Section 1 (38 marks)

Q.1 Define the following (any five) (2×5=10)

1) Schizophrenia

• Schizophrenia is a chronic and severe mental disorder that affects a person’s thinking, perception, emotions, behavior, and ability to relate to others.
• It is characterized by disturbances in thought processes, such as delusions (false beliefs), hallucinations (false perceptions), disorganized speech, abnormal motor behavior, and impaired social or occupational functioning.
• This disorder typically begins in late adolescence or early adulthood, and although its exact cause is unknown, it is linked to genetic factors, brain structure abnormalities, and neurochemical imbalances (especially involving dopamine).

2) Conduct disorder

• Conduct Disorder is a mental and behavioral disorder seen mainly in children and adolescents, characterized by a persistent pattern of behavior in which the individual repeatedly violates the rights of others or major age-appropriate social norms or rules.
• These behaviors may include aggression toward people or animals, destruction of property, deceitfulness or theft, and serious violations of rules such as truancy or running away.
• It often leads to social, academic, and legal difficulties, and if not managed early, it may progress to antisocial personality disorder in adulthood.

3) Delusion

• A delusion is a false, fixed belief that is strongly held despite clear or obvious evidence to the contrary, and is not shared by others in the same cultural or social group.
• It is commonly seen in psychotic disorders such as schizophrenia and may involve beliefs of persecution, grandeur, reference, or control that are not based in reality.

4) Antipsychotics

• Antipsychotics are a class of psychiatric medications that are primarily used to manage psychotic symptoms, such as delusions, hallucinations, thought disorders, and severe agitation, which are commonly seen in conditions like schizophrenia, bipolar disorder, and other psychotic disorders.
• These drugs work mainly by modulating neurotransmitters in the brain, especially by blocking dopamine receptors (D2), and are classified into two categories:
• Typical (first-generation) antipsychotics – e.g., haloperidol, chlorpromazine
• Atypical (second-generation) antipsychotics – e.g., risperidone, olanzapine

5) Hypochondriasis

• Hypochondriasis, also known as Illness Anxiety Disorder in recent classifications, is a mental health condition in which a person has a persistent and excessive fear or belief that they have a serious, undiagnosed medical illness, despite repeated medical evaluations and reassurance showing no significant health issue.
• Individuals with hypochondriasis misinterpret normal bodily sensations (such as minor aches or changes) as signs of severe disease, leading to frequent doctor visits, anxiety, and impaired daily functioning.

6) Anorexia nervousa

• Anorexia Nervosa is a serious eating disorder characterized by an intense fear of gaining weight, a distorted body image, and persistent restriction of food intake, leading to significantly low body weight in relation to age, sex, and physical health.
• Individuals with anorexia nervosa often engage in excessive dieting, fasting, over-exercising, or purging behaviors to lose weight, even when they are already underweight.
• This condition can cause severe physical and psychological complications, including malnutrition, organ failure, electrolyte imbalance, and increased risk of death, and requires comprehensive medical and psychological treatment for recovery.

7) Echoprexia

• Echopraxia is a neurological and psychiatric symptom in which an individual involuntarily imitates or mimics the movements, gestures, or actions of another person.
• It is commonly associated with schizophrenia, autism spectrum disorders, Tourette’s syndrome, and certain neurological conditions, and is considered a form of automatic, non-purposeful behavior.
• Echopraxia reflects an impairment in the control of voluntary actions and may indicate underlying frontal lobe dysfunction or loss of inhibition in the brain.

Q.2

a. Define alcohol dependence syndrome (1)

• Alcohol Dependence Syndrome is a chronic and progressive psychiatric condition characterized by a compulsive need to consume alcohol, resulting in physical, psychological, and social impairment, despite the individual being aware of its harmful effects.
• It involves the presence of tolerance (needing more alcohol for the same effect), withdrawal symptoms when alcohol is stopped, and a strong craving or urge to drink, which significantly interferes with the individual’s daily functioning, relationships, occupation, and health.

b. Enlist the risk factors of alcohol dependence (3)

1️⃣ Genetic Predisposition

A person having a family history of alcohol dependence is at a significantly higher risk of developing the same condition due to inherited genetic traits.

2️⃣ Early Onset of Alcohol Use

Individuals who begin consuming alcohol at a younger age are more prone to developing long-term dependence in adulthood.

3️⃣ Mental Health Disorders

Co-existing psychiatric conditions such as depression, anxiety, or bipolar disorder increase the vulnerability to alcohol dependence.

4️⃣ Peer Pressure and Social Acceptance

Being part of a social circle or environment where alcohol use is normalized or encouraged increases the risk.

5️⃣ Emotional Stress or Trauma

People who use alcohol as a coping mechanism for personal stress, trauma, or loss are more likely to become dependent.

6️⃣ Poor Family Environment

Dysfunctional families, parental neglect, or domestic violence may lead an individual to escape into alcohol use.

7️⃣ Personality Traits

Individuals with low self-esteem, impulsive nature, or thrill-seeking behavior are at increased risk.

8️⃣ Easy Access and Availability

When alcohol is easily accessible and affordable, it increases both the frequency and quantity of use, leading to dependency.

9️⃣ Lack of Awareness or Education

Poor knowledge about the harmful effects of alcohol or safe drinking limits can lead to misuse and eventual dependence.

🔟 Cultural and Occupational Influence

Certain cultures or job environments where alcohol use is common or socially accepted may contribute to habitual use and dependence.

c. Explain psychiatric disorder due to alcohol dependence (6)

Alcohol dependence is not only a physical condition but also has profound effects on mental health, leading to a variety of psychiatric disorders. These disorders may develop during chronic alcohol consumption, after prolonged use, or during withdrawal phases, and they may affect mood, cognition, perception, behavior, and overall functioning. Understanding these complications is essential for effective nursing care and recovery planning.

✅ 1. Alcohol-Induced Psychotic Disorder (AIPD)

• Alcohol-induced psychosis is a condition where the person develops hallucinations, delusions, and disorganized thoughts either during prolonged alcohol use or in early withdrawal stages.
• The hallucinations are most often auditory in nature, such as hearing voices that comment, command, or criticize, and the delusions may include paranoia or persecution beliefs.
• Unlike schizophrenia, these symptoms are directly caused by alcohol toxicity and tend to improve after abstinence and treatment.
• The person may be fully conscious but severely disconnected from reality, and this can lead to social withdrawal or aggression.

