic acid.
 Hydration therapy for Dehydration.
 -Anti craving agent-
o ;s Agents O;fDr dh Alcohol ds izfr ykylk ¼bPNk½ dks de djrs gSA
o E.g. Acomprose, Naltrexone.
3. Behaviour therapy :-
 Aversion therapy by using either, a sub threshold electric shock or an emetic like
apomorphine.
 Relaxation techniques
 Assertiveness training
 Self-control skill
 Positive reinforcement.
4. Psychotherapy :-
 Individual psychotherapy :- Education / Explanation.
 Group Psychotherapy
 Alcohol Anonymous :- These are voluntary self help group.
 Family therapy
 Marrietal therapy
5. Anta – Abuse Drug (AVERSION THERAPY)

E.g. – Disulfirum Drug
Citrated calcium carbamide
Disulfirum
Alcohol Acetaldehyde Acetate Co2 + H2o
Headache, Nausea, Vomiting,hypotension

Sweating, palpitation, shock condition.
- The onset of Reaction occurs within 30 minutes, become full blown within 1 hour, and subsides
usually within 2 hours of ingestion of Alcohol.
- Doses :- 250-500 mg / day. The effect of drug remains for 14 day after the last dose..
6. Other Medications :-
 Benzodiazepines
 Antidepressant
 Antipsychotics
 Lithium and carbamazapines.
 In the case of special Indications.
7. Psycho-social Rehabilitation :-
CAGE Questionnaire
 Developed by Dr. John Ewing
 The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely
used method of screening for alcoholism.
 Two "yes" responses indicate that the possibility of alcoholism should be investigated further.
The questionnaire asks the following questions:
1. Have you ever felt you needed to Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt Guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady
your nerves or to get rid of a hangover?
PSYCHIATRIC EMERGENCY
Psychiatric Emergency
Over Active patients Under Active patients Suicide

E.g. catatonic E.g. Depressive stupor
Excitement Catatonic stupor
-Organic Disorder MANAGEMENT
-Drug Reaction 1. Electro Convulsive therapy
-Acute Psychotic Reaction 2. Anti Psychotic
-Drug withdrawl 3. Anti depressant
MANAGEMENT 4. Psychotherapy
1.Sedation
Injectable – Haloperidol +PMZ, LZP
2. Restraint
SUICIDE :- Act of killing one self.
Facts About Suicide:-

1. Incidence – 10 – 15 / Lakh / Year in India
2. Attempted suicide ,oa okfLrod vkRegR;k dk vuqikr 15%1 gSA
3. L=h;ksa esa Attempted Suicide dk vuqikr vf/kd gksrk gSA
4. Males esa complete suicide dh nj vf/kd gksrh gSA
5. Suicide dk lcls izpfyr rjhdk ¼35½% tgj [kkdj vkRegR;k djuk gSA
6. Males, vkRegR;k gsrq fgald rjhdks tSls& QkWl
a h] fiLVy bR;kfn dk iz;ksx djrs gSa ,oa efgyk,a Drug overdose
tSls rjhdks dk vf/kd iz;ksx djrh gSA
CHILD PSYCHIATRY
Child Psychiatry
The various psychiatric disorders seen in childhood, (Disorders of psychological development
and 'behavioral and emotional' dosorders with onset usually occuring in child hood and adolescene.)
These are –
1. Mental Retardation:- It is a dosorder characterized by a significantly sub average intellectual
function, an I.Q. 70 or below.
Intellectual disability (ID), also known as general learning disability,[3] and mental
retardation (MR),[4][5] is a generalized neurodevelopmental disorder characterized by
significantly impaired intellectual and adaptive functioning. It is defined by an IQ under 70 in
addition to deficits in two or more adaptive behaviors that affect everyday, general living.
Types of MR
2. Specific Reading Disorder:- It is also called as developmental reading disorder or dyslexia.

3. Specific Arithmetic Disorder:- Also called as developmental arthmetic or mathematic disorder
or dyscalculia.
4. Attention–Deficit Hyperactive Disorder (ADHD):- It is also called Hyperkinetic syndrome.
Characterized by in attention that is failure to finish things, not listening, distractibility,
difficulty in concentrating on school work or play activity.
 Relatively common disorder, it occur in about 3% of school age children.
 Methylphenidate is the drug of choice in the treatment of ADHD. (Dose-5-60 mg/day).
 Barbiturates are contra-indicated in ADHD as they increase hyperactivity.
 Behaviour modification and counselling are very important in the sucessful management of
ADHD and can be used along with drug therapy.
5. Eating Disorders :-
(a) Anorexia Nervosa:- It is persistent lack of appetite by refusal of food.
CHILD PSYCHIATRY
 It occurs much more often in females as compared to males. The common age of onset is
13-19 years.
 There is an intense fear of becoming obese. This fear does not decrease even if body
becomes very thin and under weight.
 A large number (up to 50%) of patients with anorexia nervosa also have bulimic episodes.
These are characterised by rapid consumption of large food in a relatively short period of
time, occurring usually when alone. This is known as eating binges or binges eating.
 These binges are followed by intense guilt and attempts to remove eaten food, for
example, by self indued vomiting, Laxative abuse or diuretic abuse.
 If untreated, the weight loss can become marked. Death may occurs due to hypokalemia
(caused by self induced vomitting) dehydration, malnutrition or congestive cardiac failure
(caused by anaemia).
Management :-
 Psychotherapy :- Cognitive Behaviour therapy, group therapy, individual psychotherapy
etc.
 Antipsychotic drugs
 Antidepressants
(b) Bulimia Nervosa:-
It is an eating disorder involving repeated taking a large quantity of food and drink in a short time
(Binge-eating).
 It usually has an onset in early teens or adolescence.
Management:-
(i) Cognitive Behaviour therapy and individual therapy.
(ii) Anti- depressant drug. (SSRI's)
(c) PICA:- Persistent craving for unnatural, Non-nutritive substances such as plaster, paint, hair, starch
or dirt.
6. Elimination Disorder :-
(i) Functional Enuresis :- It is a repeated involuntary voiding of urine (bed wetting) during day or
night after the age of five years when the child has learnt to have developed control of the
bladder.
Imipramine is the drug of choice.
(ii) Functional Encorpesis :- It is a repeated voluntary or involuntary passage of feces in day or
night time in one‘s clothing after the age of four year and is not due to physical disorder.
7. Conduct Disorder :-
 Conduct is the behavior of the total individual as expressed in psychological as well as physical
activity.
 Conduct disorders marked by repetitive, persistent, aggressive conduct in which basic rights of
others are violated
E.g. rape, fire setting purse snatching (delinquent behavior)
CHILD PSYCHIATRY
8. TIC Disorders :-
 It is repeated involuntary contraction of a small group of muscles e.g. clearing the throat,
shrugging the shoulders.
9. Speech Disorders :-
 Stuttering :- It is frequent repetition or prolongation of sound or words with hesitation and pause
that disrupt speech.
10 Temper tantrum :-
 It is a violent outburst of anger occurring between the ages of two and four. The child exhibits
behaviours as screaming, kicking, biting, hitting and head banging.
COMMUNITY HEALTH SERVICES
Community Psychiatry
 Community Mental health services is the application of knowledge of psychiatric Nursing in
preventing mental illness, promoting, and maintaining Mental Health of the people, to help in
early Diagnosis and care and to rehabilitate the client after mental illness.
 Community Mental Health Nursing include the following services—
1. Preventive services
2. Promotive services
3. Curative services
4. Rehabilitative services.
Preventive Psychiatry
Stages of Prevention of Mental Illness :-
- There are three stages of level of prevention. There are-
1. Primary prevention :-
 It aims lowering the rates of new cases of mental illness. Or measures taken to prevent
mental illness before its occurance.
 blds fy, Causative Factors dks control djus dh vko’;drk gS tks fuEu izdkj gSA
(a) Biological Factors :-
 Better Antenatal, intranatal vkSj post natal care provide djukA
 During pregnancy :- Taratogenic Drug, Alcohol, repeated X-ray, vkfn dks Avoid djukA
(b) Physical Factors :-
 Every individual should get basic need-food, clothes & shelter.
(c) Psychosocial Factors :-
E.g. (i) Physical competency
(ii) Intellectual competency
(iii) Emotional competency
(iv) Social competency
(d) Socio-cultural Factors :-
2. Secondary Prevention :-
 It Aims early detection and prompt treatment of Maladaptive behavior in an individual‘s
family and community settings. Minimize duration of illness.
Secondary prevention ds eq[; mÌs’; gSa&
(i) Routine screening of general population for mental illness.
(ii) To provide mental health education.
(iii)Crisis intervention services.
COMMUNITY HEALTH SERVICES
Crisis Intervention
Crisis is an Initial disturbance that results from a stressful event or perceive threat to self. It is
self limiting (4-6 weeks).
Crisis can be-

1. Developmental Crisis :- e.g. puberty, Adolescence, Adult, Old age, menopause, pregnancy.
2. Situational Crisis :-
a. E.g. tkWc dk ugha feyuk], Divorce,loss of loved person.
3. Adventitious Crisis :-
 ;g Crisis condition O;fDr ds lkeus vpkud] fcuk fdlh iwoZ lwpuk ds mifLFkr gks tkrh gSA
 E.g. – Accidents, Diagnosis of severe illness, Rape,Natural disaster ¼HkwdEi] ck<+½
Crisis Intervention :-
 Crisis intervention euksfpfdRlk dk ,d izdkj gS ftlesa thou dh vR;Ur dfBu ifjfLFkfr;ksa (crisis) ls xqtj jgs
ejht dk bl fLFkfr ds lketL; djus esa lgk;rk dh tkrh gSA
 Partial short – time hospitalization
 Psychotherapy :-
 Abreaction
 Suggestion
 Environmental Modification
 Behaviour Modification
 Anxiolyties / sedatives and Antidepressant Drugs.
3. Tertiary Prevention :-
 It aims reducing the rate of recurrence of illness.

 It includes rehabilitation and re-socialization.
It include-
1. Treatment and follow-up
2. Individual and family therapy
3. Occupational therapy.
National Mental Health Programmes
National Mental Health Programmes (NMHP,1982)

WHO dh Alma Ata conference us 1978 esa ,d slogan fn;k ―Health For All by 2000‖ vkSj Health ds
lHkh dks ’kkfey djrs gq, ;g flQkfj’k dh fd ,mental health dks primary health care dk Hkkx gksuk pkfg, vr% vkt
Menatal Health Care PHC concept dk vkBok lw= gSA
bls ckn lu~ 1982 eas National Mental Health Programme ykxw fd;k x;kA
 Objections of NMAP :-
 Avilability and Accessibility of mental health care services.
 Promation of mental health
 Prevention of mental illness
 Approaches of NMHP :-
 Diffusion of mental health skills
 Appropriate appointment of task in MENTAL HEATH CARE
 Equitable and Balanced Distribution of Resources
 Integration of Basic mental health care into general health services.
 Mental health Training
 Mental Retardation & Drug Dependence.
 Mental health care at -

 Sub centre, PHC level
 CHC level
 District hospital level
 Mental / Psychiatric hospital
ACT RELATED TO MENTAL HEALTH
 INDIAN LUNACY ACT, 1912
Indian lunatic act, 1912 esa ykxw fd;k x;kA blds 8 psIVj gS ftuesa MENTAL ill persons ds Admission,
discharge procedure, cost management of psychiatric Hospital. Hospital policy etc. dks lEefyr djrk gSA
E.g.- Chapter-II euksjksfx;ksa ds Admission ,oa Discharge procedure dks lEefyr fd;k x;k gSA
 INDIAN MENTAL HEALTH ACT, 1987

 Indian mental health act, 22 ebZ 1987 dks ikfjr fd;k x;k A
 1 vizSy 1993 ls ;g lHkh jkT;ksa esa ykxw fd;k x;kA
 bl Act dk eq[; mÌs’; gS mental ill persons ds mipkj ,oa ns[kHky ls lEcfU/kr dkuwuksa esa la’kks/ku ,oa etcwrh
ykuk] ejht dh lEifr ,oa ekeyksa dk csgrj izca/ku djukA
National Mental Health Programmes
 IMHA ds 10 psIVj gSA
 E.g. – Chapter-IV ;g chapter psychiatric patient ds Admission vkSj discharge procedure dk o.kZu
djrk gSA
(NDPSA) The Narcotic Drugs and Psychotropic Substance Act

 Drug abuse ls lEcfU/kr igyk act o"kZ 1857 esa opium act cuk;k x;kA
 blds ckn o"kZ 1930 esa ,d vU; dkuwu Dangerous drug act vfLrRo esa vk;kA
 iqjkus Acts dh vi;kZIrrk dks ns[krs gq, narcotics vkSj psychoactive substance ds fu;eu gsrq ,d u;k act
NDPSA o"kZ 1985 esa izHkkoh :i ls ykxw fd;k x;kA
 bl Act ds vUrxZr fuEu Drugs dk Regulation lEefyr gSA
 Cannabis, Cocaine, Opium, Psychotropic Drugs etc.
 NDPSA, 1985 ds vUrxZr 6 chapter lEefyr gSA
Procedure For Admission and Discharge From Mental Hospital :-
Psychiatric patient ds Admission ,oa Discharge gsrq Indian Lunacy Act 1912 ds psIVj –II ds vUrZxr ,oa
Indian mental health act 1987 ds psIVj –IV ds vUrZxr fn’kk funsZ’k fn, x, gS blds vuqlkj Psychiatric center esa
Admission fuEu izdkj ls fd;k tk ldrk gSA
(a) Admission on voluntary basis :-

