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ENG-GNM-S.Y.-PSY-2018-( UOLOAD paper no .3)

MENTAL HEALTH NURSING

GNM-GNC- PAPER SOLUTION-YEAR-2018

Q.1 a. What is mental illness? 03

Mental illness includes any of a number of psychiatric disorders that affect a person’s thinking, mood, behavior, personality, and other parts of the body, with varying degrees of severity. It is called mental illness.

b. Enlist the biological causes of mental illness. 04

Biological causes of mental illnesses

Genetic or (hereditary) People who have a family member with a mental illness are more likely to develop a mental illness.  Mental diseases spread through genes in families. Genetic factors often play an important role in the development of mental disorders. Experts believe that many mental illnesses are linked to abnormalities in multiple genes rather than in a single gene.

Apart from this, stress, abuse, any unexpected events, environment etc. are responsible for it.

2.Hormones or Neurotransmitters Some mental illnesses are associated with an imbalance of chemicals in the brain known as neurotransmitters. When this neurotransmitter does not work properly, the brain does not receive proper messages and the person’s mood also depends on its excess.

3.Toxin exposure Lead poisoning and exposure to many gases also have effects

4.Infection Many infections, such as pediatric neurotransmitor disorder (PANDA), a bacterial infection, are associated with OCD.

5.Brain injury  Mental illness is also seen due to injury or brain defect.

    6.Nutrition Due to deficiency of many nutrition specific vitamins and minerals such as deficiency of vit.B 12

    7.Pre Natal If the baby does not get enough oxygen during pregnancy or during delivery, mental illness is also seen in it.

    c. Describe the nursing management of mental illness. 05

    1.Therapeutic Nursing Management

    • Administering medications prescribed by a psychiatrist
    • Always remember 5 right before giving medicine
    • To observe and record any side effects or changes in the patient after administration of the medicine
    • If the patient is to be given ECT, explain it and allow him to talk about his illness
    • If any changes are observed, record and inform the physician

    2.Psycho-Social Nursing Management

    Here is the translation of the provided text:


    Sitting Close to the Patient

    • Sit close to the patient and engage in conversation in a comfortable environment to alleviate their anxiety.
    • Encourage the patient to speak about their problems.
    • Never criticize the patient while they are speaking or when discussing their issues.
    • Motivate the patient to talk.
    • Communicate with the patient in simple language that they can understand.
    • When discussing the patient’s delusions, listen calmly and observe how their behavior reflects these delusions.
    • Never validate their delusions, but ensure a safe environment is provided.
    • Avoid discussing the patient’s hallucinations; focus on other topics.
    • Never ignore the patient. Occasionally pause during conversations and use interview techniques such as pinpointing, clarifying, reflecting, and summarizing.
    • Enhancing Self-Concept
    • To improve the patient’s self-concept, assign them tasks such as inviting everyone to daily activities, checking if everyone has eaten, and assigning cleaning duties.
    • Improving Attention and Judgment
    • Engage the patient in games such as carom, chess, ludo, etc. The nurse should play these games and encourage the patient to solve minor problems. Assign tasks that help maintain the patient’s focus.
    • Improving Family Support
    • A relative of the patient should always be present to assist with the patient’s problems. They should help with daily activities such as personal hygiene and diet.

    3.Physical Need Nursing Management

    To protect :

    • Do not keep any sharp or injurious objects like knives, blades, rods, glass objects etc. with the patient.
    • If the patient fights with others and hits me, punishments such as not allowing him to participate in sports can be given.
    • to help maintain personal hygiene
    • Encourage the patient to brush
    • To have the patient completely empty his bowels and bladder as the patient can fill them

    c) Helping in the fight

    • To encourage the patient to go to bed earlier at night. I switched off the light. Also put a floor light on the bed side.
    • If any patient is disturbing other patients, you should be separated
    • Give the patient a glass full of warm milk to drink.
    • Making the patient active again during the day.
    • Forbid the patient to sleep in the afternoon.

    d) Nutritional Need

    • A balance diet plan should be made for the patient on the previous day
    • The patient should be served food of his liking and in his own vessel and should eat by himself
    • If the patient is in doubt about eating, the relative should first be given a food test.
    • The patient should get food as per his requirement
    • 4. Recreational Need Nursing Management
    • The patient should be asked about his hobbies so that recreational activities of his choice can be given accordingly
    • he patient should be given games like carrom board or ludo to play
    • Games like badminton can also be given to play to use up the energy
    • Initially the patient should not be given or play any competitive games
    • If someone wins a competition, he should be congratulated
    1. Spiritual Need Nursing Management

    The patient should be encouraged to pray daily and separate arrangements should be made for it and every upcoming festival should be celebrated properly but one should never be forced to celebrate other religions or festivals.