✅ 2. Alcohol Withdrawal Delirium (Delirium Tremens – DTs)

• This is a life-threatening psychiatric emergency that typically occurs within 48–72 hours after stopping alcohol in a severely dependent individual.
• It is characterized by sudden onset of confusion, agitation, tremors, visual hallucinations (seeing insects or animals), tachycardia, fever, hypertension, sweating, and fluctuating consciousness.
• The condition results from hyperactivity of the autonomic nervous system and severe neurochemical imbalance in the brain.
• Without urgent medical intervention (including IV fluids, benzodiazepines, thiamine), the patient may develop seizures, coma, or even death.

✅ 3. Alcohol-Induced Mood Disorders

• Long-term alcohol abuse can cause or worsen depressive or manic episodes, even in individuals without a previous history of mood disorders.
• A person may present with persistent sadness, loss of interest, suicidal thoughts, sleep problems, and feelings of hopelessness, commonly seen in alcohol-induced depressive disorder.
• Some individuals may experience elevated mood, inflated self-esteem, irritability, excessive talkativeness, and risky behavior, resembling alcohol-induced mania.
• These symptoms usually improve with abstinence and psychiatric treatment, but they may become chronic if alcohol use continues.

✅ 4. Alcohol-Induced Anxiety Disorders

• Chronic alcohol users may suffer from generalized anxiety, panic attacks, and phobic disorders, especially during or after withdrawal.
• These patients may complain of palpitations, fear, chest tightness, sweating, and restlessness, which worsen their craving for alcohol as a self-soothing method.
• A vicious cycle develops where anxiety leads to drinking, and drinking increases anxiety, leading to long-term psychological distress.
• Treatment requires both medication (e.g., anti-anxiety drugs) and counseling or cognitive-behavioral therapy.

✅ 5. Korsakoff’s Psychosis and Wernicke’s Encephalopathy

• These two conditions together are known as Wernicke-Korsakoff Syndrome, caused by chronic alcohol use and thiamine (vitamin B1) deficiency.
• Wernicke’s Encephalopathy is acute and presents with a triad of confusion, ataxia (difficulty walking), and ophthalmoplegia (abnormal eye movements).
• Korsakoff’s Psychosis follows and results in severe memory loss, inability to learn new information, and confabulation (filling memory gaps with false stories).
• This syndrome indicates permanent brain damage and requires urgent thiamine supplementation and long-term abstinence from alcohol.

✅ 6. Alcohol-Induced Sleep Disorders

• Alcohol initially acts as a sedative, but chronic use disrupts the natural sleep-wake cycle (circadian rhythm).
• Patients report difficulty falling asleep, frequent awakenings, nightmares, and daytime fatigue, even when not drinking.
• During withdrawal, vivid dreams, insomnia, and night terrors are common, severely affecting mental wellness.
• Long-term sleep disturbance often worsens mood and increases risk of relapse.

✅ 7. Personality and Behavioral Changes

• Chronic alcohol dependence may result in major personality changes, such as increased impulsivity, irritability, aggression, poor decision-making, and disregard for social norms.
• Over time, such individuals may develop antisocial traits such as lying, stealing, or harming others without remorse, or borderline features like emotional instability and suicidal threats.
• These changes often lead to relationship breakdown, job loss, and legal problems, further worsening mental health.

✅ 8. Alcohol-Induced Neurocognitive Disorder (Alcohol-Related Dementia)

• Long-term heavy drinking leads to progressive brain atrophy, especially in areas responsible for memory, judgment, attention, and planning.
• Patients show signs of confusion, forgetfulness, slow thinking, poor problem-solving skills, and difficulty in performing daily tasks.
• Unlike Alzheimer’s dementia, alcohol-related dementia may be partially reversible with prolonged abstinence and nutritional support.

✅ 9. Suicidal Behavior and Self-Harm Tendencies

• Alcohol reduces inhibition and impairs judgment, leading many emotionally distressed individuals to attempt suicide or harm themselves.
• The risk of suicide is especially high in individuals with co-existing depression, unemployment, social isolation, or recent loss.
• Nurses must monitor for verbal threats, previous attempts, and risky behavior, especially during withdrawal or depressive phases.

✅ 10. Alcohol-Induced Sexual Dysfunction and Guilt

• Long-term alcohol dependence can cause decreased libido, erectile dysfunction, and fertility problems, leading to emotional stress and self-esteem issues.
• Individuals may feel guilt, shame, and worthlessness due to their inability to maintain relationships or meet social roles, worsening depression or anxiety.

Q.3

a. Define depression (1)

Depression is a common and serious mood disorder characterized by a persistent feeling of sadness, loss of interest or pleasure in most activities, low energy, and emotional numbness, which significantly interferes with the individual’s daily functioning, interpersonal relationships, and overall quality of life, and may also be associated with disturbed sleep, appetite changes, feelings of hopelessness, worthlessness, and recurrent thoughts of death or suicide.

b. Explain the causes of depression (3)

1. Biological Causes

• Imbalance of neurotransmitters like serotonin, dopamine, norepinephrine.
• Genetic predisposition or family history of depression.
• Hormonal changes (e.g., postpartum, menopause, thyroid dysfunction).
• Chronic illnesses like diabetes, cancer, stroke.

• Side effects of certain medications or substance abuse.

2. Psychological Causes

• Low self-esteem, pessimistic outlook, or excessive guilt.
• History of childhood trauma, abuse, or parental loss.
• Poor coping mechanisms and unresolved emotional conflicts.
• Personality traits like dependency or perfectionism.

3. Social & Environmental Causes

• Stressful life events (e.g., divorce, job loss, bereavement).
• Social isolation, lack of support, or loneliness.
• Unemployment, poverty, or financial stress.
• Domestic violence, abuse, or bullying.

4. Other Factors

• Poor lifestyle: sleep disturbance, unhealthy diet, inactivity.
• Postpartum depression due to hormonal and emotional changes.
• Seasonal affective disorder (due to lack of sunlight).

c. Described nursing management of severe depression patient (6)

The nursing management of a patient with severe depression involves a holistic and compassionate approach, addressing the patient’s physical, emotional, psychological, and safety needs. The nurse plays a crucial role in observation, support, intervention, medication administration, and promoting recovery.

✅ 1. Establishing a Therapeutic Nurse–Patient Relationship

• Build a trusting relationship by maintaining a calm tone, using therapeutic silence, and offering presence without pressure.
• Use open-ended questions and active listening to allow the patient to express fears, hopelessness, or guilt freely.
• Maintain honest and consistent communication, even if the patient is withdrawn or non-responsive.
• Avoid giving false hope or minimizing their experience—acknowledge their pain and help instill gradual hope for recovery.
• Use positive affirmations and encourage goal-setting once rapport is established.