(b) Admission under special circumstances :-
 ejht ds Relatives or family members ds }kjkA
(c) Admission under reception order on Application :-
 bl Js.kh esa ejht ds djhch] (relatives), family members vkSj friends ;k society ds vU; yksx ejht dks
mental hospital eas HkrhZ djkus gsrq ml {ks= ds eftLVªVs dks ,d ;kfpdk nk;j dj ldrs gSA
(d) Reception order not on Application :-
 iqfyl }kjk lafnX/k /kwers (wandering) ekufld vLoLF; O;fDr dks eftLVªVs ds lkeus is’k dj Reception
order tkjh djk, tkrs gSaA
(e) Admission of mentally ill prisoner / criminals :-
(f) Admission of patient under Judicial inquisition :-
 ;fn ,d O;fDr Judicial inquiry ds nkSjku ekufld :i ls vLoLF; ik;k tkrk gS rks High court / District
court dks ;g vf/kdkj gS fd og ,sls O;fDr;ksa dks Mental Hospital esa admission djus ds vkns’k tkjh dj
ldrk gSA
 lHkh izdkj ds Admission procedure esa psychiatrist, ekufld vLoLFk O;fDr dh tkap (mental status
examination) djrk gSA vkSj Recommond djrk gS fd O;fDr okfLrod :i ls mental hospital esa HkrhZ
djus ;ksX; gS vFkok ughaA
Discharge Procedure :-
 Discharge djus ls iwoZ Psychiatrist }kjk ;g izekf.kr gksuk pkfg, fd ejht mentally :i ls LoLFk gks x;k
gS vkSj ?kj ifjokj vkSj lekt esa jgus ;ksX; Gsa
 mlds i’pkr~ ejht dks Admission djus okyh Authorities ds ek/;e ls gh Discharge djk;k tkrk gSA
IMPORTANT NOTES
IMPORTANT NOTES
IMPORTANT NOTES
IMPORTANT NOTES
MCQ
Q.1 In following which is not a distrubance of Q.13 A mental disorder in which an individual is
consiousness aware of the stimuli but he tries to oppose
(a) Stupor (b) Hallucination these stimuli actively or passively, is known
(c) Confusion (d) Coma as:-
Q.2 Delirium is a disorder of (a) Mannerism (b) Cataplexy
(a) Consciousness (b) Perception (c) Verbigeration (d) Negativism
(c) Memory (d) Thought Q.14 In following which is not a disorder of
Q.3 Illusion is a disorder of motor activity
(a) Consciousness (b) Perception (a) Mannerism (b) Compulsion
(c) Memory (d) Thought (c) Automatism (d) Delusion
Q.4 Hallucination is a disorder of Q.15 In following which is a thought disorder
(a) Consciousness (b) Perception (a) Mannerism (b) Compulsion
(c) Memory (d) Thought (c) Automatism (d) Delusion
Q.5 Among the following conditions which all Q.16 A mental disorder characterized by
are somatoform disorder? repeatedly performing an act which is
(a) Conversion disorder unreasonable, is called as
(b) Body dysmorphic disorder (a) Mannerism (b) Compulsion
(c) Pain disorder (c) Automatism (d) Delusion
(d) All of the above Q.17 Among the following condition which one
Q.6 Perseveration is the disorder of is treated with hypnotic drugs?
(a) Consciousness (b) Perception (a) Psychosis (b) Sleep disorders
(c) Memory (d) Thought (c) Delusion (d) Hallucination
Q.7 Amnesia is a disorder of Q.18 Which of the following neurotransmitter is
(a) Consciousness (b) Perception deficient in depression? (AIIMS)
(c) Memory (d) Thought (a) Serotonin (b) 5 HT
Q.8 Disorder of consiousness in which patient (c) Both A and B (d) GABA
remains motionless and mute, is Q.19 Hallucination is defined as
(a) Confusion (a) Perception of stimulus in the presence of
(b) Clouding of consiousness an actual stimulus
(c) Hallucination (b) Perception of a stimulus in the absence
(d) Stupor of an actual stimulus
Q.9 The term which is also used to describe (c) Mistaken or misinterpretation of sense
catelepsy is impression
(a) Mannerism (d) Disorientation of time, place and person
(b) Catelepsy Q.20 A mental disorder in which a person hears
(c) Waxy flexibility the noises such as some body is knocking at
(d) Both (b) and (c) the door in the absence of actual stimulus.
Q.10 Disorder of motor activity in which the The person is suffering from
person constantly maintains a position (a) Auditory illusion
without any movement is (b) Auditory hallucination
(a) Mannerism (c) Tactile illusion
(b) Cataplexy (d) Tactile hallucination
(c) Verbigeration Q.21 A mental disorder in which a person feels
(d) Negativism that lice are crawling on his arm. But in
Q.11 A disorder of motor activity in which an actually there are no lice on his skin. The
individual repeatedly touches the neck or person is suffering from
lifts the shoulder while taking, is known as (a) Auditory illusion
(a) Mannerism (b) Cataplexy (b) Auditory hallucination
(c) Verbigeration (d) Negativism (c) Tactile illusion
Q.12 A disorder of motor activity in which there (d) Tactile hullucination
is frequently repetition of words of Q.22 In following which is not a thought disorder
sentences, is known as (a) Perseveration
(a) Mannerism (b) Verbigeration
(b) Cataplexy (c) Circumstantiality
(c) Verbigeration (d) Tangentiality
(d) Negativism
MCQ
Q.23 A mental disorder characterized by (c) Nihilistic delusions
persistent repetition of an idea is known as (d) Delusion of guilt
(a) Perseveration Q.32 A disorder of thought content in which
(b) Verbigeration patient has a false belief that members of his
(c) Circumstantiality family are trying to kill him, is
(d) Tangentiality (a) Delusion of persecution
Q.24 A mental disorder in which patient finally (b) Delusion of grandeur
reaches his objective but only after many (c) Nihilistic delusions
unneccessary or trival details, is termed as (d) Delusion of guilt
(a) Perseveration Q.33 A mental disorder in which patient becomes
(b) Verbigeration self critical and believes that is he a
(c) Circumstantiality criminal, is known as
(d) Tangentiality (a) Delusion of persecution
Q.25 The person is unable to speak (b) Delusion of grandeur
(a) Aphonia (b) Stuttering (c) Nihilistic delusions
(c) Aphasia (d) Stuperness (d) Delusion of guilt
Q.26 Common risk factor in patient with severe Q.34 "Delusion of negation" is also known as
depression is (DSSSB 2013) (a) Delusion of persecution
(a) Fatigability (b) Delusion of grandeur
(b) Hallucinations (c) Nihilistic delusions
(c) Agitation (d) Delusion of guilt
(d) Suicidal tendency Q.35 A disorder or thought control in which the
Q.27 Mental disorder hypochondriasis is defined patient does not accept the existence of the
as world around him, is known as
(a) A false fixed belief, unrelated with (a) Delusion of persecution
person's intelligence (b) Delusion of grandeur
(b) A disorder in which patient is over (c) Nihilistic delusions
conscious about his bodily health (d) Delusion of guilt
(c) Irrational fear of a specific type of Q.36 Librium is a -
stimulus or situation (a) Antimanic drug
(d) Misinterpretation of stimulus (b) Antidepressant drug
Q.28 Mental disorder phobia is defined as- (c) Antiparkinson drug
(a) A false fixed belief, unrelated with (d) Transquilizer drug
person's intelligence Q.37 A false belief in which patient thinks that he
(b) A disorder in which patient is over is being talked about by other people, is
conscious about his bodily health known as
(c) Irrational fear of a specific type of (a) Delusion of reference
stimulus or situation (b) Delusion of guilt
(d) Misinterpretation of stimulus (c) Delusion of grandeur
Q.29 The type of delusion most commonly seen (d) Delusion of self accusation
is manic patients is Q.38 Irrational pathological fear of high places, is
(a) Delusion of persecution termed as
(b) Delusion of grandeur (a) Agrophobia (b) Acrophobia
(c) Nihilistic delusions (c) Algophobia (d) Xenophobia
(d) Delusion of guilt Q.39 Abrupt withdrawal of barbiturate cause
Q.30 A disorder of thought content in which (a) Sleepiness (b) Itching
patient falsely believes that he is a prime (c) Erythema (d) Seizures
minister or he believes that he is very rich, Q.40 In which defence mechanism anxiety is
this type of disorder is known as expressed through physical symptoms ?
(a) Delusion of persecution (a) Projection (b) Regression
(b) Delusion of grandeur (c) Conversion
(c) Nihilistic delusions (d) Hypochondriasis
(d) Delusion of guilt Q.41 Which of the following delusions common
Q.31 Which type of delusional disorder in depression?
commonly found in parahoid shizophrenia (a) Delusion of Nihilism
is:- (b) Delusion of poverty
(a) Delusion of persecution (c) Delusion of persecution
(b) Delusion of grandeur (d) All the above
MCQ
Q.42 Creating imaginary events to fill up the Q.55 In following which is the commonest
memory gap is known as- organic disorder
(a) Circumstantiality (b) Neologism (a) Dementia
(c) Confabulation (d) Compulsion (b) Delirium
Q.43 In following which is an un-pleasurable (c) Organic Amnestic Syndrome
affect disorder (d) Organic Hallucination
(a) Exaltation (b) Ecstasy Q.56 Clinical features of delirium includes
(c) Depression (d) All (a) Clouding of Consciousness
Q.44 An unpleasurable reaction to an imagined (b) Disorientation
danger, is termed as (c) Visual Hallucination
(a) Fear (b) Anxiety (d) All
(c) Apathy (d) Ambivalence Q.57 Organic cause of mental disorder includes
Q.45 An unpleasurable reaction to a real or (a) Hypo or hyper functions of endocrinal
threatened situation is termed as glands
(a) Fear (b) Anxiety (b) Head injury
(c) Apathy (d) Ambivalence (c) Sub arachnoid haemorhage and hematoma
Q.46 In following which is not an affect disorder (d) All
(a) Elation (b) Depression Q.58 The most effective treatment for alcoholism
(c) Hallucination (d) Grief is
Q.47 Excessive retention of memories is termed (a) Group therapy
as (b) Disulfiram therapy
(a) Amnesia (b) Hypermnesia (c) Total abstinence
(c) Paramnesia (d) Anemia (d) Chlorpromazine
Q.48 An attempt to avoid expression actual Q.59 Gastro intestinal complication which may
emotions associated with a stressful occur due to alcohol dependence is
situation by using the intellectual process of (a) cirrhosis of liver (b) gastritis
logic, reasoning and analysis is - (AIIMS) (c) pancreatitis (d) all
(a) Suppression (b) regression Q.60 The complication that may occur due to
(c) Intellectualization (d) Displacement chronic use of alcohol is
Q.49 Partially or completely absence of memory (a) Rum fits
is known as (b) Peripheral neuropathy
(a) Amnesia (b) Hypermnesia (c) Wernicke korsakoff psychosis
(c) Paramnesia (d) Anemia (d) All
Q.50 Type of amnesia in which patient is unable Q.61 A condition in which thoughts enter into the
to recall past events, is known as mind of the person though he does not want
(a) Retrograde amnesia to think about them, is known as-
(b) Anterograde amnesia (a) Obsession (b) Delusion
(c) Circumscribed amnesia (c) Regression (d) Suppression
(d) Paramnesia Q.62 In following which is not a withdrawl
Q.51 Type of amnesia in which patient is unable symptom of alcohol
to recall the recent events, is known as (a) Delerium tremens
(a) Retrograde amnesia (b) Rum fits
(b) Anterograde amnesia (c) Cirrhosis of liver
(c) Circumscribed amnesia (d) Alcoholic hallucination
(d) Paramnesia Q.63 You need to abide by the unit rules and
Q.52 Which is the characteristic of anorexia attend the community meeting. This
nervosa? statement by the nurse is indicative of .......
(a) Obsessed with weight loss theory
(b) Body image disturbance (a) Crisis theory
(c) Healthy family relation ship (b) Milieu theory
(d) Both A and B (c) Family system theory
Q.53 In following which is a disorder of attendion (d) Biological theory
(a) Amnesia (b) Paramnesia Q.64 Characteristic of Paranoid personality
(c) Distractibility (d) Delusion disorder includes-
Q.54 In following which is not a thought disorder (a) Constantly on guard and hyper vigilant
(a) Hypochondria (b) Flight of ideas (b) Appear tense and irritable
(c) Tangantiality (d) Amnesia (c) Avoid interaction with other people
(d) All the above
MCQ
Q.65 The disease characterised by 4 A's is (d) MI and cardiac arrest
(a) MDP (b) OCD Q.77 Antidote of benzodiazepine:
(c) Schizophrenia (d) Delirium (a) Lithium (b) Methadone
Q.66 In following which is not included in the 4 (c) Flumazenil (d) Chlorpromazine
A's of schizophrenia Q.78 Most Common type of hallucination seen in
(a) Ambivalence schizophrenia patient is
(b) Autism (a) Auditory (b) Visual
(c) Anxiety (c) Tactile (d) Olfactory
(d) Association disorder Q.79 The drug of choice for treatment of manic
Q.67 All are anti-depressant drug EXCEPT episode is
(a) Tricyclic antidepressants (a) Haloperiodal (b) CPZ
(b) Monoamine oxidase inhibitors (MAOIs) (c) Lithium (d) Imipramine
(c) Selective serotonin reuptake inhibitors Q.80 The drug of choice for treatment of
(SSRIs) generalized anxiety is
(d) Thiazides (a) Lithium
Q.68 No speech production is termed as (b) Haloperiodal
(a) Poverty of ideation (c) Benzodiazepine
(b) Mutism (d) Imipramine
(c) Poverty of speech Q.81 A psychiatric disorder in which pt has an
(d) Echolalia irrational idea and during this condition
Q.69 Reduced speech productions is termed as patient tries to resist against it but is unable
(a) Poverty of ideation to do this is known as-
(b) Mustism (a) Compulsion (b) Obsession
(c) Poverty of speech (c) Delusion (d) Delirium
(d) Echolalia Q.82 A form of behaviour which is usually
Q.70 The schizophrenia that is characterized by follows obsession is
extreme retardation of psychomotor activity (a) Compulsion (b) Phobia
(a) Hebephrenic schizophrenia (c) Delusion (d) Delirium
(b) Stuporous catatotnic schizophrenia Q.83 Disulfiram therapy is indicated in
(c) Paranoid schizophrenia (a) Acute alcohol intoxication
(d) Latent schizophrenia (b) Acute opium intoxication
Q.71 Gamophobia mean- (c) Alcohol dependence
(a) Fear of sound (d) Cannabis dependence
(b) Fear of marriage Q.84 A sleep disorder in which there is difficulty
(c) Fear of social isolation in maintaining sleep is termed as
(d) Fear of speed (a) Asomnia (b) Insomnia
Q.72 In following which is not a feature of manic (c) Hypersomnia (d) Somnambulism
episode Q.85 ADHD is usually treated with
(a) Elevated expansive mood (a) Lorazepam (b) Haloperidol
(b) Patient becomes more talkative (c) Methylphenidate (d) Methocarbamol
(c) Reduced psychomotor activity Q.86 National mental health programme was
(d) Delusion of Grandeur launched in the year of
Q.73 The patient may not talk at all (a) 1982 (b) 1981
(a) Mutism (b) Aphonia (c) 1980 (d) 1979
(c) Stupor (d) Thought block Q.87 Who coined the term schizophrenia?
Q.74 The extreme feeling of happiness is- (a) Eugene Bleuler (b) William Tuke
(a) Euphoria (b) Elation (c) Karl Menninger (d) John Weber
(c) Exaltation (d) Ecstasy Q.88 Anorexia nervosa is more common in
Q.75 Identify common motor symptoms in (a) Adolescence male
conversion disorder (b) Old males
(a) Paralysis (c) Adolescence females
(b) Impaired balance (d) Old females
(c) Double vision Q.89 Drug of choice to treat alcohol withdrawal
(d) All the above symptoms such as tremors, and high BP
Q.76 The most common side effect of ECT is: include
(a) Permanent memory loss (a) Disulfiram (b) Lorazepam
(b) Temporary memory loss (c) Cloxacillin (d) Benzotropine
(c) Fracture of cranial bone
MCQ
Q.90 The disorder that is commonly present with (a) Thumb sucking (b) Nail biting
anorexia nervosa is (c) Mental retardation
(a) Significant weight loss (d) Biting body parts
(b) Amenorrhea Q.102 Impaired insight is evident in (AIIMS
(c) Patient becomes thin PGMEE 1992, NBE DNB 2009)
(d) All (a) Psychosomatic disorder
Q.91 The disorder that is found only in females (b) Anxiety neurosis
(a) Schizophrenia (c) Post Traumatic Stress Disorder
(b) MDP (d) Schizophrenia
(c) Delusion Q.103 In following which is not a antipsychotic
(d) Post partum psychosis drug
Q.92 A child's IQ level ronges between 50-70 O (a) Haloperidol (b) Imipramine
the child a is suffering from (c) Chlorpromazine (d) Trifluoperazine
(a) Mild mental retardation Q.104 Extra pyramidal side effects of antipsychotic is
(b) Moderate mental retardation (a) Parkinsonian syndrome
(c) Severe mental retardation (b) Akathisia
(d) Profound mental retardation (c) Rabbit syndrome
Q.93 The prominent symptom that last at least for (d) All
1 month and helpful to diagnose paranoid Q.105 Indications for anti psychotic drug is
schizophrenia is (a) Schizophrenia
(a) Delusions and hallucination (b) Major depression
(b) Poverty of speech with apathy (c) Delerium tremens
(c) Bizzarre behavior associated with drug (d) All
use Q.106 Antidepressant drug is
(d) Disturbed relationship and poor (a) Flouxetine (b) Clomipramine
grooming (c) Amitryptiline (d) All
Q.94 Condition indicating abnormality in Q.107 Indications for the use of antidepressants are
perception is- except
(a) Illusion (b) Obsession (a) Manic attack
(c) Hallucination (d) Compulsion (b) Depressive episode
Q.95 An abnormal involuntary movement which (c) OCD
occurs suddenly, repetitively, rapidly and is (d) Somnambulism
purposeless, termed as Q.108 Hallucinations are seen in All Except (MP
(a) Enuresis (b) TIC PGMEE 1997, NBE DNB 2003)
(c) Stuttering (d) Encopresis (a) Schizophrenia
Q.96 Physical symptom which is present in panic (b) Seizure due tolntracerebral space
attack is- occupying lesions
(a) Sweating and palpitation (c) LSD
(b) Seizure (c) Vomiting (d) Anxiety
(d) Restlessness Q.109 Contraindication of lithium use is
Q.97 Repetitive passing of urine at inappropriate (a) Presence of heart related or neurological
places, is termed as diseases
(a) Enuresis (b) Tic (b) During first trimester or pregnancy
(c) Stuttering (d) Encopresis (c) Presence of blood dyscrasia
Q.98 Repetitive passing of stool at inappropriate (d) All
time and or place is termed as Q.110 Contraindication of electro convulsive
(a) Enureris (b) Tic therapy is-
(c) Stuttering (d) Encopresis (a) Raised intracranial pressure
Q.99 Clang association means- (b) MI
(a) Impaired verbal communication (c) Severe hypertension
(b) Risk for violence (d) All
(c) Ineffective health maintenance Q.111 Voltage used in ECT is
(d) Disturbed sensory perception (a) 20-30 volt (b) 90-150 volt
Q.100 Who is the first psychiatric nurse? (c) 400-500 volt (d) 2-3 kilovat