✅ 2. Ensuring Patient Safety

• Conduct frequent suicide risk assessments using tools like the Columbia Suicide Severity Rating Scale (C-SSRS).
• Place the patient under close observation or 1:1 supervision during high-risk periods, especially during shift changes or nights.
• Educate the patient about safe coping alternatives when experiencing self-harming thoughts.
• Document all safety checks, verbal threats, and behavior patterns meticulously for legal and clinical purposes.
• Involve family members in recognizing warning signs of self-harm and emergency response steps at home.

✅ 3. Promoting Self-Care and Daily Living Activities

• Assist the patient in performing activities of daily living (ADLs) while gradually promoting independence.
• Offer step-by-step instructions for self-care tasks if cognitive function is impaired due to depression.
• Maintain personal hygiene kits and grooming supplies at bedside to encourage self-initiation.
• Involve the patient in planning their own daily routine, which promotes a sense of control and motivation.
• Reinforce and appreciate small efforts toward grooming or eating, as they reflect improving mental energy.

✅ 4. Administering Medication and Monitoring Effects

• Administer antidepressants such as SSRIs (e.g., fluoxetine), TCAs (e.g., amitriptyline) under supervision.
• Monitor for common side effects like gastrointestinal upset, insomnia, headache, and educate the patient to report any changes.
• Be alert to increased suicidal ideation, which may temporarily worsen after starting antidepressants.
• Ensure medication adherence, especially during discharge planning, by explaining the delayed therapeutic onset (2–4 weeks).
• Collaborate with the psychiatrist regarding dosage adjustment or side-effect management as needed.

✅ 5. Providing Emotional and Psychological Support

• Encourage the patient to express emotions without judgment, using reflective communication and empathy.
• Validate the patient’s feelings by acknowledging emotional pain without offering premature solutions.
• Introduce journaling, art therapy, or music therapy to help patients externalize emotions creatively.
• Guide patients through positive self-talk and goal visualization techniques once emotional stability improves.
• Monitor for verbal or non-verbal signs of emotional overwhelm, and intervene early.

✅ 6. Encouraging Social Interaction and Structured Activity

• Gradually introduce the patient to non-demanding group activities such as board games or quiet reading sessions.
• Promote peer interaction in a controlled setting to combat feelings of isolation and social fear.
• Create opportunities for patient involvement in unit tasks, like watering plants or setting tables, to foster responsibility.
• Avoid overstimulation in early phases; allow the patient to pace their social engagement.
• Praise attempts to engage, regardless of the outcome, to build confidence.

✅ 7. Educating Patient and Family

• Educate about the nature of depression, emphasizing that it is treatable and not a sign of personal weakness.
• Explain the importance of continuing medication and therapy even after symptom improvement.
• Guide family members on effective communication techniques, such as avoiding confrontation and being supportive.
• Provide educational leaflets and access to helplines or mental health apps for ongoing guidance.
• Discuss potential relapse indicators, such as changes in sleep, mood, or daily interest, for early intervention.

✅ 8. Coordinating with Multidisciplinary Team

• Collaborate with the psychiatrist, clinical psychologist, occupational therapist, and social worker to plan comprehensive care.
• Participate in interdisciplinary case conferences to evaluate progress and modify care plans.
• Ensure smooth communication by updating team members on daily mood changes, behavior, and medication response.
• Involve the team in discharge planning and community reintegration, particularly for patients with limited support.
• Maintain consistent documentation for inter-professional continuity of care.

✅ 9. Planning Discharge and Follow-Up Care

• Educate the patient and caregiver on the importance of follow-up appointments and regular psychiatric check-ups.
• Help the patient set short-term achievable goals to prevent feelings of failure or helplessness.
• Provide community mental health resources, including support groups and rehabilitation centers.
• Ensure the patient has a crisis plan with emergency contact numbers in case of relapse or suicidal urges.
• Promote gradual return to work or school with structured reintegration plans.

Q.4

a. Define dementia (1)

Dementia is a progressive and chronic neurocognitive disorder characterized by a decline in cognitive functions such as memory, judgment, language, reasoning, and problem-solving, which is severe enough to interfere with the individual’s daily activities, occupational ability, and social functioning, and is often accompanied by personality changes, confusion, and emotional instability, without an impairment in consciousness.

b. Enlist clinical features according to the stages of dementia (3)

✅ 1. Early Stage (Mild Dementia)

• Forgetfulness of recent events
• Difficulty in word finding
• Mild confusion in unfamiliar places
• Loss of interest in hobbies
• Occasional mood changes or depression

✅ 2. Middle Stage (Moderate Dementia)

• Increased memory loss
• Disorientation to time and place
• Difficulty with personal care (bathing, dressing)
• Behavioral changes like agitation or suspicion
• Problems with communication and reasoning

✅ 3. Late Stage (Severe Dementia)

• Inability to recognize family members
• Complete dependency in daily activities
• Severe communication problems
• Loss of mobility and coordination
• Incontinence and risk of complications (bedsores, infections)

c. Explain follow up home care and rehabilitation for dementia patient (4)

Dementia is a progressive and irreversible condition that requires continuous support, both medically and emotionally. The goal of home care and rehabilitation is to enhance the quality of life, maintain independence as long as possible, and provide comfort and dignity in the advanced stages.

✅ 1. Regular Follow-Up and Medical Monitoring

• The patient should be regularly followed up by a neurologist or psychiatrist to assess disease progression and treatment response.
• Cognitive assessments, such as MMSE (Mini Mental State Examination), should be repeated to monitor decline.
• Medications like cholinesterase inhibitors (e.g., donepezil) or memantine should be reviewed for side effects and dose adjustment.
• Co-morbid conditions like hypertension, diabetes, and depression should be properly managed to avoid complications.
• Follow-up includes reviewing nutrition, hydration status, and signs of complications such as infections or pressure sores.

✅ 2. Home Environment Modification

• The home should be made dementia-friendly, including removing obstacles, using grab bars, labeling doors, and ensuring good lighting.
• Use of reminder boards, clocks, calendars, and pictures helps in orientation and memory support.
• Safety measures like locking up hazardous items (gas, chemicals, knives) and installing sensor alarms are essential to prevent accidents.
• A calm, familiar, and structured environment helps reduce agitation and confusion in the patient.

✅ 3. Family and Caregiver Education

• Caregivers should be trained on how to communicate with the patient, using simple, slow, and repeated instructions.They must understand the nature of the disease, that behaviors like aggression or forgetfulness are symptoms, not intentional acts.
• Emotional support, patience, and routine reinforcement help reduce anxiety in both patient and caregiver.
• Families should be educated about emergency signs, such as sudden confusion or refusal to eat, and when to seek help.

✅ 4. Activities of Daily Living (ADL) Support

• Encourage the patient to maintain independence in bathing, grooming, eating, and dressing as long as possible, with supervision.
• When dependence increases, caregivers must assist in ADLs using a gentle and respectful approach, preserving the patient’s dignity.
• Use of adaptive aids, such as large-handled utensils or easy-button clothing, can simplify daily tasks.

✅ 5. Nutritional and Hydration Care

• The patient may forget to eat or drink, so scheduled meals and fluids must be provided regularly.
• Offer nutritious, finger-friendly foods and monitor for chewing or swallowing difficulties (dysphagia).
• Supplements may be needed in advanced stages due to poor intake or weight loss.

✅ 6. Cognitive and Social Rehabilitation

• Engage the patient in cognitive stimulation activities like puzzles, music, reading, or reminiscing therapy to slow memory decline.
• Encourage social interaction with close family, friends, or caregivers to avoid isolation.
• Group-based therapies like occupational therapy, memory games, or light physical activities improve function and mood.
• Encourage participation in day-care centers or support groups for older adults.

✅ 7. Behavioral and Emotional Support

• Monitor for signs of depression, anxiety, agitation, or hallucinations and report them to the mental health team.
• Use behavioral strategies, such as distraction or redirection, to manage aggression or wandering.
• Apply music therapy, pet therapy, or aromatherapy as non-pharmacological ways to reduce restlessness.

✅ 8. Legal, Financial, and Ethical Planning

• Assist families in planning for legal guardianship, advance directives, or power of attorney, especially as cognition worsens.
• Provide guidance on financial planning for long-term care and possible institutionalization if needed.
• Encourage ethical decision-making around end-of-life care and comfort measures.

✅ 9. Palliative and End-of-Life Support (Advanced Stage)

• In late-stage dementia, focus shifts from rehabilitation to comfort care, ensuring the patient is free from pain, distress, or hunger.
• Prevent complications like bedsores, aspiration pneumonia, or dehydration through meticulous nursing care.
• Emotional support to the family is vital during this stage, and hospice referral may be considered.

Section 2 (37 marks)

Q.5 Write short notes (any four) (4×5=20)

1) Misconceptions about mental illness

✅ 1. Mental illness is a sign of personal weakness

• Many people falsely believe that those with mental illness are weak-minded or lack the ability to face life’s problems.
• In truth, mental illness is just like physical illness — it can affect even the strongest and most intelligent individuals due to brain chemistry, trauma, or genetics.
• Seeking help is a sign of strength, not weakness, and should be encouraged to promote early recovery.

✅ 2. People with mental illness are violent or dangerous

• Movies and media often depict mentally ill people as dangerous, which spreads fear and stigma in society.
• The truth is, most individuals with mental illness are peaceful, and only a small percentage may show aggression, usually when untreated or under extreme stress.
• In fact, people with mental illness are more likely to harm themselves than to harm others.

✅ 3. Mental illnesses are rare and affect only a few people

• It is wrongly assumed that mental illness affects only a specific group of people such as the poor or uneducated.
• However, mental health conditions affect people across all socioeconomic classes, professions, and cultures, including children, elderly, and celebrities.
• According to WHO, 1 in 4 people worldwide will experience a mental health condition at some point in their lives.

✅ 4. Mental illness cannot be treated or cured

• This belief often stops people from seeking timely help, thinking it’s hopeless.
• In fact, modern psychiatric treatments have a high success rate, especially for conditions like depression, anxiety, and bipolar disorder when started early.
• Recovery is possible through a combination of medication, counseling, lifestyle changes, and family support.

✅ 5. Only “mad” people need psychiatric help

• Many people avoid going to a psychiatrist for fear of being labeled as “mad” or “crazy”.
• In truth, mental health professionals help with common issues like stress, sleep disorders, exam anxiety, trauma, and marital conflict.
• Mental healthcare is as normal and necessary as visiting a doctor for physical illness.

✅ 6. Mental illness is caused by evil spirits or supernatural forces

• In rural or less-educated areas, mental illness is still considered a punishment from God or the result of black magic.
• Such beliefs lead families to seek help from faith healers instead of doctors, delaying proper diagnosis and treatment.
• Education and awareness are essential to explain that mental illness has scientific and biological causes, not spiritual possession.

✅ 7. Mental health problems are a result of bad parenting

• This misconception blames parents, especially mothers, for the child’s mental illness, causing guilt and social stigma.
• However, conditions like autism, ADHD, or schizophrenia often result from genetic and neurochemical factors, not parenting alone.
• In many cases, even children raised in healthy families can develop mental illness due to peer pressure, bullying, or brain changes.

✅ 8. Once mentally ill, always mentally ill

• This leads to social rejection, isolation, and lack of job or marriage opportunities for people who have recovered.
• The fact is, many individuals recover completely or learn to manage their symptoms just like in diabetes or asthma.
• With early treatment and rehabilitation, many can lead independent, productive, and fulfilling lives.

✅ 9. People with mental illness cannot work or be successful

• This misconception results in denial of employment, promotion, or educational opportunities to mentally ill individuals.
• However, many people with past or ongoing mental illness have excelled as doctors, lawyers, actors, scientists, and politicians.
• All they need is reasonable support, understanding, and workplace accommodations, not exclusion.

✅ 10. Talking about mental illness makes it worse

• Families often avoid open discussions, believing that talking about depression or suicide may “put thoughts in the person’s head.”
• In reality, talking about mental health problems in a non-judgmental and supportive manner actually helps the person feel understood and encouraged.
• Open communication promotes healing, trust, and early intervention, and should always be encouraged.

✅ 11. Children and adolescents do not suffer from mental illness

• A common but false belief is that mental illness affects only adults, and that children or teenagers are too young to experience such problems.
• In reality, mental health disorders such as anxiety, depression, ADHD, and conduct disorders can begin in childhood or adolescence, and if left untreated, they may worsen with time and interfere with development, education, and relationships.
• Early identification and intervention in children is essential for better outcomes and to ensure healthy emotional and cognitive growth.

2) Mental health services available for psychiatric patient

Mental health services are designed to provide comprehensive, accessible, and patient-centered care to individuals suffering from various psychiatric conditions. These services aim to promote mental well-being, provide treatment, ensure rehabilitation, and safeguard the rights of mentally ill individuals. Both government and private sectors play a major role in delivering these services across different levels of care.