(a) Hildegard Peplau (b) Linda Richards Q.112 The duration of ECT is about
(c) Sigmund Freud (d) Jean Watson (a) 0.1 to 1 second (b) 0.1 to 1 minute
Q.101 Common habit disorder found in children (c) 1-2 minute (d) 20-30 second
are except
MCQ
Q.113 The usual amount of current passed in an (c) Tangentiality
ECT session is (d) Circumstantiality
(a) 100-300 mA (b) 200-1600 mA Q.124 In India the commonest way of committing
(c) 200-1600 Amp (d) 50-60 mA suicide is
Q.114 Aim of psychotic therapy includes (a) Hanging
(a) Removing existing abnormal symptoms (b) Ingestion of poison
(b) Improving disturbed patterns of (c) Drowning
behaviour (d) Jumping in front of train
(c) Promoting positive growth and Q.125 The most common type of hallucination
development seen in patients with mental illness is
(d) All (JIPMER Nursing Tutor Entrance 2011)
Q.115 Psychogenic amnesia is characterized by:- (a) Gustatory hallucination
(AIIMS PGMEE 1997, NBE DNB 2000) (b) Auditory hallucination
(a) Antegrade Amnesia (c) Olfactory hallucination
(b) Retrograde Amnesia (d) Visual hallucination
(c) Both with confabulation Q.126 Fixed false belief of a person which cannot
(d) Patchy impairment of Personal memories be changed by logical reasoning is known as
Q.116 Systematic desensitization is the treatment (a) Illusion
of choice in (b) Hallucination
(a) Phobia and OCD (c) Delusion
(b) Depression (d) Thought fixation
(c) MDP Q.127 The mental health act was passed on
(d) Schizophrenia (a) 20 may 1987 (b) 22 may, 1987
Q.117 The behaviour therapy that is used for the (c) 22 feb, 1981 (d) 20 feb, 1987
treatment of conditions which are pleasant Q.128 When a patient is not aware of his/her
but undesirable eg. alcohol dependence, is- mental disorder, it is called
(a) Systematic desensitization (a) Impaired awareness (b) Disorientation
(b) Aversion therapy (c) Lack of insight (d) Unconscious
(c) Flooding Q.129 Sleep walking is otherwise called
(d) ECT (a) Somnambulism (b) Somnokinesis
Q.118 Most common psychiatric illness seen in (c) Insomnia (d) Enuresis
majority in India is- (NBE DNB 2005, NBE Q.130 The narcotic drugs and psychotropic
DNB 2008) substance act came in force from
(a) Mania (b) Depression (a) 1985 (b) 1987
(c) Schizophrenia (d) OCD's (c) 1992 (d) 1977
Q.119 Insight is present in all except:- Q.131 Code of ethics for psychiatrists are except
(NBE FMGE September 2005) (a) A psychiatrist must maintain high
(a) Neurosis standard of professional competence
(b) Obsessive compulsive disorders (b) patient welfare is of paramount concern
(c) Phobias (d) Psychosis to a psychiatrist
Q.120 Visual hallucinations is seen in (c) confidentiality of the patient record
(a) Alcoholism (b) Mania (d) self interset precede patient interset
(c) Depression (d) Phobia Q.132 Presence of anxiety with severe motor
Q.121 Auditory hallucinations not seen in restlessness is termed as
(TN PGMEE 1990) (a) Alexithymia (b) Agitation
(a) Schizophrenia (b) Mania (c) Anhedonea (d) Distractibility
(c) Hysteria Q.133 Inability to explain one's emotional feeling
(d) Amphetamine toxicity is termed as
Q.122 Commonest cause of death among (a) Alexithymia
psychiatric patient is (b) Agitation
(a) Schizophrenia (c) Anhedonea
(b) Anorexia nervosa (d) Distractibility
(c) Suicide Q.134 A patient is unable to experience pleasure in
(d) Hysteria previously pleasurable activities, the
Q.123 Persistent mechanical repetition of speech problem patient has, is
or movement is known as (a) Alexithymia (b) Agitation
(a) Echolalia (c) Anhedonea (d) Distractibility
(b) Stereotype
MCQ
Q.135 A disorder in which patient is unable to Q.145 Nursing interventions should be given
concentrate attention is termed as during giving ECT are except
(a) Alexithymia (b) Agitation (a) Place well padded mouth gag
(c) Anhedonea (d) Distractibility (b) Flexion of the head with support to the
Q.136 Psychoanalytic therapy was developed by chin
(a) Freud (b) Jacobson (c) Remove lipstick and nailpolish
(c) Aristotle (d) Ladislau (d) Make an observation of grand mal
Q.137 Flattening of emotions is otherwise known seizures
as Q.146 The nursing care should be given after ECT
(a) Loose association (b) Ambiguity includes
(c) Blunted affect (d) Suppression (a) Assessment of vital signs
Q.138 The psychotherapy which is based on (b) reassure the patient
providing a healthy environment which (c) Put the railing to prevent the patient
helps in the recovery of the patient from falling
(a) Millieu therapy (d) All
(b) Marital therapy Q.147 A memory disturbance in which familiar
(c) Abreaction therapy object is treated as unfamiliar object, is
(d) Aversion therapy known as-
Q.139 During bilateral ECT the electrodes are (a) Jamais Vu (b) Deja-Vu
place on (c) Confabulation (d) Hypermnesia
(a) Biparital region Q.148 Which type of hallucination is more
(b) Bitemporal region common in schizophrenic patient
(c) Just above the frontal area (a) Visual (b) Auditory
(d) Occipital region (c) Tactile (d) Olfactory
Q.140 The type of seizure produced at the time of Q.149 Obsessive compulsive disorder is a
giving Electro convulsive therapy (a) Neurotic disorder
(a) Grand mal seizure (b) Psychotic disorder
(b) Epileptic sezures (c) Endocrinal disorder
(c) Seizures are not produced during ECT (d) Cardio vascular disorder
(d) Mild seizure Q.150 Eating disorder marked by persistent eating
Q.141 Agoraphobia is fear of (NBE FMGE of unnatural substances such as plaster,
March 2007, NBE FMGE September paint, is termed as
2003, ESI IMO 2014) (a) Pica (b) Obesity
(a) Agar (b) Strangers (c) Anorexia (d) Bulimia nervosa
(c) Open spaces (d) Closed spaces Q.151 Anorexia is defined as (GMCH-2006)
Q.142 Adverse effect or complication that may (a) Loss of appetite
occur after giving electroconvulsive therapy (b) Increase appetite
is (c) Eating more food at a time
(a) Amnesia (d) Eating of non nutritive substances such
(b) Fractures of long bones as plaster, paint etc.
(c) Headache Q.152 Psychosocial therapy includes all of these
(d) All except.
Q.143 Nursing intervention that are given before (a) Psychoanalysis (b) Somatic therapy
giving ECT is (c) Hypnosis (d) Phobia
(a) Obtain written consent Q.153 Delirium is also known as
(b) Remove artificial denture (a) Acute confusional state
(c) The patient should be given nothing (b) Acute brain syndome
orally before treatment (c) Acute organic reaction
(d) All (d) All
Q.144 Before giving ECT, lipstick, nail polish or Q.154 A delirious person is most commonly
any other make up should be removed what disoriented regarding
is the purpose behind this (a) Time (b) Place
(a) These may reduced the effect of ECT (c) Person (d) None
(b) To do this is very essential to check for Q.155 Most common type of hallucination seen in
cyanosis a delirious person is
(c) This should not be done (a) Visual (b) Auditory
(d) Lipstick or nail polish may increase (c) Tactile (d) Gustatory
voltage of ECT
MCQ
Q.156 Predisposing factor in delirium includes (b) Low self esteem
(a) Alcohol dependence (c) Escape from reality
(b) History of head injury (d) All
(c) Very old and very young age Q.167 Cage questionnaire is used to identify
(d) All severity of
Q.157 An organic mental disorder characterized by (a) Alcoholism
clouding of consciousness, disorientation (b) Schizophrenia
and distrubance in sleep wake cycle, the (c) Eclampsia
disease is (d) Delusion
(a) Delirium (b) Dementia Q.168 At which body fluid alcohol level, coma
(c) Schizophrenia (d) Delusion may occure
Q.158 Commonest type of dementia is (a) 25-100 mg%
(a) Alzheimer's dementia (b) 100-200 mg%
(b) Multi infact dementia (c) 200-300 mg%
(c) Hypothyroid dementia (d) 350-400 mg%
(d) AIDS dementia Q.169 The most common withdrawl symptom of
Q.159 An organic mental disorder which is mainly alcohol use is
characterized by impaired intellectual (a) Rum fits
functions and memory and deterioration of (b) Delirium tremens
personality (c) Hangover on next morning
(a) Delirium (d) Amnesia
(b) Dementia Q.170 In following which EPS may occure as a
(c) Orgonic amnestic syndrome side effect of antipsychotic drug
(d) Organic mania (a) Vertigo
Q.160 In following which is not an example of (b) Parkinsonian disease
opioid- (c) Hydrocephalus
(a) Morphine (b) Heroin (d) Bulimia nervosa
(c) Pethidine (d) Naloxone Q.171 Rum fits are
Q.161 The most common cause of organic (a) Withdraw syndrome of chronic alcohol
amenstci syndrome is use
(a) Head injury (b) Seizures that occure after delivery
(b) Chronic alcoholism (c) Seirzures occure during childhood
(c) Hypoxia (d) Seizures occure during head injury
(d) Encephalitis Q.172 The most common cause of wernicke's
Q.162 A drug that is capable of altering the mental encephalopathy is
functioning is known as (a) Cerebral_infection
(a) Psychiatric drug (b) Chronic alcohol use
(b) Psychotic drug (c) Head injury
(c) Antipsychiatric drug (d) Hypoglycaemia
(d) Psychoactive drug Q.173 The psychiatric disorder often follows
Q.163 The psychoactive substance which is taken wernicke's encephalopathy is
by only oral route (Most commonly) (a) Delusion
(a) Alcohol (b) Opoids (b) Rum fits
(c) Cannabis (d) Nicotine (c) Korasakoff's psychosis
Q.164 In following which substance has maximum (d) Dementia
chances of physical and phychological Q.174 In following which is not a feature of
dependence dementia
(a) Alcohol (b) Opoids (a) Hallucination
(c) Cannabis (d) Nicotine (b) Distrubed remote memory
Q.165 Social factor which may cause substance (c) Orientation- usually normal
use disorder, is (d) Clouding of consciousness
(a) Peer pressure Q.175 During alcoholism the drug of choice for
(b) Intrafamilial struggle detoxification is
(c) Poor family support (a) Antipsychotics
(d) All (b) Lithium
Q.166 Psychological factor causing substance use (c) Benzodiazepines
disorder includes (d) Antidepressant
(a) Poor impulse control
MCQ
Q.176 The behaviour therapy which is most Q.188 Persistent repetition of words beyond their
commonly used for treating alcoholism, is relevance is termed as
named as (a) Echolalia (b) Verbigeration
(a) Flooding (b) Aversion (c) Perseveration (d) Echopraxia
(c) Systematic desensitization Q.189 Patient of contamination phobia was asked
(d) Hypnosis by therapist to follow behind and touch
Q.177 Example of alcohol sensitizing drug is everything he touches in patient's house.
(a) Disulfiram Therapist kept talking quietly & calmly all
(b) Citrated calcium carbimide the time. And the patient was asked to
(c) Metronidozole repeat the procedure twice daily. The
(d) All procedure is (AIIMS PGMEE 2010)
Q.178 After ingestion of alcohol by a person who (a) Flooding
is on disulfiram, disulfiram ethanol reaction (b) Modelling
occures within (c) Positive reinforcement
(a) 10 min (b) 30 min (d) Aversion therapy
(c) 60 min (d) 120 min Q.190 The schizophrenia characterized by
Q.179 In following which is not a characteristic of agitation, increase in PMA, excitement etc.
disulfiram ethanol reaction The type of schizophrenia is
(a) Tachycardia (b) Hypotension (a) Excited catatonia
(c) Hypertension (d) Headache (b) Excited paranoid
Q.180 For treatment of alcoholism, usual dose of (c) Stuporous catatonia
disulfiram is (d) Excited hebephrenic schizophrenia
(a) 100-200 mg/day Q.191 The features of stuporous catatonia are
(b) 10-20 mg/day (a) Excitement, mutism, delusion of
(c) 250-500 mg/day grandiosity
(d) 1000-1200 mg/day (b) Mutism, stupor, waxy flexibility, rigidity
Q.181 Opoid is derived from (c) Delusion of persecution, increase in
(a) Unripe seeds of papaver somniferum PMA, stupor
(b) Ripe seeds of papaver somniferum (d) Stupor, more talkative, delusion of
(c) Unripe seed of connabis sativa gradiosity
(d) Unripe seed of codeine Q.192 Loosening of association is an example of
Q.182 In following which is not a natural alkaloid (All India PGMEE 2006)
of opium (a) Formal thought disorder
(a) Codeine (b) Papaverine (b) Schneider's first symptoms
(c) Morphine (d) Heroine (c) Preservation
Q.183 The most important dependence producing (d) Concrete thinking
opoid derivatives are Q.193 Treatment of choice for OCD (MP PGMEE
(a) Codein and papaverine 2006)
(b) Morphine and heroine (a) Behaviour therapy
(c) Heroine and methadone (b) Drug therapy
(d) Pethidine and nolaptrine (c) Psychosurgery
Q.184 Drug most useful in treatment of obsessive (d) Combination of behaviour and drug
compulsive disorder is (NBE DNB 1997, therapy
2000, 2001, 2003, 2005, 2006, 2007) Q.194 During schizophrenia the drugs commonly
(a) Amoxapine (b) Fluoxetine used is
(c) Doxepin (d) Dothiepin (a) Chlorpromazine (b) Haloperidol
Q.185 Commenest type of phobia seen in clinical (c) Olanzapine (d) All
practice (NBE DNB 1992, 2004) Q.195 In following which is not a typical or
(a) Social phobia (b) Simple phobia traditional Anti psychotic-
(c) Agoraphobia (d) Claustrophobia (a) Chlorpromazine (b) Haloperidol
Q.186 The psychiatrist who described 4A's of (c) Flupenthixol (d) Sertraline
schizophrenia Q.196 Treatment of schizophrenia includes
(a) Emil kraepelin (b) Eugen bleuler (a) Antipsychotic drugs
(c) Kurt schneider (d) Friedmonn (b) ECT
Q.187 Desensitization is a type of (Recent (c) Millieu therapy
Question 2012, 2013) (d) All
(a) Psychotherapy (b) Psychoanalysis
(c) Behavioral therapy (d) None
MCQ
Q.197 Short time emotional response to an idea is Q.206 Instability between mild depression and
termed as mild mania is termed as
(a) Affect (b) Mood (a) Euthymia
(c) Thinking (d) Perception (b) Dysthymia
Q.198 Long term emotional response to an idea is (c) Elation
termed as (d) Cyclothymia
(a) Affect (b) Stable emotions Q.207 Treatment of depression encludes
(c) Mood (d) Perception (a) Imipramine (b) ECT
Q.199 Drug of choice for Panic Disorder (AIIMS (c) Behaviour therapy (d) All
PGMEE 1994) Q.208 Therapeutic blood lithium level is
(a) Fluoxetine (b) Lithium (a) 0.8-1.2 m eq/L
(c) Diazepam (d) Chlorpromazine (b) 0.2-0.8 m eq/L
Q.200 In psychiatric unit, nurse is caring for a (c) 1.5-2.2 m eq/L
male client who experience false sensory (d) 2.0-3.0 m eq/L
perceptions with no basis in reality. This Q.209 Therapeutic dose of lithium is
perception is known as: (a) 2-6 mg/day
(a) Hallucinations (b) Delusions (b) 900-1500 mg/day
(c) Loose associations (d) Neologisms (c) 100-300 mg/day
Q.201 In Psychiatric female ward a nurse is caring (d) 20-60 mg/day
for a female client who has suicidal Q.210 For treatment of mania, lithium is used in
tendency. Nurse should- the form of
(a) Give her privacy (a) Lithium sulphate
(b) Allow her to urinate (b) Lithium carbonate
(c) Open the window and allow her to get (c) Lithium nitrate
some fresh air (d) Lithium chloride
(d) Observe her Q.211 Example of mood stabilizer is
Q.202 In following which sentence is false (a) Sodium valproate
(a) Life time risk of depression is more than (b) Carbamazepine
mania (c) Amikacine
(b) Life time risk of depression in males is (d) Both (a) and (b)
more than females Q.212 In following which statement does not fulfil
(c) Prevalence of schizophrenia is about 0.5- the criteria of psychosis
1% (a) Insight is absent
(d) Severe depression is a good prognostic (b) Contact with reality is present
factor in mood disorder (c) Marked disturbance in personality
Q.203 In following which is not an antidepressant (d) Presence of characteristic symptoms like
drug deusions and hallucinations
(a) Sodium valproate Q.213 In following which statement does not fulfil
(b) Clomipramine the criteria of neurosis
(c) Flouxetine (a) Insight is present
(d) Sertraline (b) Personality is preserved
Q.204 A female client with anorexia nervosa was (c) Behaviour is grossly distrubed
admitted in the psychiatric unit and Sister (d) The contact with reality is present
Nisha is preparing a care plan for her. Q.214 In following which is not a psychotic
Which action should the nurse include in the disorder
plan of treatment? (a) Depression (b) Delusion
(a) Provide privacy during meals (c) Schizophrenia (d) Hysteria
(b) Set-up a strict eating plan for the client Q.215 The feature which differentiate psychotic
(c) Encourage client to exercise to reduce disorder from neurotic, is
anxiety (a) Insight in absent
(d) Restrict visits with the family (b) Marked disturbance in personality
Q.205 Mood disorder characerized by recurrent (c) Marked distrubance in behaviour
episodes of mania and depression in the (d) All
same patient at different times Q.216 Examples of neurotic disorder are except-
(a) Recurrent depressive disorder (a) OCD (b) Phobia
(b) Persistent mood disorder (c) Hysteria (d) Delusion
(c) Bipolar mood disorder
(d) Schizophrenia
MCQ
Q.217 Which is the commonest clinical syndrome (a) Organic Brain damage
of OCD (b) Schizophrenia
(a) Checkers (c) Mania
(b) Washers (d) None of the above
(c) Pure-obsessions Q.228 A neurotic disorder in which the person
(d) Primary obessive slowness adopts a new identity with complete
Q.218 A client is experiencing anxiety attack. The amnesia for the earlier life
most appropriate nursing intervention (a) Dissociative fuge
should include? (b) Dissociative amnesia
(a) Turning on the television (c) Dissociative identity disorder
(b) Leaving the client alone (d) Hysterical fits
(c) Staying with the client and speaking in Q.229 The primary aim of psychiatric treatment is
short sentences to-
(d) Ask the client to play with other clients (a) Release the of patients symptoms
Q.219 A neuromuscular blocking agent is (b) Return the patient to his home
administered to a client before ECT therapy. (c) Help the patient to make better
The Nurse should carefully observe the psychosocial adjustment
client for ? (d) Prevent the patient from becoming
(a) Respiratory difficulties psychotic
(b) Nausea and vomiting Q.230 Hysteria is a
(c) Dizziness (d) Seizures (a) Psychotic disorder
Q.220 If pt has irrational fear of eating in company (b) Neurotic disorder
of others, then it is known as (c) Gynaecological disorder
(a) Acrophobia (b) Socialphobia (d) Obstetrical disorder
(c) Agoraphobia (d) Algophobia Q.231 Hypochondriasis is a
Q.221 The behaviour therapy which is most (a) Psychotic disorder
commonly used for treating phobia, is (b) Neurotic disorder
(a) Flooding (c) Gynaecological disorder
(b) Systematic desensitziation (d) Obstetrical disorder
(c) Aversion Q.232 In following which statement does not fulfil
(d) Both (a) and (b) the criteria of hypochondriasis
Q.222 In following which is the commonest (a) Long term preoccupation of having any
psychiatric symptom- serious disease
(a) Hallucination (b) Anxiety (b) Investigations do not show any
(c) Apathy (d) Depression abnormality
Q.223 A person repeatedly and unnecessarily (c) There is not tendency for changing the
washes his hands. The person is suffering doctors
from (d) All
(a) Phobia (b) OCD Q.233 The condition in which patient has an
(c) Anxiety (d) Hysteria involuntary grinding of teeth during sleep
Q.224 Treatment of ADHD involves the following (a) Enuresis (b) Bruxism
drugs except (Kerala PSC 2004) (c) Somniloquy (d) Insomnia
(a) Amphetamine Q.234 Sleep talking is also known as
(b) Antidepressants (a) Hypermnesia
(c) Barbituarates (b) Somnambulism
(d) Lithium carbonate (c) Somniloquy
Q.225 Psychotherapy which is used for the (d) Insomnia
treatment of OCD, includes Q.235 An eating disorder in which the pt refuses to
(a) Thought stopping and its modification eat due to fear of becoming obese
(b) Response prevention (a) Anorexia nervosa (b) Bulimia nervosa
(c) Systematic desensitization (c) Hypermnesia (d) Anorexia
(d) All Q.236 Resperidone is a-
Q.226 Hysterical fits are also known as (a) Atypical antidepressant
(a) Dissociative amnesia (b) Atypical antipsychotic
(b) Dissociative fuge (c) Benzodiazipine
(c) Dissociative convulsions (d) Mood stabilizer
(d) Dissociative motor disorder
Q.227 Disorientation is most commonly seen in
MCQ
Q.237 Treatment of anorexia nervosa include Q.246 Legislation of mentally retarted person is
except included in
(a) Behaviour therapy (b) Avoid eating (a) Primary prevention
(c) Group therapy (b) Secondary prevention
(d) Use of antidepressants (c) Tertiary prevention
Q.238 Most common type of post partum (d) All
psychosis is Q.247 Developmental reading disorder is known as
(a) Depressive episode with psychotic (a) Dyslexia
symptoms (b) Dyscalculia
(b) Schizophrenia (c) Dysphasia
(c) Mania (d) Delirium (d) Autism
Q.239 Modified ECT is not given frequently in Q.248 Developmental mathmatic disorder is
routine practice because of known as
(a) Non availability of anesthetist (a) Dyslexia (b) Dyscalculia
(b) Myocardial infarction (c) Dysphasia (d) Autism
(c) Osteoporosis Q.249 A child has following features-absent social
(d) All of the above smile, remains engaged in solitary games
Q.240 Which is the overall, priority goal of in- treats people as non living organism, no
patient psychiatric treatment? attachment to relatives the child is suffering
(a) Maintenance of stability in the from
community. (a) Tic disorder (b) Autism
(b) Medication compliance. (c) Delusion (d) Hallucination
(c) Stabilization and return to the Q.250 Management of non organic enuresis
community. includes
(d) Better communication skills. (a) Bladder training
Q.241 Food that should be avoided in Alcohol (b) Sleep should be interrupted before the
withdrawal client? expected time of urination
(a) Milk (b) Orange Juice (c) Imipramine
(c) Soda (d) Regular Coffee (d) All
Q.242 Primary prevention for mental retardation Q.251 Language development in autistic child
includes resembles:
(a) ↑se education level (a) Scanning speech (b) Speech lag
(b) Universal immunization (c) Shuttering (d) Echolalia
(c) Genetic counselling Q.252 What are the most specific signs and
(d) All symptoms that would be used for diagnosis
Q.243 In following which is a part of secondary anorexia nervosa are?
prevention of MR (a) Excessive weight loss, amenorrhea and
(a) Early detection and treatment [if abdominal distension
possible] of mental retardation (b) Slow pulse, 10% weight loss and
(b) rehabilitation alopecia
(c) Good perinatal medical care (c) Compulsive behavior, excessive fears
(d) Improve socio-economic condition and nausea
Q.244 Tertiary prevention of mental retardation (d) Excessive activity, memory lapses and
includes an increased pulse
(a) ↑se education level Q.253 Depression:
(b) Rehabilitation (a) is a normal part of ageing
(c) Early detection of presence of mental (b) is not a normal process of ageing
retardation (c) includes symptoms such as loss of
(d) Immunization of children with DPT, interest, sadness, weight loss and
BCG, OPV and MMR worthless feelings
Q.245 Based on the knowledge of electro- (d) B and C are the correct answer
convulsive treatment, the nurse explains to Q.254 What is the mode of action of antipsychotic
the student nurse that atropine is given drugs
before the treatment primarily to: (a) They block dopamine receptors
(a) Minimize intestinal contractions (b) They increase dopamine secretion
(b) Decrease anxiety (c) They increase CSF secretion
(c) Dry up body secretions (d) All
(d) Prevent aspiration
MCQ
Q.255 The group of drugs most commonly used to Q.264 Side effects of antidepressants include
treat schizophrenia is except
(a) Antipsychotic (b) Antidepressants (a) Diarrhoea (b) Tremor
(c) Antiparakinsonian (d) Antianxietic (c) Tachycardia (d) Weight gain
Q.256 A nurse enters the ward and notices that Mrs Q.265 Which is the commonest side effect of
Sheetal is constantly watching the floor and lithium
looks very anxious. What should be the (a) Seizures (b) Diarrhoea
nurse most therapeutic treatment in (c) Skin rashes (d) Tremor
minimizing client anxiety? Q.266 Side effects of lithium use, are except
(a) Would you like to watch TV? (a) Muscular weakness
(b) Would you like me to talk with you? (b) Nephrotic syndrome
(c) Are you feeling upset now? (c) Hyperthyroidism
(d) Ignore the client and do the rest of work (d) Metallic taste
Q.257 Which group of drugs also known as Q.267 The drug which is used as a first line
thymoleptics treatment of acute mania
(a) Antimanic (a) Lithium (b) Haloperidol
(b) Antidepressants (c) Sodium valproate
(c) Analgesic (d) Both (a) and (c)
(d) Antiparkinsonian Q.268 The group of drug which is also known as
Q.258 A psychiatric illness may be marked by all minor transquilizers
of the following except: (RRB 86) (a) Antimanic (b) Antidepressants
(a) Disturbance in behaviour (c) Antianxietic (d) Antipsychotic
(b) Impairment in preexisting functioning Q.269 In following which is not a long acting
(c) Impoverishment of feelings antianxietic drug
(d) Unpopular beliefs (a) Chlordiazepoxide (b) Nitrazepam
Q.259 An 80-year-old woman has sudden onset of (c) Lorazepam (d) Clonazepam
right-sided paresis, short-term memory loss, Q.270 Example of short acting antianxietic drug is
depression, right visual field detect, and (a) Alprazolam (b) Diazepam
mild expressive aphasia, indicating a (c) Haloperidol (d) Flurozepam
possible stroke. The most likely part of the Q.271 A characteristic that would suggest the
brain affected is the: nurse that Miss. Shikha may have bulimia
(a) Right hemisphere. would be:
(b) Left hemisphere. (a) Frequent regurgitation and re-
(c) Brain stem. (d) Cerebellum. swallowing of food
Q.260 In following which is not a selective (b) Previous history of gastritis
serotonin reuptake inhibitors, (c) Badly stained teeth
antidepressants (d) Positive body image
(a) Flouxetine (b) Sertraline Q.272 In following which is not a side effect of
(c) Paroxetine (d) Carbamazepine benzodiazepines
Q.261 When working with a male client suffering (a) ↑se salivation (b) Diarrhoea
phobia about lizards, Nurse should (c) Epigastric pain (d) Vertigo
anticipate that a problem for this client Q.273 The antipsychotic which was first of all
would be? discovered
(a) Anxiety when discussing phobia (a) Chlorpromazine (b) Haloperidol
(b) Anger toward the feared object (c) Olanzapine (d) Risperidone
(c) Denying that the phobia exist Q.274 Thiamine has been prescribed for an
(d) Distortion of reality when completing alcoholic patient. The rationale for
daily routines administration of this medication is the
Q.262 Indications for use of lithium include except prevention of:
(a) Treatment of mania (a) Alcoholic dementia
(b) Treatment of schizoaffective disorder (b) Huntington's disease
(c) Major depression (c) Wernicke-korsakoff syndrome
(d) Treatment of cyclothymia (d) Alcohol withdrawal syndrome
Q.263 lithium is a- Q.275 If ECT is given with muscle relaxants and
(a) Antimanic agent general anaesthesia, then it is known as
(b) Antidepressant (a) Direct ECT (b) Modified ECT
(c) Mood stabilizing agent (c) Bilateral ECT (d) Unilateral ECT
(d) Both (a) and (c)
MCQ
Q.276 Preparations of a patient before giving ECT (c) Relaxation training, hierarchy formation,
include except supervision
(a) Obtain written consent (d) Hierarchy formation, relaxation training,
(b) Empty bladder and bowel aversion therapy
(c) Give light breakfast just before starting Q.286 The psychotherapy used for the treatment of
ECT conditions which are pleasant but
(d) Loosen the cloth undesirable
Q.277 A nurse is caring for a client having suicidal (a) Flooding (b) Aversion therapy
thoughts. So a nurse should alert for the (c) Millieu therapy
feeling of: (d) Systematic desensitization
(a) Frustration and fear of death Q.287 Imipramine is a-
(b) Anger and resentment (a) Antimanic drug
(c) Anxiety and loneliness (b) Antipsychotic drug
(d) Helplessness and hopelessness (c) Antidepressant drug
Q.278 Purpose of giving succinylcholine before (d) Antianxiety drug
ECT is
(a) To increase oral secretion Q.288 Features of psychogenic stupor include
(b) To produce anaesthetic effect except
(c) To decrease oral secretion (a) Presence of previous psychiatric illness
(d) For muscle relaxation (b) Absence of precipitating stressor
Q.279 Dose of atropine given before ECT is (c) Presence of protective devices
(a) 0.5-0.6 mg (b) 2-3 mg (d) Urinary incontinence is not common
(c) 0.1-0.2 mg (d) 5-10 mg Q.289 If a client with depression who has not
Q.280 The solution which is used for moistening responded to antidepressant medication. The
electrodes before ECT, is nurse anticipates that what treatment
(a) Dettol (b) Betadine procedure may be prescribed?
(c) H2O2 (d) Normal saline (a) Neuroleptic medication
Q.281 In following which is not an antidepressant (b) Short term seclusion
drug- (c) Psychosurgery
(a) Imipramine (b) Nortryptiline (d) Electroconvulsive therapy
(c) Sertraline (d) Olanzapine Q.290 During electroconvulsive therapy (ECT) the
Q.282 Before giving unilateral ECT, in which side client receives oxygen by mask via positive
of head electrodes are placed in right pressure ventilation. The nurse assisting
handed person with this procedure knows that positive
(a) Right side (b) Left side pressure ventilation is necessary because?
(c) It may be placed in right or left side (a) Anesthesia is administered during the
(d) In between right and left procedure
Q.283 During bilateral ECT, each electrode is (b) Decrease oxygen to the brain increases
placed confusion and disorientation
(a) 2.5-4.0 cm below the midpoint on a line (c) Grand mal seizure activity depresses
joining the tragus of ear and lateral respirations
canthus of eye (d) Muscle relaxations given to prevent
(b) 2.5-4.0 cm above the midpoint on a line injury seizure activity depress
joining the tragus of the ear and lateral respirations.
cantheus of eye Q.291 A male client who is experiencing
(c) midpoint of the line joining the tragus of disordered thinking about food being
ear and centre of occiput poisoned is admitted to the mental health
(d) just above the tragus of ear unit. The nurse uses which communication
Q.284 Schedule of giving ECT includes technique to encourage the client to eat
(a) Daily (b) 3 times in a week dinner?
(c) Weekly (d) Twice in a week (a) Focusing on self-disclosure of own food
Q.285 Correct order of steps of systematic preference
desensitization is (b) Using open ended question and silence
(a) Relaxation training, hierarchy formation, (c) Offering opinion about the need to eat
systematic desensitization (d) Verbalizing reasons that the client may
(b) Flooding, relaxation training, systematic not choose to eat
desensitization
MCQ
Q.292 In following which EPS is more common (b) Imbalanced nutrition: Less than body
(a) Parkinsonism (b) Akathisia requirements
(c) Dystonia (d) Tardive dyskinesia (c) Ineffective family coping
Q.293 What is a defense mechanism? (DSSSB) (d) Impaired verbal communication
(a) A mechanism designed to reduce stress Q.299 In following which is not a part of nursing
and conflict caused by specific care to the patient who is taking
experiences. antipsychotic drug
(b) A method for negotiating a stage of (a) Give a piece of lemon or chewing to
development. reduce dry mouth
(c) Any form of martial arts (b) advise the pt to take antacids because
(d) A mechanism designed to remove they will increase absorption of
psychological barriers. antipsychotic drug
Q.294 A 23-year-old client has been admitted with (c) advise the pt not to take antacids because
a diagnosis of schizophrenia says to the they will decrease absorption of
nurse "I won five cigars. I've been to antipsychotics
Havana. She rose out of the water, in a (d) Explain the pt not to increase or decrease
bikini." or stop taking drugs without discussing
That's literal you know". These statements the doctor
illustrate: Q.300 The drugs which are used to treat extra
(a) Neologisms pyramidal symptoms occured as a side
(b) Echolalia effect of antipsychotics
(c) Flight of ideas (a) Psychotic drug
(d) Loosening of association (b) Antiparkinsonian drug
Q.295 A long term goal for a paranoid male client (c) Benzodizepines
who has unjustifiably accused his wife of (d) Phenobarbitones
having many extramarital affairs would be Q.301 In following which is not an
to help the client develop: antiparkinsonian drug
(a) Insight into his behavior (a) THP
(b) Better self control (b) Procyclidine hydrochloride
(c) Feeling of self worth (c) Risperidone (d) Carbidopa
(d) Faith in his wife Q.302 A client is admitted to the psychiatric unit of
Q.296 Which of the following is an example of a local hospital with chronic
repression? undifferentiated schizophrenia. During the
(a) Stopping yourself from behaving the next several days, the client is seen
sway you want to laughing, yelling, talking to herself. This
(b) Suppressing bad memories or current behavior is characteristic of:
thoughts that cause anxiety (a) delusion
(c) Suppressing you natural instincts (b) looseness of association
(d) Stopping others from behaving (c) illusion (d) hallucination
inappropriately Q.303 What medication would probably be
Q.297 A client receiving haloperidol (Haldol) ordered for the acutely aggressive
complains of stiff jaw and difficulty schiozophrenic client?
swallowing. The nurse's first action is to (a) chlorpromazine (Thorazine)
(a) reassure the client and administer as (b) haloperidol (Haldol)
needed lorazepam IM. (c) lithium carbonate (Lithonate)
(b) administer as needed dose of (d) amitriptyline (Elavil)
benztropine I.M. as ordered. Q.304 O.D. dose of antipsychotic should be taken
(c) administer as needed dose of benztropine at bed time because
by mouth as ordered. (a) During sleeping it absorbs very fast
(d) administer as needed dose of haloperidol (b) During sleeping it absorbs slowly
by mouth. (c) Of its sedative effect
Q.298 The nurse is planning care for a client (d) During night it is more effective
admitted to the psychiatric unit with Q.305 To reduce metallic taste of lithium, it should
diagnosis of paranoid schizophrenia. Which be given
nursing diagnosis should receive the highest (a) In the morning
priority? (b) After sleeping
(a) Risk for violence toward self or others (c) In powder form
(d) During or after meal
MCQ
Q.306 One of the most important nursing role (d) Ask the client to describe what the
during providing care to the patient who is voices are saying
on lithium Q.312 Before giving ECT all the metallic articles
(a) Assess blood lithium level are removed from patient's body because
(b) Restrict salt and fluid intake (a) They may be misplaced
(c) Maintain intake output chart (b) They may be theft
(d) Give medicine before meal (c) Electric current may pass on body parts
Q.307 Roles of nurse in psychiatric ward include (d) It may cause difficult to handle patient
except Q.313 Increased suicidal tendency is associated
(a) Observe the patient for presence of side with alteration in the brain levels of:
effect of antipsychotic drugs if he is (a) Noradrenaline (b) Serotonin
taking (c) Dopamine (d) GABA
(b) Follow five right rule while Q.314 Antipsychotic drug induced Parkinsonism is
administering drugs treated by:
(c) If psychiatric symptoms subside, then (a) Anti-chole (b) Atropine
sudden stop the drug (c) Prochlorperazine (d) Perphenazine
(d) Advise the pt not to use any Q.315 Nursing care during giving ECT include
psychoactive substances except-
Q.308 Putting a bitter taste on nails for nail biting (a) Restrain the thighs
is an example of (b) Flexion of the head
(a) Flooding (b) Aversion therapy (c) Observe the patient for grandmal seizures
(c) Systematic desensitization (d) None
(d) Hypnosis Q.316 Which position is provided to the patient
Q.309 Which of the following groups of after giving ECT
characteristics would the nurse expect to see (a) Supine (b) Prone
in the client with schizophrenia? (c) Side lying (d) Lithotomy