✅ 1. Outpatient Psychiatric Clinics (OPD Services)

• These services are available in general hospitals, psychiatric hospitals, and community health centers, where patients can consult a psychiatrist, psychologist, or psychiatric nurse without being admitted.
• OPDs offer diagnosis, medication prescription, counseling, follow-up care, and referral services.
• This model is cost-effective and allows patients to receive ongoing care while living at home.

✅ 2. Inpatient Psychiatric Services (Hospitalization)

• For patients with acute mental illness, risk of suicide, violence, or severe dysfunction, inpatient care is provided in mental hospitals or psychiatric units in general hospitals.
• Services include round-the-clock medical monitoring, pharmacotherapy, psychotherapy, nursing care, and crisis intervention.
• Admission can be voluntary or involuntary under legal provisions like the Mental Healthcare Act, 2017.

✅ 3. Emergency Mental Health Services

• These are available in emergency departments of hospitals to manage patients in acute crisis, such as those with suicidal attempts, substance intoxication, or psychotic agitation.
• Services include stabilization, initial assessment, sedation if required, and referral to appropriate care facilities.
• Mental health nurses play a critical role in ensuring safety and immediate support during psychiatric emergencies.

✅ 4. Community Mental Health Services (CMHS)

• These are provided at primary health centers (PHCs), community health centers (CHCs), and through mobile mental health units, bringing psychiatric care to rural and underserved areas.
• Services include mental health awareness, early identification of illness, home visits, family education, and referral to higher centers.
• This decentralized approach encourages mental health care at the grassroots level.

✅ 5. Day Care and Rehabilitation Centers

• These centers help individuals with chronic mental illnesses regain social, vocational, and life skills through structured daily programs without needing overnight hospitalization.
• Services include occupational therapy, skill training, psychoeducation, recreational therapy, and group therapy sessions.
• Patients are encouraged to function independently while receiving supervised care.

✅ 6. Halfway Homes and Supported Accommodation

• These are transitional residential facilities for patients who are stable but not ready to return to their families or society completely.
• Services include life skills training, psychosocial rehabilitation, medication supervision, and community reintegration support.
• They help in reducing relapse and re-hospitalization after discharge.

✅ 7. De-Addiction and Substance Abuse Treatment Centers

• Specialized centers offer care to patients with alcohol or drug dependency through detoxification, behavioral therapy, group therapy, and relapse prevention counseling.
• These centers may be attached to psychiatric hospitals or function as stand-alone government or NGO-run facilities.
• Family involvement and follow-up care are emphasized for long-term recovery.

✅ 8. Counseling and Psychotherapy Services

• Psychiatric patients have access to individual, family, marital, and group counseling provided by trained psychologists or counselors.
• Services address emotional distress, trauma, relationship issues, anxiety, depression, and behavioral problems.
• Psychotherapy improves insight, coping mechanisms, and quality of life.

✅ 9. Helplines and Telepsychiatry Services

• Mental health helplines like iCall, AASRA, Snehi, and government-supported tele-mental health platforms (e.g., Tele-MANAS) provide free counseling and crisis support via phone or video.
• These are especially helpful for patients in remote areas, during emergencies, or in pandemic situations.
• Services include anonymous support, medication follow-up, suicide prevention, and mental health guidance.

✅ 10. School and Workplace Mental Health Services

• Mental health services are now being integrated into schools, colleges, and workplaces through counselors, mental health educators, and employee wellness programs.
• Services aim at early identification of stress, anxiety, depression, bullying, and burnout, and promote mental well-being and resilience building.
• These initiatives reduce dropout, absenteeism, and job-related stress.

✅ 11. Forensic and Legal Mental Health Services

• These services are provided to mentally ill individuals in conflict with the law, such as those in prisons or under court observation.
• Psychiatrists conduct mental status evaluations for competency, criminal responsibility, and fitness to stand trial.
• Institutions like NIMHANS and government forensic units offer specialized care and legal coordination.

✅ 12. NGO and Voluntary Sector Services

• Several non-governmental organizations (e.g., The Banyan, Sangath, SCARF) offer community-based psychiatric services, suicide prevention programs, and rehabilitation.
• They often target marginalized and vulnerable populations, such as the homeless mentally ill, women with mental illness, and disaster victims.
• Nurses and social workers are essential in these teams for home visits, patient tracking, and education.

3) Rights of Psychiatric patient

✅ 1. Right to Access Mental Healthcare

• Every psychiatric patient has the right to receive timely and appropriate mental health care from government or private institutions.
• This care should be affordable, available near their place of residence, and provided without discrimination based on caste, class, gender, religion, or disability.
• Mental healthcare must also include promotion, prevention, treatment, and rehabilitation services, ensuring continuity of care even after discharge.

✅ 2. Right to Dignity and Respect

• Every patient has the right to be treated with courtesy and without any form of humiliation, regardless of their mental condition.
• Patients should be called by their names and not labeled by their diagnosis (e.g., schizophrenic or addict).
• Institutional environments must be clean, comfortable, and humanely managed, where patients are treated as individuals with rights, not objects of control.

✅ 3. Right to Confidentiality

• The nurse and other healthcare workers must ensure that patient records, diagnosis, and therapy plans are kept private and only shared when necessary.
• Even in group therapy or family therapy, information shared must be protected, and patients should be informed of this confidentiality.
• Disclosure without consent is only permitted when there is a threat to the patient’s or others’ life or safety and must be justified legally.

✅ 4. Right to Informed Consent

• The patient has the right to receive full explanation about proposed treatments in a language they can understand, including benefits, risks, and alternatives.
• Consent must be free, voluntary, and documented, not obtained through pressure or deceit.
• For those who are mentally incompetent to consent, a legal guardian or nominated representative must be involved, as defined under the Mental Healthcare Act, 2017.

✅ 5. Right to Live in the Community

• Every person has the right to live with their family or in supported housing within the community, instead of being isolated in mental hospitals.
• Government bodies must establish halfway homes, community centers, and rehabilitation services to support community-based living.
• This promotes social inclusion, independence, and dignity for persons with chronic mental illness.

✅ 6. Right to Protection from Abuse and Neglect

• Institutions must implement policies to prevent physical violence, sexual exploitation, verbal abuse, and emotional manipulation of psychiatric patients.
• Nurses must report any suspected or observed abuse immediately to hospital authorities or the Mental Health Review Board.
• Regular training and supervision of staff, as well as access to helpline services, must be made available to ensure this right.

✅ 7. Right to Legal Aid

• The patient is entitled to free legal services for issues related to admission, rights violation, property disputes, or unlawful detention.
• Hospitals must display information about legal aid availability and help the patient contact legal representatives when needed.
• The patient can also seek help from Mental Health Review Boards or Human Rights Commissions if their rights are denied.