(a) loose associations, grandiose delusions, Q.317 In following which is not a part of nursing
and auditory hallucinations care after giving ECT
(b) Periods of hyperactivity and irritability (a) assess vital signs
alternating with depression (b) allow the patient to sleep for 30-60
(c) Delusions of jealousy and persecution, minutes
paranoia, and mistrust (c) do not give anything to drink or eat upto
(d) Sadness, apathy, feeling of 6-8 hours after procedure
worthlessness, anorexia, and weight loss (d) help the patient to perform his daily
Q.310 Which of the following actions should the activity
nurse take first following a violent episode Q.318 Extra pyramidal symptoms are a
on a psychiatric unit? (RAK MSc entrance complication of treatment with following
2010) drugs:
(a) Conduct a staff debriefing (a) Antipsychotic (b) Anti anxiety drugs
(b) Contract hospital administration (c) Anti depressants
(c) Discuss the incident with the other (d) Anti malarial drugs
(d) Call hospital security Q.319 A woman treated with lithium during
Q.311 The nurse is caring for a client with pregnancy, the fetus should be tested for:
schizophrenia who experiences auditory (a) Neural tube defects
hallucinations. The client appears to be (b) Cardiac malformations
listening to someone who isn't visible. He (c) Urogenital abnormalities
gestures, shouts angrily, and stops shouting (d) Scalp defects
in mid-sentence. Which nursing intervention Q.320 Alzheimer's disease is more common in
is the most appropriate? (a) Infancy (b) Childhood
(a) Approach the client and touch him to get (c) Adulthood (d) Old age
his attention Q.321 The definition of nihilistic delusions is
(b) Encourage the client to go to his room (a) a false belief about the functioning of the
where he'll experience fewer body
distractions. (b) Belief that the body is deformed or
(c) Acknowledge that the client is hearing defective in a specific way.
voices but make it clear that the nurse (c) false ideas about the self, others, or the
doesn't hear these voices. world
(d) the inability to carry out motor activities
MCQ
Q.322 A client with schizophrenia hears a voice (b) Do not leave any sharp instrument near
telling him he is evil and must die. The the patient
nurse understands that the client is (c) Encourage the patient to talk about his
experiencing: suicidal plan
(a) a delusion (b) flight of ideas (d) All
(c) Ideas of reference. (d) a hallucination Q.332 All overt and covert activities of human
Q.323 PICA is more common is beings that can be observed, known as
(a) Young children (b) Old age (a) Personality (b) Mind
(c) Pregnant woman (d) Both (a) and (c) (c) Behaviour (d) Adjustment
Q.324 An eating disorder of non-nutetitive Q.333 The series of processes by which an
substance such as plaster, soil etc is known individual maintains a satisfactory
as- equilibirum with his world
(a) Bulimia nervosa (b) PICA (a) Personality (b) Mind
(c) Anorexia nervosa (d) Tic (c) Behaviour (d) Adjustment
Q.325 Withdrawal symptoms of opium include Q.334 The subsystem of personality which is
except concerned with immediate gratification of
(a) Dilated pupils (b) Anorexia needs
(c) Constipation (d) Rhinnorrhea (a) Id (b) Ego
Q.326 Disorders characterized by physical (c) Superego (d) Super Id
symptoms resulting from psychologic Q.335 The subsystem of personality based on
factors reality principal
(a) Somatopsychic disorders (a) Id (b) Ego
(b) Schizophrenia (c) Superego (d) Super Id
(c) Psychosomatic disorders Q.336 The subsystem of personality which judges
(d) Phobic disorder wheather an action is right or wrong as per
Q.327 Nursing care to a schizophrenic patient standards of society
include except (a) Id (b) Ego
(a) Give the drugs as prescribed by (c) Superego (d) Super Id
psychiatrist Q.337 Replacement of an acceptable need attitude
(b) Allow the pt to talk about his illness or emotion with one more socially
(c) Criticise the patient acceptable?
(d) Do not criticise the patient (PGIMER 2006, AIIMS)
Q.328 To improve socialization of a schizophrenic (a) displacement (b) sublimation
patient, what steps will you take as a nurse (c) substitution (d) suppression
(a) allow the patient to talk to other patients Q.338 Excessive use of abstract thinking or
(b) encourage the patient to play with other generalization to decrease painful thinking
patient is:
(c) pat the patient for his good performance (a) projection (b) rationalization
in the group (c) intellectualization. (d) over explanation
(d) all Q.339 Eating behavior is controlled by: (Nursing
Q.329 Nursing care for improving sleep pattern of Grade-II 2007)
a schizophrenic patient include except (a) Hypothalamus (b) Adrenal glands
(a) Switch off the main lights (c) Pancreas (d) Thyroid
(b) Give a glass of hot milk before sleeping Q.340 Emotion can be best expressed through
(c) Avoid day time activities which of the following? (Nursing Grade-II
(d) Provide calm and cool environment 2007)
Q.330 As a psychiatric nurse, what steps will you (a) Language (b) Gesture
take to protect the psychiatric patient from (c) Facial expression (d) All of the above
injury Q.341 The cognitive changes during old age
(a) Provide a non stimulating environment mostly affect which of the following
(b) Avoid arguments in the ward aspects? (Nursing Grade-II 2007)
(c) Avoid competitive games which may (a) Emotion (b) Memory
cause hostility (c) Sentiment (d) Intelligence
(d) All Q.342 The part of mind that distinguish right from
Q.331 To prevent suicidal attempt, what nursing wrong and acts as censor of behavior?
care will you provide to the patient (RPSC Nursing tutor 2009)
(a) Do not leave the patient alone (a) Ego (b) Id
(c) Libido (d) Superego
MCQ
Q.343 A patient keeps repeating the last few words (a) Lying (b) Denying
of what he hears the condition is known as: (c) Retionalizing (d) Confabulation
(RPSC Nursing tutor 2009) Q.354 The nurse understands that one of the most
(a) Neologism (b) Echopraxia difficult tasks for the depressed client is the-
(c) Echolalia [RPSC NG-II-2010]
(d) Thought insertion (a) Remorse and guilt
Q.344 Type of defense mechanism in which (b) Need for comforting
emotional feeling is transferred to objects (c) Anger towards other
who are less dangerous than those who (d) Feeling of low self esteem
initially aroused the emotion Q.355 The therapeutic environment for client with
(a) Displacement (b) Substitution bulimia nervosa would be one that is-
(c) Conversion (d) Transference [RPSC NG-II-2010]
Q.345 A person who has not been able to select as (a) Controlling (b) Empathetic
a college lecturer may try to select as third (c) Focussed on food
grade teacher it is an example of (d) Based on realistic limits
(a) Substitution (b) Fixation Q.356 A person who deliberately pretends an
(c) Reaction formation (d) Transference illness is usually thought to be- [RPSC NG-
Q.346 Type of defence mechanism in which II-2010]
unacceptable real feelings are repressed and (a) Neurotic (b) Malingering
acceptable feeling are expressed (c) Out of concept with reality
(a) Identification (d) Using conversation defenses
(b) Reaction formation Q.357 Abrupt withdrawal of barbiturate use could
(c) Transference cause a person to experience-
(d) Rationalization [RPSC NG-II-2010]
Q.347 'Grapes are sour' is the example of which (a) Ataxia (b) Urticaria
defense mechanism (c) Diarrhea (d) Seizures
(a) Rationalization (b) Reaction formation Q.358 Group therapy can best help those who-
(c) Suppression [RPSC NG-II-2010]
(d) Identification (a) Are emotionally ill
Q.348 La Bella indifference is related to which of (b) Are dependent on others
the following neurosis? (RPSC Nursing (c) Feel/that they have a problem
tutor 2009) (d) Have no one to listen to them
(a) Phobic anxiety (b) Anxiety disorder Q.359 Self help group such as alcoholic.
(c) Obsessional compulsion disorder Anonymous are successful because they
(d) Conversion reaction. meet the clients need to- [RPSC NG-II-2010]
Q.349 Gustatory hallucination affects the: (RPSC (a) Grow (b) Belong
Nursing tutor 2009) (c) Be trusted (d) Be independent
(a) Nose (b) Taste buds Q.360 Persecutory delusion is common in: (RPSC
(c) Ears (d) Skin Nursing tutor 2009)
Q.350 The therapeutic effective serum lithium (a) Schizophrenia
concentration level is monitored: (RPSC (b) Paranoid Schizophrenia
Nursing tutor 2009) (c) Manic Depressive Psychosis
(a) 12-24 hours (b) 24-48 hours (d) Bipolar affective disorder
(c) 3-5 days (d) 10-14 days Q.361 La Bella indifference is related to which of
Q.351 Physical symptoms in psychosomatic the following neurosis ?
disorders are caused by- [RPSC NG-II- [RPSC Ng. Tutor-2009]
2007] (a) Phobic anxiety (b) Anxiety disorder
(a) Emotional factors (c) Obsessional compulsion disorder
(b) Physical factors (d) Conversion reaction
(c) Environmental factors Q.362 Gustatory hallucination affects the-
(d) Genetic factors [RPSC Ng. Tutor-2009]
Q.352 For the clients with alcoholism, the primary (a) Nose (b) Taste buds
rehabilitator is the- [RPSC NG-II-2010] (c) Ears (d) Skin
(a) Client (b) Nurse Q.363 Abrupt withdrawal of barbiturate use could
(c) Physician (d) Entire health team cause a person to experience: (RPSC 2010)
Q.353 When a client makes up stories to fill in the (a) Ataxia (b) Utricaria
blank spaces of memory it is known as- (c) Diarrhoea (d) Seizures
[RPSC NG-II-2010]
MCQ
Q.364 Which of these nursing actions belong to the Q.375 What will nurse do, in a case of a patient
secondary level of preventive intervention? have seizures if alcohol is withdrawn
(a) Providing mental health consultation to suddenly- (RUHS-M.Sc. Aug.-2015)
health care providers (a) Make patient comfortable and restrain
(b) Providing emergency psyciatric services (b) Take blood sample for ethanol level
(c) Being politically active in relation to (c) Monitor vital signs
mental health issues (d) Prevent patient from injury
(d) Providing mental health education to Q. 376 Anorexia nervosa complications are-
members of the community (RUHS-M.Sc. Aug.-2015)
Q.365 The primary aim of psychiatric treatment is (a) Hypokalemia, Dehydration, Anaemia,
to- [RPSC Ng. Tutor-2009] Electrolyte imbalance
(a) Release the of patients symptoms (b) Obesity, Electrolyte imbalance, Anaemia
(b) Return the patient to his home (c) Protein deficiency, Dehydration,
(c) Help the patient to make better Anaemia
psychosocial adjustment (d) Vitamin and protein deficiency with
(d) Prevent the patient from becoming anaemia
psychotic Q. 377 Psychological treatment for the personality
Q.366 Common risk of severe depression is: problems, adjustment is done by-
(DSSSB 2013) (RUHS-M.Sc. Aug.-2015)
(a) Fatigability (b) Hallucinations (a) Milieu therapy (b) Family therapy
(c) Thought block (d) Suicide (c) Individual therapy (d) Psycho therapy
Q.367 Tocan economy is a- Q. 378 45 years patient shows severe brain and
(a) Behavioural therapy (b) CBT mental deterioration, emotional distress,
(c) Individual therapy (d) Hypnotic therapy over activity. Patient can be diagnosed to be
Q.368 Perception of any object in the absence of suffering with- (RUHS-M.Sc. Aug.-2015)
actual stimulus is termed as- [PGJ-2006] (a) Alzeimer‟s disease
(a) Illusion (b) Hallucination (b) Picks disease
(c) Delusion (d) Dementia (c) Parkinson‟s disease
Q.369 In following which therapy is used for (d) Harington‟s disease
treating phobia- [ESI-2007] Q. 379 What will be the diagnosis of the patient in
(a) Aversion therapy (b) ECT case nurse found patient is giving silly
(c) Systematic Desensitization smile, giggling, had hallucinations, fantasy
(d) Hypnosis delusions, do not maintain daily personal
Q.370 Imipramine is a- [AIIMS-2010] hygiene- (RUHS-M.Sc. Aug.-2015)
(a) Antimanic drug (a) Hebephrenic schizophrenia
(b) Antipsychotic drug (b) Simple schizophrenia
(c) Antidepressant drug (c) Catatonic schizophrenia
(d) Antianxiety drug (d) Paranoid schizophrenia
Q.371 A patient with OCD frequently washes his Q. 380 Most of the goals of nurse-patient
hands, what is the reason behind this- relationship can be achieved during-
[AIIMS-2010] (IGNOU-B.Sc-2012)
(a) He protect himself from infections (a) Orientation phase (b) Trusting phase
(b) He protect himself from dirt (c) Termination phase (d) Working phase
(c) Hand washing relieves anxiety Q. 381 When an individual blames others for his
(d) It is the part of treatment suggested by own mistakes, it is called as-
psychiatrist (IGNOU-B.Sc-2012)
Q.372 In following which is not an example of (a) Projection (b) Rejection
opioid- [AIIMS-2011] (c) Aggression (d) Repression
(a) Morphine (b) Heroin Q. 382 „Therapy‟ „Psycho-
(c) Pethidine (d) Naloxone social therapies‟ (Include)
Q.373 Librium is a- [ESI-2009] (IGNOU-B.Sc-2014)
(a) Antipsychotic drug (b) Transquilizer (a) Behaviour therapy (b) Family therapy
(c) Anti parkinsonian (d) Anti manic (c) ECT (d) Cognitive therapy
Q.374 Resperidone is a- [RUHS Pre-M.Sc.-2010] Q. 383 A patient with the clinical manifestations of
(a) Atypical antidepressant delusion of persecution and auditory
(b) Atypical antipsychotic hallucinations and refers to himself as “The
(c) Benzodiazipine Man” is admitted to a psychiatric unit.
(d) Mood stabilizer When asked, “How are you doing today?”
MCQ
The patient responds by addressing himself Q. 392 Which of the following disorder have
in third person “The Man is not doing well.” symptom like persecution, grandeur, idea of
This response of the patient is an example reference, incoherence (RUHS-M.Sc.2015)
of- (Patna AIIMS June-2015) (a) Disorder of activity
(a) Displacement (b) Transference (b) Disorder of attention
(c) Identification (d) Dissociation (c) Disorder of thought
Q. 384 Which of the following best illustrates (d) Disorder of perception
Delusion of Reference? Q. 393 In a case of psychiatric patient is having
(Patna AIIMS June-2015) liver or cardio vascular disorder, the nurse
(a) My food is being poisoned. should take precautions while
(b) The TV reporter is talking about me. administering- (RUHS-M.Sc. Aug.-2015)
(c) I am the President of this country. (a) Anti-depressants (b) Anti-histamines
(d) The Government is trying to steal my (c) Anti-cholinergics (d) Anti-psychotic
invention. Q. 394 Patient Anxiety „Panic form‟
Q. 385 All behaviour can be said to be- Nurse
(RPSC-Tutor-2009) Clinical findings (Signs &
(a) A response to stimulus symptoms)
(b) An intellectual response (IGNOU-B.Sc-2012)
(c) A conditioned response (a) Being not clear and talk with action
(d) An emotional response (b) Have increased activity
Q. 386 Nurses “Nurse- (c) Demands help
client relationship” Most difficult (d) Tense all the time
stage Q. 395 After consuming alcohol, it can be detector
(RRB Feb. 2015 Red II) in the blood within- (IGNOU-B.Sc-2014)
(a) Remaining therapeutic and professional (a) 2-3 Minutes (b) 3-4 Minutes
(b) Being able to understand and accept the (c) 4-5 Minutes (d) 5-6 Minutes
client‟s behaviour Q. 396 Selective Serotonin reuptake inhibitors
(c) Developing an awareness of self and the (SSRIs) belong to which category of
professional role in the relationship psychotropic drugs? (Patna AIIMS 2015)
(d) Accepting responsibility in identifying (a) Antipsychotics (b) Anti-depressants
and evaluating the real needs of the (c) Mood stabilizers (d) Hypotics
client Q. 397 An exaggerated concept of one‟s own
Q. 387 The most effective psychotherapy for a 9 importance, power and knowledge of
year old child dignosed with Attention identity is- (Patna AIIMS June-2015)
Deficit Hyperactivity Disorder (ADHD) is- (a) Delusion of Control
(BHU Jan.-2015) (b) Delusion of Reference
(a) Play therapy (b) Milieu therapy (c) Delusion of Persecution
(c) Behaviour therapy (d) Family therapy (d) Delusion of Gradiosity
Q. 388 A sleep disorder where undersirable Q. 398 Nurse, Mentally ill patient
behaviour occur during sleep is known as- Assessment Patient
(Kerala PSC April 06/2015) Observe Patient,
(a) Insomnia (b) Narcolepsy Repeat
(c) Hypersomnia (d) Parasomnia Nurse Patient Activity
Q. 389 Abnormal involuntary movement which “Medical term”
occurs suddenly, repetitively and (RPSC-Tutor-2009)
purposeless is known as- (a) Neologism (b) Echopraxia
(Kerala PSC-38/2014) (c) Echolalia (d) Thought insertion
(a) Tic (b) Mannerism Q. 399 Intellectual quotient [I.Q.] tells about-
(c) Cataplexy (d) Compulsion (RPSC-Tutor-2009)
Q. 390 Inability to recognize familiar objects is (a) Intellectual maturity
termed as- (ESIC Delhi-2009) (b) Mental age in relation to chronological
(a) Ataxia (b) Apraxia age
(c) Amnesia (d) Agnosia (c) Academic achievement
Q. 391 The condition when a rope may be (d) Mental Growth
perceived by person as a snake in the dark is
referred as- (IGNOU-B.Sc-2012)
(a) Suspicion (b) Hallucination
(c) Illusions (d) Delusion
MCQ
Q. 400 World mental health day is observed on- Q.409 The techniques of psychoanalysis includes
(Kerala PSC Jan.-20/2015) the following, EXCEPT:
(a) Oct. 10 (b) Dec. 14 (a) Exploration
(c) June 5 (d) April 8 (b) Free association
Q.401 What is the condition in which children is (c) Clay association
pulling out hair? (d) Transference
(a) Trichotellomania (b) Acrophobia (AIIMS Raipur Staff Nurse, 2017)
(c) Imipramine (d) Olanzepine Q.410 Thinking containing erroneous conclusions
(AIIMS Raipur Staff Nurse, 2017) and internal contradiction is called?
Q.402 When a patient is not aware of his / her (a) Autistic thinking
mental illness, it is called? (b) Critical thinking
(a) Discorientation (c) Illogical thinking
(b) Lack of insight (d) Logical thinking
(c) Uncosciousness (AIIMS Raipur Staff Nurse, 2017)
(d) Lack of concentration Q.411 According to DSM IV, the positive
(AIIMS Raipur Staff Nurse, 2017) symptoms of Schizophrenia includes:
Q.403 Who is the first psychiatric nurse? (a) Hallucinations
(a) Hildegard Peplau (b) Delusions
(b) Linda Richards (c) Flat affect
(c) Sigmund Freud (d) Bizarre behavior
(d) Jean Watson (a) a,b,cb. (b) b,c,d
(AIIMS Raipur Staff Nurse, 2017) (c) a,c,d (d) a,b,d
Q.404 A person who is aloof, isolated & does not (AIIMS Raipur Staff Nurse, 2017)
soci alized, falls into which of the Q.412 The following are the barriers of
following category? Therapeutic relationships:
(a) Withdrawn (a) Too many questions
(B) Anxious (b) Assertive style
(C) Aggressive (c) Stereotyping
(D) Obsessive (d) Patronizing
(AIIMS Raipur Staff Nurse, 2017) (a) a,b,cb. (b) b,c,d
Q.405 In which defence mechanism anxiety is (c) a,c,d (d) a,b,c,d
expressed through physical symptoms? (AIIMS Raipur Staff Nurse, 2017)
(a) Projection Q.413 The hallucination in which the content is
(b) Regression consistent with either a depressed or manic
(c) Conversion mood is called:
(d) Hypochondriasis (a) Somatic hallucination
(AIIMS Raipur Staff Nurse, 2017) (b) Mood – congruent hallucination -
Q.406 What is total score in Mini Mental Status (c) Mood – incongruent hallucination –
Examination (MMSE)? (d) Haptic hallucination -
(a) 25 (b) 30 (AIIMS Raipur Staff Nurse, 2017)
(c) 32 (d) 35 Q.414 A state of diminished consciousness in
(AIIMS Raipur Staff Nurse, 2017) which the patient remains mute and still
Q.407 Which is common risk factor in patient with with the eyes open is called:
severe depression? (a) Catatonia (b) Stupor
(a) Fatigability (c) Panic (d) Hysteria
(b) Hallucinations (AIIMS Raipur Staff Nurse, 2017)
(c) Agitation Q.415 Which phase of the nurse – patient
(d) Suicidal Tendency relationship focuses to develop clarity about
(AIIMS Raipur Staff Nurse, 2017) the patient‟s preconceptions and
Q.408 Temporary loss of muscle tone and expectations of nurses and develop
weakness precipitated by a variety of acceptance of each other and respond to
emotional states is called: people who can offer help is?
(a) Cataplexy (a) Orientation Phase
(b) Catharsis (b) Working Phase
(c) Compulsion (c) Exploitation Phase
(d) Confabulation (d) Termination Phase
(AIIMS Raipur Staff Nurse, 2017) (AIIMS Raipur Staff Nurse, 2017)
MCQ
(a) dry mouth, difficult in micturition and
Q.416 A clinical features of patient with major constipation
depression includes: (b) Epileptic seizures, tremors and muscle
(a) Agitation twitching
(b) Behaviour variation (c) Skin rashes and jaundice
(c) Increased appetite (d) Somnolence and orthostatic hypotension
(d) Panic attack (AIIMS Raipur Staff Nurse, 2017)
(a) a,b,cb. (b) b,c,d Q.423 Mrs. Gowri, on assessment, shows the
(c) a,b,d (d) a,c,d following behaviour.
(AIIMS Raipur Staff Nurse, 2017) (a) Maintaining rigid posture
Q.417 Mr. Anand is a mentally ill person and need (b) Being mute
to be admitted immediately as of the (c) Hears “God‟s voice”
medical officer incharge. In his case the (d) Repeating the phrases
following statement are TRUE EXCEPT: These are the characteristics of:
(a) He should be produced before magistrate (a) Paranoid Schizophrenia
within 72 hours (b) Undifferentiated schizophrenia
(b) The magistrate should meet Mr. Anand (c) Catatonic schizophrenia
in hospital and examine him within 72 hours (d) Residual Schizophrenia
(c) The magistrate can produce the reception (AIIMS Raipur Staff Nurse, 2017)
order later in case of emergency Q.424 Which group of drug is the choice for
(d) The magistrate is eligible to extent the Attention Deficit Hyperactivity Disorder?
time period of 72 hours (a)Benzodiazepine
(a) a,b,c (b) b,c,d (b) CNS stimulant
(c) a,b,d (d) a,c,d (c) Anti-psychotics
(AIIMS Raipur Staff Nurse, 2017) (d) Anticonvulsant
Q.418 Mr. Raju says that he is the first lead of the (AIIMS Raipur Staff Nurse, 2017)
world and he is born with a special mission Q.425 Disturbances of orientation memory &
in life. These are the symptoms of: intelligence is present in which of the
(a) Autochthonous delusion following condition?
(b) Delusion of grandeur (a) Organic Psychosis
(c) Delusion of persecution (b) Functional Psychosis
(d) Delusion of reference (c) Hallucination
(AIIMS Raipur Staff Nurse, 2017) (d) Phobia
Q.419 Inability to carryout normal activities (AIIMS Raipur Staff Nurse, 2017)
despite intact motor function is: Q.426 The level of anxiety that enhance the
(a) Anhedonia individual‟s power of perception is:
(b) Apraxia (a) Mild (b) Panic
(c) Apathy (c) Moderate (d) Severe
(d) Amnesia (AIIMS Raipur Staff Nurse, 2017)
(AIIMS Raipur Staff Nurse, 2017) Q.427 Which of the following neurotransmitter is
Q.420 The end phase of psychoanalytical oriented deficient in depression?
psychotherapy constitutes the following, (a) Serotonin (b) 5HT
EXCEPT: (c) Both a and b (d) GABA
(a) Strengthening of insight (AIIMS Raipur Staff Nurse, 2017)
(b) Reinforcing the patient‟s improvement Q.428 The most common psychotherapy used to
(c) Application of therapeutic techniques help a person with Obsessive Comulsive
(d) Preparing the patient for termination of Disorder is:
treatment (a) Behavior modifaction
(AIIMS Raipur Staff Nurse, 2017) (b) Transaction Therapy
Q.421 A form of speech in which the client tends (c) Abreaction
to wander away from the intended point and (d) Flooding
never returning to the original idea is called: (AIIMS Raipur Staff Nurse, 2017)
(a) Verbigeration Q.429 All of the following are neurotransmitters
(b) Thought insertion EXCEPT:
(c) Tangentiality (a) Dopamine (d) GABA
(d) Thought block (c) Serotonin (d) Troponin
(AIIMS Raipur Staff Nurse, 2017) (AIIMS Raipur Staff Nurse, 2017)
Q.422 The side effects of antidepressant includes:
MCQ
Q.430 Which among the following holds true for Q.439 The most common deficiency seen in
depersonalization syndrome? alcoholics is:
(a) precedes the onset of Schizophrenia (a) Thiamine
(b) feels that other person has changed (b) Riboflavin
(c) Associated with depression (c) Pyridoxine
(d) indication of Electrocunvulsive Therapy (d) Pantothenic acid
(Recruitment Tutor-Nursing, 2016) (RUHS B.Sc Nur. Ex., 2017)
Q.431 Which among the following is a Q.440 ____________ occurs when a response is
characteristic feature of Schizophrenia? followed by experiencing something
(a) Incongruity of affect pleasurable
(b) Auditory hallucinations with clouding of (a) Positive reinforcement
consciousness (b) Negative reinforcement
(c) Memory impairment (c) Punishment
(d) Grandiose (d) Generation
(Recruitment Tutor-Nursing, 2016) (RUHS B.Sc Nur. Ex., 2017)
Q.432 State of uneasiness arising out of Q.441 Cognition refers to:-
anticipation of danger is termed as: (a) Behavior that is observable and external
(a) Obsessions (b) Anxiety (b) Behavior that is directly measureable
(c) Phobia (d) Compulsions (c) The mental events that take place while
(RUHS B.Sc Nur. Ex., 2017) is person behaving
Q.433 Pathological repetition involving imitation (d) Emories
of speech of another person is termed as: (RUHS B.Sc Nur. Ex., 2017)
(a) Enuresis (b) Echolalia Q.442 Memory can be best described as
(c) Encopresis (d) Echopraxia (a) A series of storage bins or boxes
(RUHS B.Sc Nur. Ex., 2017) (b) Or process of storage
Q.434 Fear of heights is termed as: (c) A series of passive data files
(a) Algophobia (d) An active system that encodes, stores,
(b) Claustrophobia and retrieves information
(c) Acrophobia (RUHS B.Sc Nur. Ex., 2017)
(d) Gamophobia
(RUHS B.Sc Nur. Ex., 2017) Q.443 Which structure of the personality according
Q.435 Grandiose delusions occur in which of the to Freud, works on the reality Principle?
following disorder? (a) ID (b) ego
(a) Manic disorder (c) Super ego (d) Ubido
(b) Obsessive compulsive disorder (RUHS B.Sc Nur. Ex., 2017)
(c) Phobic disorder Q.444 Electroconvulsive therapy was first
(d) Anxiety disorder introduced by
(RUHS B.Sc Nur. Ex., 2017) (a) Moniz and Lima
Q.436 Clouding of consciousness is characteristic (b) Cerietti and Bini
of: (c) Fraud and Jung
(a) Schizophrenia (b) Dementia (d) Meduna and Paracelsus
(c) Hysteria (d) Delirium (Kerala PSC, 2017)
(RUHS B.Sc Nur. Ex., 2017) Q.445 Agoraphobia is a dread of
Q.437 A patient has been taking Lithium carbonate (a) Strong light (b) Strangers
for his hypomania. While taking this drug (c) Open places (d) Pain
which mineral would you recommend in (Kerala PSC, 2017)
adequate quantities? Q.446 Which of the following is not a defense
(a) Sodium (b) Iron mechanism?
(c) Iodine (d) Calcium (a) Rationalisation (b) Inhibition
(RUHS B.Sc Nur. Ex., 2017) (c) Sublimation (d) displacement
Q.438 Emotion can be best expressed through (Kerala PSC, 2017)
which of the following? Q.447 Electroconvulsive therapy is contraindicated in
(a) Language (a) Parkinsonism
(b) Gestures (b) Hypertension
(c) Facial Expression (c) Pregnancy
(d) All of the above (d) Increased intracranial pressure
(RUHS B.Sc Nur. Ex., 2017) (Kerala PSC, 2017)
MCQ
Q.448 Chlorpromazine is usually not administered consciously attributes (or transfers) to the
intravenously as it can cause serious nurse feelings and behavioural
(a) Dystonia (b) Tremors predispositions formed towards a person
(c) Cerebral oedema (d) Hypotension from his or her past is
(Kerala PSC, 2017) (a) Resistance
Q.449 Who coined the term „Schizophrenia‟? (b) Boundary violation
(a) Kraepelin (b) Sander (c) Transference
(c) Bleuler (d) Mayer Gross (d) Counter transference
(Kerala PSC, 2017) (AIIMS Jodhpur and Rishikesh, 2017)
Q.450 Most common postoperative psychiatric Q.458 False sensory perception not associated with
condition is real external stimuli is called
(a) Depression (b) Schizophrenia (a) Concrete thinking
(c) Mania (d) Delirium (b) Hallucination
(Kerala PSC, 2017) (c) Delusion
Q.451 Tardive dyskinesia is a (d) Illusion
(a) Side effect of anti-psychotics (AIIMS Jodhpur and Rishikesh, 2017)
(b) Cause of dementia Q.459 A client with schizophrenia has been started
(c) Psychosomatic disorder on medication therapy with clozapine. The
(d) Cause of mania nurse would assess the results of which
(Kerala PSC, 2017) laboratory study to monitor for adverse
Q.452 Which type of hallucinations are common in effect of this medication
schizophrenia? (a) Liver function studies
(a) Visual (b) Tactile (b) Blood glucose level
(c) Olfactory (d) Auditory (c) White blood cell count
(Kerala PSC, 2017) (d) Platelet count
Q.453 Delusion is a disorder of (AIIMS Jodhpur and Rishikesh, 2017)
(a) Perception (b) Thought Q.460 Method used to give Halloperidol injection
(c) Orientation (d) Memory (a) Z track (b) M track
(Kerala PSC, 2017) (c) N track (d) W track
Q.454 A patient on antipsychotic medication (AIIMS Jodhpur and Rishikesh, 2017)
developed rolling of eyes upward. This is Q.461 A client sleep between conversation,
indicative of describe as
(a) Therapeutic action (a) Sleep apnea
(b) Drug has not reached its therapeutic (b) Narcolepsy
level in blood (c) Somnambulism
(c) Extrapyramidal symptoms (d) Insomnia
(d) Myasthenia gravis (AIIMS Jodhpur and Rishikesh, 2017)
(AIIMS Jodhpur and Rishikesh, 2017) Q.462 A patient shows which of the following
Q.455 A relative of a schizophrenic patient symptom of overdose of lithium
informed nurse that patient is having (a) Polyuria and drinking water
suicidal ideation. All of the following (b) Weight loss
nursing action is appropriate in this situation (c) Leukocytopenia
EXCEPT (d) Hyporeflexia
(a) Inform the Doctor regarding the situation (AIIMS Jodhpur and Rishikesh, 2017)
(b) Do not ask patient direct questions Q.463 “Scheduled activity” therapy used for the
regarding suicidal ideation patient with:-
(c) Increase the environmental safety (a) Negative symptoms of schizophrenia
(d) Continuous observation of the patient (b) Depression
(AIIMS Jodhpur and Rishikesh, 2017) (c) Mania
Q.456 All of the following are mood stabilizing (d) OCD
agents, EXCEPT (AIIMS Jodhpur and Rishikesh, 2017)
(a) Lithium carbonate Q.464 Which symptom is not shown in the patient
(b) Fluoxetine with anxiety
(c) Valproic Acid (a) Hallucination
(d) Carbamazepine (b) Nervous behavior
(AIIMS Jodhpur and Rishikesh, 2017) (c) Worry
Q.457 A phenomenon during therapeutic nurse (d) Restlessness
client relationship when the client un- (AIIMS Jodhpur and Rishikesh, 2017)
MCQ
Q.465 An alcoholic patient stop the alcohol (d) Dream analysis
consumption before 24 hours. He faced (AIIMS Bhopal, 2016)
tremors, agitation and confusion. What is the Q.473 A strong persistent and irrational fear of
diagnosis some specific object or situation that
(a) Alcohol dependence syndrome with presents little or no danger to a person is
alcohol withdrawal called________
(b) Normal finding in alcohol consuming (a) Amnesia (b) Phobia
persons (c) Syncope (d) Insomnia
(c) Wernicke‟s encephalopathy (ESIC Delhi, 2016)
(d) Psychosis Q.474 Schizophrenia comes under________from
(AIIMS Jodhpur and Rishikesh, 2017) of psychological disorders
Q.466 Impairment in consciousness and cognition (a) Dysthymic disorder
for short time is the (b) Depressive disorder
(a) Delirium (b) Dementia (c) Cyclothymic disorder
(c) LOC (d) Parkinson (d) Psychotic disorder
(AIIMS Jodhpur and Rishikesh, 2017) (ESIC Delhi, 2016)
Q.467 What name did Freud give to his model of Q.475 __________is considered mood disorder,
development which comprise id. Ego na which include the occurrence of depressive
superego? episodes and one or more elated mood
(a) Genetic model episodes
(b) Unconscious model (a) Psychotic disorders
(c) Topographical model (b) Bipolar disorders
(d) Structural model (c) Delusional disorders
(AIIMS Bhopal, 2016) (d) Depressive disorders
Q.468 Anxiety is caused by: (ESIC Delhi, 2016)
(a) Hostility turned to self Q.476 A patient diagnosed with a terminal illness
(b) Masked depression tells the doctor, “Life is not fair. This cannot
(c) An objective threat happen to me”. This is an expression of:
(d) A subjective, perceived threat (a) Denial (b) Bargaining
(AIIMS Bhopal, 2016) (c) Introspection (d) Acceptance
Q.469 Hallucination is …………………… (GMCH Chandigarh, 2016)
(a) Misinterpretation of real external stimuli Q.477 The subjective feeling of right and wrong is
(b) Perception without stimuli psychiatry is known as:
(c) Clear perception of stimuli (a) Biothetics (b) Values
(d) Wrong perception of stimuli (c) Morality (d) Religion
(AIIMS Bhopal, 2016) (Banaras Hindu University, 2016)
Q.470 Which one of the following helps to reduce Q.478 Which of the following features is present
anxiety and post-operative pain? only in Dementia when compared with
(a) Rest and sleep Delirium?
(b) Psychological counseling (a) Misperception
(c) Pre-operative teaching (b) Systematised delusions occur early
(d) Pre-operative checklist (c) Hallucination
(AIIMS Bhopal, 2016) (d) Vivid illusions
Q.471 What are NOT the misconception related to (AIIMS Bhopal Staff Nurse Gr.2, 2018)
mental health? Q.479 Which of the following is considered under
(a) It is possible to prevent mental health acute neuropsychiatric complications of
illness AIDS?
(b) Mental problems do not affect health (a) Delirium
(c) People with mental health problems are (b) Organic hallucinosis
violent and un-predictable (c) AIDS dementia
(d) Children do not experience mental health (d) Organic personality disorder
problems (AIIMS Bhopal Staff Nurse Gr.2, 2018)
(AIIMS Bhopal, 2016) Q.480 „No, not me‟ reaction of the patient is seen
Q.472 Which of the following techniques is used in which stage of death (Terminal Patients)?
in psychotherapy? (a) Anger (b) Denial
(a) Narcotic need (c) Acceptance (d) Bargaining
(b) Projective (AIIMS Bhopal Staff Nurse Gr.2, 2018)
(c) Electroconvulsive therapy
MCQ
Q.481 Which of the following is a long-term effect Q.490 A client with a diagnosis of depression who
of „Medical complication of Alcoholism‟? has attempted suicide says to the nurse. "I
(a) Delirium Tremens should have died. I've always been a failure.
(b) Paranoia Nothing ever goes right for me. "Which
(c) Korsakoff‟s Psychosis response by the nurse demonstrates
(d) Dpression therapeutic communication?
(AIIMS Bhopal Staff Nurse Gr.2, 2018) (a) "You have everything to live for."
Q.482 Which of the following is NOT an (b) "Why do you see yourself as a failure?"
anticonvulsant drug? (c) "Feeling like this is all part of being
(a) Ethosuximide depressed."
(b) Phenobarbitone (d) "You've been feeling like a failure for a
(c) Nortriptyline while?"
(d) Phenytoin Q.491 The nurse visits a client at home. The client
(AIIMS Bhopal Staff Nurse Gr.2, 2018) states "I haven't slept at all the last couple of
Q.483 Which of the following is NOT a type of nights." Which response by the nurse
conflict? demonstrates therapeutic communication?
(a) Intrapersonal (b) Manifest (a) "I see."
(c) Intragroup (d) Interpersonal (b) "Really."
(AIIMS Bhopal Staff Nurse Gr.2, 2018) (c) "You're having difficulty sleeping?"
Q.484 Which of the following is an example of (d) "Sometimes I have trouble sleeping too."
sublimation? Q.492 On review of the client's record, the nurse
(a) A young man who is dealing with notes that the admission was voluntary.
aggression by playing football Based on this information, the nurse plans
(b) Child starts bedwetting after the birth of care anticipating which client behavior?
sibling (a) Fearfulness regarding treatment
(c) Blaming the teacher for failing in exams measures
(d) A women has no memory of being (b) Anger and aggressiveness directed
sexually assaulted as a child toward others
(AIIMS Bhopal Staff Nurse Gr.2, 2018) (c) An understanding of the pathology and
Q.485 Separation of a thought or memory from its symptoms of the diagnosis
associated feeling or emotion is known as: (d) A willingness to participate in the
(a) Idolisation planning of the care and treatment plan
(b) Intellectualisation Q.493 A client is preparing to attend a Gamblers
(c) Isolation Anonymous meeting for the first time. The