✅ 8. Right to Make Advance Directives

• Patients have the right to make a written document in advance (called an Advance Directive) stating which treatment they prefer or refuse in case they lose mental capacity in the future.
• They can also nominate a representative to make decisions on their behalf during crisis periods.
• Healthcare professionals are legally bound to respect and implement these directives, unless declared invalid by the Review Board.

✅ 9. Right to Participation in Treatment Planning

• The patient has the right to participate in discussions regarding their diagnosis, medications, therapies, and expected outcomes.
• Their values, choices, and preferences must be considered and incorporated into the care plan as far as clinically possible.
• The mental health team should also provide regular updates, reviews, and re-evaluation of care goals, involving the patient wherever possible.

✅ 10. Right to Complain and Seek Redressal

• Patients and families can file complaints regarding mistreatment, wrongful admission, rights violation, or poor care to the Mental Health Review Board (MHRB).
• They also have the right to receive information about how to file a complaint, along with expected timeframes for resolution.
• Complaint mechanisms must be easy to access, transparent, and free from retaliation, with the institution obligated to respond fairly.

✅ 11. Right to Family Contact and Communication

• Unless restricted for safety, psychiatric patients have the right to communicate freely with their family, friends, and legal advisors.
• Patients should be allowed regular visits, phone calls, or written communication, which helps in emotional support and reintegration.
• The institution must provide a safe and private space for such communication, and restrictions must be reviewed periodically.

✅ 12. Right to Refuse Participation in Research

• Patients have the absolute right to refuse to be part of any medical or psychological research, even if they are hospitalized.
• Participation must be based on free, informed, and written consent, and patients must be allowed to withdraw at any point without penalty.
• The ethics committee and the research team must ensure protection of vulnerable groups like psychiatric patients from exploitation.

4) Techniques of crisis intervention

Crisis intervention is a short-term, goal-directed, and supportive approach used by nurses and mental health professionals to help individuals cope with sudden psychological distress, emotional breakdowns, or traumatic events. The main goal is to stabilize the individual, ensure safety, and restore their ability to function.

The following are the key techniques of crisis intervention:

✅ 1. Active Listening

• Active listening involves giving full attention to the person in crisis, using verbal and non-verbal cues to show empathy and presence.
• The nurse should use eye contact, nodding, minimal encouragements, and restating the patient’s feelings to make them feel understood and supported.
• This technique helps the patient feel validated, reduces anxiety, and opens up communication.

✅ 2. Clarification and Reality Orientation

• The nurse helps the patient clarify confusing thoughts, separate facts from distorted perceptions, and remain oriented to reality.
• This is especially useful for patients experiencing panic, confusion, or dissociation, as it brings structure and logic to their emotional chaos.
• Statements like “You are safe here now” or “Let’s talk about what happened step by step” are commonly used.

✅ 3. Catharsis and Ventilation

• The nurse encourages the patient to express their deep emotions, fears, anger, or sadness related to the crisis.
• Releasing these feelings is therapeutic and helps relieve internal tension.
• The nurse must provide a non-judgmental space for emotional outpouring, assuring the patient that it’s okay to cry or express hurt.

✅ 4. Problem-Solving and Goal Setting

• Once emotional intensity reduces, the nurse helps the patient to identify immediate problems, set short-term achievable goals, and explore solutions.
• This empowers the individual to regain control and focus on practical steps rather than feeling helpless.
• Collaborative planning helps the patient shift from “Why did this happen?” to “What can I do next?”

✅ 5. Supportive Counseling and Reassurance

• Providing emotional support, encouragement, and reassurance helps the individual feel safe and reduces fear.
• The nurse might say, “You are not alone; we are here to help you,” which gives a sense of belonging and comfort.
• Supportive counseling also involves validating the patient’s reaction as normal under crisis conditions.

✅ 6. Developing Coping Strategies

• The nurse helps the individual identify healthy coping mechanisms such as deep breathing, journaling, relaxation, or talking to trusted people.
• The goal is to replace maladaptive coping (like substance use or isolation) with constructive strategies.
• Coping skills enhance resilience and prepare the person for future stressors.

✅ 7. Mobilizing Social Support Systems

• The nurse encourages the involvement of family members, friends, support groups, or community services to help the patient.
• Social connections improve emotional strength and reduce the feeling of being overwhelmed.
• The nurse may also refer the patient to psychologists, social workers, or crisis hotlines for continued support.

✅ 8. Creating a Safety Plan

• In cases involving suicidal ideation, abuse, or aggression, the nurse must help develop a clear, written safety plan.
• This includes removing harmful objects, identifying safe contacts, and setting emergency actions.
• The primary aim is to prevent harm and ensure physical and psychological safety.

✅ 9. Using a Calm and Controlled Approach

• The nurse must maintain a calm tone, steady posture, and composed behavior, which helps de-escalate the patient’s anxiety.
• Reacting with panic or judgment can worsen the crisis; therefore, professional composure is crucial.
• Speaking slowly, gently, and confidently provides reassurance.

✅ 10. Follow-Up and Evaluation

• After the crisis subsides, the nurse must follow up to evaluate the patient’s emotional state, coping skills, and support needs.
• This ensures that the crisis intervention has been effective and identifies whether referral for long-term therapy is needed.
• Regular follow-up builds trust and supports ongoing recovery.