(d) Projection nurse should tell the client that which is the
(AIIMS Bhopal Staff Nurse Gr.2, 2018) first step in this 12-step program?
Q.486 Formed visual hallucinations are seen in the (a) Admitting to having a problem
lesion of: (b) Substituting other activities for gambling
(a) Parietal (b) Temporal (c) Stating that the gambling will be stopped
(c) Occipital (d) Frontal (d) Discontinuing relationships with people
(AIIMS Bhubaneswar Staff Nurse, 2018) who gamble
Q.487 Most common symptom of alcohol Q.494 The nurse employed in a mental health
withdrawal is: clinic is greeted by a neighbor in a local
(a) Rhinorrhea (b) Bodyche grocery store. The neighbor says to the
(c) Tremor (d) Diarrhea nurse, "How is Carol doing? She is my best
(AIIMS Bhubaneswar Staff Nurse, 2018) friend and is seen at your clinic every week.
Q.488 Biochemical etiology of Alzheimer‟s "Which is the most appropriate nursing
disease relates to: response?
(a) Acetylcholine (b) Epinephrine (a) "I cannot discuss any client situation
(c) Serotonin (d) Dopamine with you."
(AIIMS Bhubaneswar Staff Nurse, 2018) (b) "If you want to know about Carol, you
Q.489 Best test for diagnosis of organic mental need to ask her yourself,"
disorder is: (c) "Only because you're worried about a
(a) Thematic appreciation test friend, I'll tell you that she is improving."
(b) Bender gestalt test (d) "Being her friend, you know she is
(c) Sentence completion test having a difficult time and deserves her
(d) Rorschach test privacy."
(AIIMS Bhubaneswar Staff Nurse, 2018)
MCQ
Q.495 What is the most appropriate nursing action When the nurse firmly states that this is
to help manage a manic client who is inappropriate and will not be allowed, the
monopolizing a group therapy session? client becomes verbally abusive and
(a) Ask the client to leave the group for this threatens physical violence to the nurse.
session only. Based on the analysis of this situation,
(b) Refer the client to another group that which intervention should the nurse
includes other manic clients. implement?
(c) Tell the client to stop monopolizing in a (a) Place the client in seclusion for 30
firm but compassionate manner. minutes.
(d) Thank the client for the input, but inform (b) Tell the client that the behavior is
the client that others now need a chance to inappropriate.
contribute. (c) Escort the client to their room, with the
Q.496 A client says to the nurse. "The federal assistance.
guards were sent to kill me." Which is the (d) Tell the client that their telephone
best response by the nurse to the client's privileges are revoked for 24 hours.
concern? Q.501 The nurse observes that a client is pacing,
(a) "I don't believe this is true." agitated, and presenting aggressive gestures.
(b) "The guards are not out to kill you." The client's speech pattern is rapid, and
(c) "Do you feel afraid that people are trying affect is belligerent. Based on these
to hur you?" observations, which is the nurse's immediate
(d) "What makes you think the guards were priority of care?
sent to hurt you ?" (a) Provide safety for the client and other
Q.497 A client is admitted to the mental health unit clients on the unit.
with a diagnosis of depression. The nurse (b) Provide the clients on the unit with a
should develop a plan of care for the client sense of comfort and safety.
that includes which intervention? (c) Assist the staff in caring for the client in
(a) Encouraging quiet reading and writing a controlled environment.
for the first few days (d) Offer the client a less stimulating area in
(b) Identification of physical activities that which to calm down and gain control.
will provide exercise Q.502 The nurse is caring for a client just admitted
(c) No socializing activities, until the client to the mental health unit and diagnosed with
asks to participate in milieu catatonic stupor. The client is lying on the
(d) A structured program of activities in bed in a fetal position. Which is the most
which the client can participate. appropriate nursing intervention?
Q.498 When planning the discharge of a client (a) Ask direct questions to encourage
with chronic anxiety, the nurse directs the talking.
goals at promoting a safe environment at (b) Leave the client alone so as to minimize
home. Which is the most appropriate external stimuli.
maintenance goal? (c) Sit beside the client in silence the
(a) Suppressing feelings of anxiety occasional open-ended questions.
(b) Identifying anxiety-producing situations (d) Take the client into the dayroom with
(c) Continuing contact with a crisis counselor other clients so that they can help watch
(d) Eliminating all anxiety from daily them.
situations Q.503 The nurse is caring for a client diagnosed
Q.499 A client is admitted to a medical nursing with paranoid personality disorder who is
unit with a diagnosis of acute blindness after experiencing disturbed thought processes. In
being involved in a hit-and-run accident. formulating a nursing plan of care, which
When diagnostic testing cannot identify any best intervention should the nurse include?
organic reason why this client cannot see, a (a) Increase socialization of the client with
mental health consult is prescribed. The peers
nurse plans care based on which condition (b) Avoid using a whisper voice in front of
that should be the focusd of this consult? the client.
(a) Psychosis (c) Begin to educate the client about social
(b) Repression supports in the community.
(c) Conversion disorder (d) Have the client sign a release of
(d) Dissociative disorder information to appropriate parties for
Q.500 A manic client begins to make sexual assessment purposes.
advances toward visitors in the dayroom.
MCQ
Q.504 The nurse is planning activities for a client be assigned to this client's room. Which
diagnosed with bipolar disorder with client would be the best choice as a
aggressive social behavior. Which activity roommate for the client with anorexia
would be most appropriate for this client? nervosa?
(a) Chess (a) A client with pneumonia
(b) Writing (b) a client undergoing diagnostic tests
(c) Ping pong (c) A client who thrives on managing others
(d) Basketball (d) A client who could benefit from the
Q.505 The nurse determines that the wife of an client's assistance at mealtime
alcoholic client is benefiting from attending Q.509 The nurse is monitoring a hospitalized client
an Al-anon group if the nurse hears the wife who abuses alcohol. Which findings should
make which statement? alert the nurse to the potential for alcohol
(a) "I no longer feel that I deserve the withdrawal delirium?
beatings my husband inflicts on me." (a) Hypotension, ataxia, hunger
(b) "My attendance at the meetings has (b) Stupor, lethargy, muscular rigidity
helped me to see that I provoke my (c) Hypotension, coarase hand tremors,
husband's violence." lethargy
(c) "I enjoy attending the meetings because (d) Hypertension, changes in level of
they get me out of the house and away from consciousness, hallucinations
my husband." Q.510 The spouce of a client admitted to the
(d) "I can tolerate my husband's destructive mental health unit for alcohol withdrawal
behaviors now that I know they are common says to the nurse, "I should get out of this
among alcoholics." bad situation. " Which is the most helpful
Q.506 A hospitalized client with a history of response by the nurse?
alcohol abuse tells the nursem, "I am (a) "Why don't you tell your spouse about
leaving now. I have to go. I don't want any this?"
more treatment. I have things that I have to (b) "What do you find difficult about this
do right away. "The client has not been situation?"
discharged and is scheduled for an (c) "This is not the best time to make that
important diagnostic test to be performed in decision."
1 hour. After the nurse discusses the client's (d) "I agree with you. You should get out of
concerns with the client, the client dresses this situation."
and begins to walk out of the hospital room. Q.511 A client with anorexia nervosa is a member
what action should the nurse take? of a pre-discharge support group. the client
(a) Call the nursing supervisor. verbalizes that she would like to buy some
(b) Call security to block all exit areas. new clothes, but her finances are limited.
(c) Restrain the client until the health care Group members have brought some used
provider (HCP) can be reached. clothes to the client to replace the client's
(d) Tell the client that the client cannot old clothes. The client believes that the new
return to this hospital again if the client clothes are much too tight and has reduced
leaves now. her calorie intake to 800 calories daily. How
Q.507 The nurse is caring for a female client who should the nurse evaluate this behavior?
was admitted to the mental health unit (a) Normal behavior
recently for anorexia nervosa. The nurse (b) Evidence of the client's disturbed body
enters the client's room and notes that the image
client is engaged in rigorous push-ups. (c) Regression as the client is moveing
Which nursing action is most appropriate? toward the community
(a) Interrupt the client and weigh her (d) Indicative of the client's ambivalence
immediately. about hospital discharge.
(b) Interrupt the client and offer to take her Q.512 The nurse is reviewing the assessment data
for a walk. of a client admitted to the mental health
(c) Allow the client to complete her exercise unit. The nurse notes that the admission
program. nurse documented that the client is
(d) Tell the client that she is not allowed to experiencing anxiety as a result of a
exercise rigorously. situational crisis. The nurse plans care for
Q.508 A client with a diagnosis of anorexia the client. determining that this type of crisis
nervosa, who is in a state of starvation, is in could be caused by which event?
a 2-bed room. A newly admitted client will (a) Witnessing a murder
MCQ
(b) The death of a loved one (c) Secure and record a detailed history
(c) A fire that destroyed the client's home (d) Encourage and assist the client to
(d) A recent rape episode experienced by the feelings
client Q.518 A moderately depressed client who was
Q.513 The nurse is conducting an initial hospitalized 2 days ago suddenly begins
assessment of a client in crisis. When smiling and reporting that the crisis is over.
assessing the client's perception of the The client says to the nurse. "I am finally
precipitating event that led to the crisis. cured." How should the nurse interprct this
which is the most appropriate question? behavior as a cue to modify the treatment
(a) "With whom do you live?" plan?
(b) "Who is available to help you?" (a) Suggesting a reduction of medication
(c) "What leads you to seek help now?" (b) Allowing increased "in-room" activities
(d) "What do you usually do to feel better?" (c) Increasing the level of suicide
Q.514 The nurse is crating a plan of care for a precautions
client in a crisis state. when developing the (d) Allowing the client off-unit privileges as
plan, the nurse should consider which needed
factor? Q.519 The nurse is planning care for a client being
(a) A crisis state indicates that the client has admitted to the nursing unit who attempted
a mental illness sucide. Which priority nursing inteervention
(b) A crisis state indicates that the client has should the nurse include in the plan of case?
an emotional illness. (a) One-to-one suicide precautions
(c) Presenting symptoms in a crisis situation (b) Sucide precautions with 30 minutes
are similar for all clients experiencing a checks
crisis. (c) Checking the whereabout of the client
(d) A client's response to a crisis is every 15 minutes.
individualized and what constitutes a crisis (d) Asking the client to report sucidal
for one client may not constitute a crisis for thoughts immediately
another client. Q.520 The emergency department nurse is caring
Q.515 The nurse in the emergency department is for an adult client who is a victim of family
caring for a young female victim of sexual volence. Which priority instruction should
assault. The client's physical assessment is be included in the discharge insturctions?
complete, and physical evidence has been (a) Information regarding shelters
collecte. The nurse notes that the client is (b) Instructions regarding calling the police
withdrawn, confused, and at times (c) Instructions regarding self-defence
physically immobile. How should the nurse classes
interpret these behaviours? (d) Explaining the improtance of leaving the
(a) signs of depression violent situation.
(b) Reactions to a devastating event Q.521 A client with schizophremia has been
(c) Evidence that the client is a high suicide risk started on medication therapy with
(d) Indicative of the need for hospital clozapine. The nurse should assess the
admission results of which laboratory study to monitor
Q.516 A depressed client on an inpatient unit says for adverse effects from this medication?
to the nurse. "My family would be better off (a) Plateletn count
without me." Which is the nurse's best (b) Blood glucose level
response? (c) Liver function studies
(a) "Have you talked to your family about (d) White blood cell count
this"? Q.522 A client is scheduled for discharge and will
(b) "Everyone feels this way when they are be taking phenobarbital for an extended
depressed." period. The nurse would place highest
(c) "You will feel better once your priority on teaching the client which point
medication begins to work." that directly relates to client safety?
(d) "You sound very upset. Are you (a) Take the medication only with meals.
thinking of hurting yourself? (b) Take the medication at the same time
Q.517 The police arrive at the emergency each day.
department with a client who has arrestted (c) Use a dose container to help prevent
both . Which is the initial nursing action. missed doses.
(a) Adminster an antianxiety agent (d) Avoid drinking alcohol while taking this
(b) Assess and treat the would sites. medication.
MCQ
Q.523 A client taking lithium reports vomiting, Q.524 A Client gives the home health nurse a
abdominal pain, diarrhea, blurred vision, bottle of clomipramine. The nurse notes that
tinnitus, and tremors. The lithim level is 2.5 the medication has not been taken by the
mEq/L (2.5 mmol/L). The nurse plans care client in 2 months. Which behavior
based on which representation of this level? observed in the client would validate
(a) Toxic noncompliance with this medication?
(b) Normal (a) Complaints of insomnia
(c) Slightly above normal (b) Complaints of huger and fatgue
(d) Excessively below normal (c) A pulse rate less than 60 beats/minute
(d) Frequent hand washing with hot, soapy
water
1 B 2 A 3 B 4 B 5 D 6 D 7 C 8 D 9 D 10 B
11 A 12 C 13 D 14 D 15 D 16 B 17 B 18 C 19 B 20 B
21 D 22 B 23 A 24 C 25 A 26 D 27 B 28 C 29 B 30 B
31 A 32 A 33 D 34 C 35 C 36 D 37 A 38 B 39 D 40 C
41 D 42 C 43 C 44 B 45 A 46 C 47 B 48 C 49 A 50 A
51 B 52 D 53 C 54 D 55 B 56 D 57 D 58 C 59 D 60 D
61 A 62 C 63 B 64 D 65 C 66 C 67 D 68 B 69 C 70 B
71 B 72 C 73 A 74 A 75 D 76 B 77 C 78 A 79 C 80 C
81 B 82 A 83 C 84 B 85 C 86 A 87 A 88 C 89 B 90 D
91 D 92 A 93 A 94 A 95 B 96 A 97 A 98 D 99 A 100 B
101 C 102 D 103 B 104 D 105 D 106 D 107 A 108 D 109 D 110 D
111 B 112 A 113 B 114 D 115 D 116 A 117 B 118 B 119 D 120 A
121 C 122 C 123 B 124 B 125 B 126 C 127 B 128 C 129 A 130 A
131 D 132 B 133 A 134 C 135 D 136 A 137 C 138 A 139 B 140 A
141 C 142 D 143 D 144 B 145 B 146 D 147 A 148 B 149 A 150 A
151 A 152 D 153 D 154 A 155 A 156 D 157 A 158 A 159 B 160 D
161 B 162 D 163 A 164 B 165 D 166 D 167 A 168 D 169 C 170 B
171 A 172 B 173 C 174 D 175 C 176 B 177 D 178 B 179 C 180 C
181 A 182 D 183 B 184 B 185 C 186 B 187 C 188 C 189 B 190 A
191 B 192 A 193 D 194 D 195 D 196 D 197 A 198 C 199 C 200 A
201 D 202 B 203 A 204 B 205 C 206 D 207 D 208 A 209 B 210 B
211 D 212 B 213 C 214 D 215 D 216 D 217 B 218 C 219 A 220 B
221 D 222 B 223 B 224 C 225 D 226 C 227 A 228 A 229 C 230 B
231 B 232 C 233 B 234 C 235 A 236 B 237 B 238 A 239 A 240 C
241 D 242 D 243 A 244 B 245 D 246 C 247 A 248 B 249 B 250 D
251 D 252 A 253 C 254 A 255 A 256 B 257 B 258 D 259 B 260 D
261 A 262 C 263 D 264 A 265 D 266 C 267 D 268 C 269 C 270 A
271 C 272 A 273 A 274 C 275 B 276 C 277 D 278 D 279 A 280 D
281 D 282 A 283 B 284 B 285 A 286 B 287 C 288 B 289 D 290 D
291 B 292 B 293 A 294 D 295 C 296 B 297 B 298 A 299 B 300 B
301 C 302 D 303 B 304 C 305 D 306 A 307 C 308 B 309 A 310 D
311 C 312 C 313 B 314 A 315 B 316 C 317 C 318 A 319 B 320 D
MCQ
321 C 322 D 323 D 324 B 325 C 326 C 327 C 328 D 329 C 330 D
331 D 332 C 333 D 334 A 335 B 336 C 337 B 338 C 339 A 340 D
341 B 342 D 343 C 344 A 345 A 346 B 347 A 348 D 349 B 350 A
351 A 352 A 353 A 354 A 355 D 356 B 357 D 358 D 359 B 360 B
361 D 362 B 363 D 364 B 365 C 366 D 367 A 368 B 369 C 370 C
371 C 372 D 373 B 374 B 375 D 376 A 377 D 378 A 379 A 380 D
381 A 382 C 383 D 384 B 385 A 386 C 387 C 388 D 389 A 390 D
391 C 392 C 393 A 394 D 395 A 396 B 397 D 398 C 399 B 400 A
401 A 402 B 403 B 404 A 405 C 406 B 407 D 408 A 409 C 410 C
411 D 412 C 413 B 414 B 415 B 416 C 417 C 418 B 419 B 420 C
421 C 422 A 423 C 424 B 425 A 426 A 427 C 428 A 429 D 430 C
431 A 432 B 433 B 434 C 435 A 436 D 437 A 438 D 439 A 440 A
441 C 442 D 443 B 444 A 445 C 446 B 447 D 448 D 449 C 450 D
451 A 452 D 453 B 454 C 455 B 456 B 457 C 458 B 459 C 460 A
461 B 462 A 463 B 464 A 465 A 466 A 467 D 468 D 469 B 470 C
471 A 472 D 473 B 474 D 475 B 476 A 477 A 478 B 479 A 480 B
481 C 482 C 483 B 484 A 485 C 486 B 487 C 488 A 489 B 490 D
491 C 492 D 493 A 494 A 495 D 496 C 497 D 498 B 499 C 500 C
501 A 502 C 503 B 504 B 505 A 506 A 507 B 508 B 509 D 510 B
511 B 512 B 513 C 514 D 515 B 516 D 517 B 518 C 519 A 520 A
521 D 522 D 523 A 524 D