5) Difference between epileptic seizure and pseudo seizure

🔹 Point of Difference	⚡ Epileptic Seizure	🌀 Pseudo Seizure (PNES)
1. Definition	Epileptic seizure is defined as a sudden, uncontrolled burst of abnormal electrical activity in the brain that results in involuntary movements, altered awareness, or sensory disturbances.	A pseudo seizure is a seizure-like event that appears similar to an epileptic seizure but occurs due to psychological causes, without any abnormal electrical activity in the brain.
2. Cause	It is caused by neurological conditions such as epilepsy, brain injury, stroke, tumor, or infections that affect brain functioning.	It is typically caused by emotional distress, psychological trauma, personality disorders, or conversion disorder.
3. EEG Findings	Electroencephalogram (EEG) during or after the seizure shows abnormal brain waves or epileptiform activity in epileptic seizures.	EEG remains normal during and after pseudo seizures, as there is no abnormal brain activity involved.
4. Consciousness	The patient often loses consciousness or becomes unresponsive, especially in generalized seizures.	Consciousness may appear to be lost, but the patient often retains partial or full awareness during the episode.
5. Movement Pattern	Movements are usually rhythmic, stereotypical, and follow a predictable pattern like tonic (stiffening) and clonic (jerking) phases.	Movements are often irregular, inconsistent, and may be exaggerated, with no fixed pattern or muscle involvement typical of true seizures.
6. Associated Signs	Common signs include tongue biting, frothing at the mouth, urinary or fecal incontinence, and postictal confusion or fatigue after the seizure.	Physical signs such as tongue biting or incontinence are usually absent, and patients often recover quickly without postictal confusion.
7. Response to Antiepileptic Drugs (AEDs)	These seizures generally improve with antiepileptic medications such as phenytoin, valproate, or carbamazepine.	Pseudo seizures do not improve with antiepileptic drugs and instead require psychological counseling, cognitive behavioral therapy, or psychiatric care.
8. Duration and Recovery	Recovery may take several minutes and is often followed by a postictal phase of disorientation, sleepiness, or headache.	Recovery is usually sudden and complete without the typical drowsiness or confusion seen after true epileptic seizures.
9. Patient Awareness During Episode	The patient is usually unaware of their surroundings and does not recall the event (amnesia).	The patient may be partially aware and can often describe the event afterward in detail.
10. Management Approach	Requires neurological evaluation, use of EEG/MRI, and long-term use of antiepileptic therapy under a neurologist’s supervision.	Requires psychiatric evaluation, psychotherapy, stress management, and reassurance to address underlying emotional or psychological triggers.

Q.6

a. Explain antipsychotic drug mechanism of action (2)

• Antipsychotic drugs work primarily by blocking dopamine receptors in the brain, especially D2 (dopamine-2) receptors located in areas such as the mesolimbic and mesocortical pathways. These pathways are involved in thought, emotion, and behavior regulation. In conditions like schizophrenia, there is believed to be overactivity of dopamine, particularly in the mesolimbic pathway, leading to positive symptoms such as hallucinations and delusions.
• By blocking D2 receptors, antipsychotic medications help to reduce excessive dopamine transmission, thereby alleviating psychotic symptoms. Typical (first-generation) antipsychotics such as haloperidol and chlorpromazine have strong D2 antagonism, which is effective against positive symptoms but may lead to extrapyramidal side effects (EPS) due to dopamine blockade in the nigrostriatal pathway.
• Atypical (second-generation) antipsychotics like risperidone, olanzapine, and clozapine not only block dopamine receptors but also antagonize serotonin (5-HT2A) receptors, which helps reduce both positive and negative symptoms of schizophrenia with fewer motor side effects.

b. Explain Extrapyramidal symptoms (3)

Definition of Extrapyramidal Symptoms

Extrapyramidal symptoms are drug-induced neurological disorders that cause abnormal, involuntary movements, muscle tone disturbances, and motor control impairments, commonly seen in patients treated with dopamine antagonists, especially for psychotic disorders.

Causes of EPS

• Use of typical antipsychotics (e.g., haloperidol, fluphenazine).
• High doses or prolonged use of antipsychotic medications.
• Sensitivity of certain individuals, especially the elderly and children.
• Abrupt withdrawal or interaction with other CNS depressants or antiparkinsonian drugs.

Types of Extrapyramidal Symptoms

a) Acute Dystonia

• Sudden and painful muscle contractions, especially in the face, neck, and back.
• Symptoms include torticollis (twisting of the neck), oculogyric crisis (upward eye deviation), and facial grimacing.
• Usually occurs within hours to a few days of starting or increasing the dose of an antipsychotic.

b) Akathisia

• A feeling of inner restlessness, with an urge to move constantly.
• Patients may appear anxious, pacing, or unable to sit still.
• Appears within days to weeks of initiating therapy.

c) Parkinsonism

• Mimics Parkinson’s disease with tremors, rigidity, bradykinesia (slowness of movement), and masked facial expressions.
• Usually develops within days to weeks of treatment.

d) Tardive Dyskinesia (TD)

• Involves involuntary, repetitive movements of the mouth, lips, tongue (e.g., chewing, lip smacking), trunk, or limbs.
• Usually occurs after prolonged use (months or years) of antipsychotic drugs.
• Often irreversible and worsens with continued drug use.

Management of EPS

• Reducing the dose of the antipsychotic or switching to an atypical antipsychotic with fewer EPS risks (e.g., risperidone, olanzapine, quetiapine).
• Administering anticholinergic medications such as benztropine or trihexyphenidyl to manage dystonia and parkinsonism.
• Beta-blockers (e.g., propranolol) or benzodiazepines may be used to treat akathisia.
• Discontinuing or reducing the offending drug in cases of tardive dyskinesia; in some cases, switching to clozapine is effective.
• Regular monitoring using AIMS or Simpson-Angus Scale is essential to detect early signs and prevent long-term damage.

Role of Nurse in EPS Management

• Monitor patients regularly for early signs of EPS, especially after starting or increasing antipsychotic dosage.
• Educate the patient and family about possible motor side effects and to report them immediately.
• Ensure timely referral to the physician for dose adjustment or medication change.
• Administer prescribed anti-EPS medications and monitor for side effects.
• Provide emotional support, as these symptoms can be distressing and stigmatizing for patients.

Q.7

a. Define mental health (2)

• Mental health is a state of well-being in which an individual is able to realize their own potential, can cope with normal stresses of life, can work productively and fruitfully, and is capable of making meaningful contributions to their family, society, and community.
• It involves the balanced development of emotional, psychological, and social well-being, and allows a person to think clearly, manage emotions, build relationships, and make responsible decisions in everyday life.

b. Explain concept of normal and abnormal behaviour (5)

Concept of Normal Behaviour

1️⃣ It is defined as a set of thoughts, emotions, and behaviors that are socially acceptable, culturally appropriate, developmentally expected, and functionally adaptive, allowing the individual to live effectively in society.

2️⃣ It is commonly seen that a person with normal behavior shows emotional balance, which includes the ability to feel, express, and regulate emotions like happiness, sadness, anger, and fear in a socially acceptable manner.

3️⃣ It is characterized by rational thinking, in which the individual can make logical decisions, analyze situations realistically, and solve problems using cognitive ability.

4️⃣ It includes awareness of reality, which means the person is oriented to time, place, and person, and has no perceptual disturbances like hallucinations or delusions.

5️⃣ A normal individual is usually able to maintain interpersonal relationships, form friendships, fulfill family roles, and participate in community life appropriately.

6️⃣ It is observed that such individuals can handle stress, grief, or frustration in a constructive way and return to a state of emotional equilibrium after the crisis.

7️⃣ Normal behavior also involves self-respect and respect for others, where the person adheres to moral, ethical, and social norms of their culture.

8️⃣ It is important to remember that the definition of normal behavior varies across cultures, age groups, time periods, and situations, and it is not always universal.

9️⃣ For example, mourning after the death of a family member is considered normal, but prolonged withdrawal and self-neglect for months may not be considered normal.

10️⃣ Nurses must understand that normal does not mean perfect, but it refers to behavior that is functional, adaptive, and not harmful to self or others.

Concept of Abnormal Behaviour

1️⃣ Abnormal behaviour is defined as a pattern of emotion, thought, or action that deviates significantly from cultural norms or expectations, and causes distress, dysfunction, or danger to the person or others.

2️⃣ It is often associated with mental illness, in which the person’s behavior is not just unusual, but maladaptive, meaning it interferes with their personal, social, or occupational functioning.

3️⃣ It includes symptoms like hallucinations (false perceptions), delusions (false beliefs), disorganized thinking, severe mood swings, and inappropriate affect or speech, which are commonly seen in psychotic disorders.

4️⃣ People with abnormal behavior may experience severe anxiety, irrational fears, compulsions, depression, suicidal thoughts, or intense anger that is not proportionate to the situation.

5️⃣ It is important to note that abnormal behavior is not always visible or dramatic; it may manifest as social withdrawal, excessive dependence, rigid thinking, or obsessive rituals.

6️⃣ Abnormal behavior is diagnosed and classified using standard diagnostic manuals like the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – 5th edition) or ICD-11 by the World Health Organization, which provide criteria for identifying mental disorders.

7️⃣ The causes of abnormal behavior are multifactorial, including biological factors (like genetics, brain injury, or neurotransmitter imbalances), psychological factors (like trauma, abuse, or personality issues), and social factors (like poverty, stress, or poor family dynamics).

8️⃣ It often leads to loss of productivity, strained relationships, self-harm, legal issues, or even hospitalization, and requires professional psychiatric or psychological intervention.

9️⃣ In psychiatric nursing, it is important to identify, document, and respond to abnormal behavior with compassion, clinical accuracy, and without stigma or judgment.

10️⃣ Early detection and nursing support can prevent the progression of mild behavioral issues into severe mental illness, thus improving patient outcomes.

Key Differences Between Normal and Abnormal Behaviour

Criteria	Normal Behaviour	Abnormal Behaviour
Functionality	Helps the individual to function effectively in daily life	Impairs daily functioning, self-care, and social roles
Perception of Reality	Oriented, logical, and accurate	May involve hallucinations, delusions, and distorted reality
Emotional Expression	Balanced emotions appropriate to the situation	Inappropriate, exaggerated, or blunted emotions
Social Norms	Complies with cultural, ethical, and legal standards	Deviates significantly from accepted norms
Adaptability	Adapts well to changes, stress, or loss	Poor stress tolerance, rigidity, or overreaction
Self-Insight	Aware of one’s thoughts, behavior, and its consequences	Often lacks insight into one’s condition or behavior
Interpersonal Relationships	Maintains healthy relationships with others	May isolate, become aggressive, or overly dependent on others
Help-Seeking Behavior	Willing to seek support when needed	May refuse help, deny problems, or resist treatment

c. Explain the general principles of mental health nursing (5)

Mental health nursing involves the care and rehabilitation of individuals suffering from mental illnesses, with the goal of promoting mental well-being, ensuring safety, and helping patients function effectively in society. The nurse must follow certain guiding principles that form the foundation of effective psychiatric care.

✅ 1. Establishing Therapeutic Nurse-Patient Relationship

• The nurse should always strive to build a trust-based, empathetic, professional relationship with the patient, as it forms the basis for all other therapeutic interventions.
• This relationship should be non-judgmental, confidential, and supportive, helping the patient feel secure and respected.

✅ 2. Maintaining Accepting and Non-Judgmental Attitude

• The nurse must accept the patient as they are, without showing criticism, prejudice, or bias, regardless of their behavior or diagnosis.
• Every patient must be treated with dignity, compassion, and equality, to foster a healing environment.

✅ 3. Ensuring Individualized Care

• Mental health care should be based on the individual needs, preferences, cultural background, and severity of the patient’s illness.
• The nurse should tailor care plans specific to the patient’s condition, strengths, and coping abilities.

✅ 4. Ensuring Safety and Security

• Safety is a top priority in psychiatric nursing. The nurse must protect the patient from self-harm, aggression, or violence toward others.
• Environmental precautions, observation protocols, and suicide risk assessments must be followed vigilantly.

✅ 5. Maintaining Confidentiality

• All patient information should be kept private and secure, and only shared with the health care team when necessary for treatment.
• Maintaining confidentiality helps build trust and rapport, and is an ethical and legal responsibility of the nurse.

✅ 6. Using Effective Communication Skills

• The nurse should use active listening, empathy, open-ended questions, and therapeutic silence to promote meaningful dialogue.
• Non-verbal cues, tone of voice, and body language must be appropriate and consistent to avoid misinterpretation.

✅ 7. Promoting Patient Autonomy

• Patients should be encouraged to make their own decisions regarding their care and treatment, whenever they are capable.
• This fosters a sense of control, self-worth, and responsibility, which are crucial for recovery.

✅ 8. Providing a Structured Environment

• Psychiatric patients respond well to a predictable and organized setting, with daily routines and rules.
• A therapeutic environment helps reduce anxiety and promotes positive behavior reinforcement.

✅ 9. Observing and Documenting Patient Behavior

• The nurse must consistently observe the patient for changes in mood, behavior, communication, and physical signs, and document all findings accurately.
• Timely reporting to the psychiatrist or multidisciplinary team ensures early intervention and better outcomes.

✅ 10. Providing Health Education and Psychoeducation

• Nurses should educate patients and families about the nature of the illness, medications, coping strategies, and available resources.
• Awareness helps reduce stigma, improve treatment adherence, and prevent relapses.

✅ 11. Working as Part of the Multidisciplinary Team

• The nurse collaborates with psychiatrists, psychologists, occupational therapists, and social workers to provide comprehensive, holistic care.
• Regular team discussions and shared care planning help achieve better therapeutic outcomes.

✅ 12. Respecting Patients’ Rights and Legal Safeguard

• The nurse must be aware of and uphold the legal and human rights of mental health patients, including the right to informed consent, dignity, and freedom from abuse.
• Ethical care should be at the core of all interventions, especially in settings involving involuntary admissions or restraints.

✅ 13. Encouraging Social Skills and Rehabilitation

• The nurse should support the patient in developing social skills, self-care abilities, and confidence through occupational activities, group therapy, and community exposure.
• The ultimate aim is to rehabilitate the patient back into society with maximum functional independence.