Psychiatric Nursing

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Psychiatric Nursing

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INTRODUCTION

Health- According to WHO:-

Disease: According to WHO:-

Psychiatric Nursing/Mental Health Nursing

Environment Body, mind & spirit

Characteristics of Mentally Health Person

2. Personality:- Personality word Latin word persona derived

Personality Physical and mental qualities Individual

(iii) SELDON (1942):-

(iv) Jung theory:-

 Psychoanalytic theory has three major parts:-

6. Lunatic :- the person of an unsound mind. Or A person who is mentally ill.

 Historical Development of Psychiatry :-

 Father of modern psychology-Wilhelm wundt"

 Some Important Milestones of Psychiatry in India/World :-

 Misconception of Mental Health/MYTHS :-

4. Mental Health physical Health

10. Mentally ill should only be treated in asylums.

 F00 – F09 :- Organic Mental Disorders.

 Etiology/Causes of Mental Disorders :- It is difficult to pin point one cause of mental

The Causes of mental disorders are categorized under three heading

GENETIC CONSTITUTIONAL PHYSICAL PHYSICAL INFECTION

Maternal Deprivation Pathogenic Family Pathogenic Inter Stress

War & Violence Economic and Employment Technological & Social

(Disturbance) (Disturbance) (Disturbance) (Disturbance) (Disturbance) (Disturbance) (Disturbance)

 Confusion :- Inability to think or reason in a focused, clear manner.

Increase Activity Dysactivity Decrease Activity

Repetitions Automatic Negativism compulsion violence suicide

Position Movement Speech

(A) Repetitious Activity :- The Activity is needless and purposeless. Person

(B) Automatism :- person activity conscious level

3. Disorders / Disturbance of Perception :- Perception can be defined as whatever is

Formation Level Progression Level Content Level

Over Delusion Hypochondrias Obsession Phobia

Flight of Thought Thought Circum- Tengentiality Thought Incohrence

 Thought Formation :- Normal thought process involves imagination, co-ordination and

(a) Disorders of thought at formation level :-

C. Disturbance of thought at content level :-

(iv) Delusin of guilt :- Commonly seen in depression. patient self-critical

D. Other disorder of thinking :-

 Thought broadcasting :- patient

Euthymic Mood :- Normal range of mood

Disorders of AFFECT / Mood

Pleasurable AFFECT Unpleasurable AFFECT Other AFFECT

Euphoria Elation Exaltation Ecstasy Depression Grief

Inappropriate Bluted Labile FLAT Apathy Anxiety Ambivance Mood Depersonalis-

Panic agitation aggression derealisation alexithymia anhedonia

Immediate Memory Recent Memory Remote Memory

(i) Hypermnesia :- Excessive retention of memory. common in paranoid schizophrenia and in

 Attention :- It means focusing of sense organ towards a particular stimulus.

THE MENTAL STATUS EXAMINATION

 Components of the Mental Status Examination

VI. Speech and Language (Observed)

XI. Suicidality and Homicidality

WHAT IS THE MMSE TEST?

Insulin shock treatment :-

A Injection of large Dose of Insulin To Patient Hypoglycemia in patient

Patient wake up glucose IV Then coma state for three

 ugo carletti lucino Bini ª (EST/ECT)

1. Direct ECT :- In this atropine Sulphate (salivary secretion ) is given

2. Modified / Indirect ECT :-

 Seizure production :- (Grand mal seizure)

 Ect Treatment Is Not Effective In :-