    OR

    a. What is therapeutic communication?    03

    Therapeutic Communication :- Therapeutic communication is verbal or non-verbal communication between a patient and a health care provider with the main purpose of better understanding and providing care to the patient.

    b. What are the components of therapeutic nurse patient relationship.04

    Components of the Therapeutic Relationship

    1. Rapport This is one of the most important unconscious person characteristics to interact with

    Rapport means a mutual agreement between two people, trust or agreement. Mental health nurse is very important to build the trust of the patient and build a trusting relationship, for that he should have qualities like understanding, non-judgmental attitude, warmth etc.

    2.Empathy:- Empathy is generally defined as the ability to recognize, understand and directly experience the feelings of others. Empathy is often described as the ability to “put oneself in another’s shoes”, or to experience another person’s point of view or feelings within oneself, a type of emotional resonance so that one can better understand the other person’s emotions and the cause of their problem.

    3:Genuineness :- To act in such a way that in one’s words and one’s behavior, one’s own various feelings and attitudes are expressed.

    4.Acceptance :- Accepting the patient as he is develops a good relationship that we can use to care for the patient.

    5.Understanding:-It is very important to understand the feelings of the patient as he is and for this the nurse should have understanding

    1. Warmth:-We help the shunt to feel comfortable Accepting the person as a unit Participating in happiness and sadness and caring for him

    7 Respect :- Treating the mentally ill patient as if he is a human being and treating him well and respecting him throughout the ongoing therapeutic relationship.

    c. Explain the phases of therapeutic nurse – patient relationship. 05

    Phases of the Nurse Patient Relationship Relationship

    1. Pre-interaction phase

    Phase No begins when the nurse is assigned a patient, before interacting with him. During this phase, the nurse has some fear and anxiety. She sets her objectives and takes the help of the clinical supervisor to overcome her anxiety. There are many misconceptions or beliefs about the patient that whether the patient will accept me or not violent behavior, he often talks to the nurse of the next shift or guesses from the record.

    2.Orientation Phase

    The orientation phase begins when the nurse interacts with the patient, introducing themselves, while the patient is initially unfamiliar with the nurse. During this phase, both parties become acquainted with each other, accept one another, and establish a treatment contract. It is important for the nurse to demonstrate trustworthiness in their behavior while communicating with the patient. The nurse should inform the patient about the confidentiality of the information shared. The orientation phase is considered complete when both the nurse and the patient recognize each other as unique human beings.

    3.Working Phase

    This phase involves the problem-solving process for both the nurse and the patient, focusing on achieving the goals established during the orientation phase. The nurse works on tasks aimed at the patient’s recovery and manages their own anxiety, which helps reduce their fear. During this time, the nurse encourages the patient to socialize, motivates them to communicate, assists in finding solutions, and performs other related tasks.

    Termination Phase

    This is the final stage of the therapeutic relationship between the nurse and the patient. It is also known as the resolution phase or end phase. The main purpose of the termination phase is to bring the therapeutic relationship between the nurse and the patient to a close. The termination phase begins when the patient’s contract was established during the orientation phase. The termination phase occurs for various reasons, such as when the patient is discharged, goes on parole, or does not return; when clinical rotations require the nurse to move to a different location; when the patient shows improvement and no longer needs one-on-one attention; or when the patient is discharged from the hospital and the therapeutic relationship naturally concludes. It is important to inform the patient about the termination and to respect their right to know. The patient should be allowed to express their thoughts and feelings regarding the termination.

    Q.2 a. Describe the nursing management of depression patient. 08

    Therapeutic Nursing Management

    • Provide the patient with a comfortable environment and instruct the patient’s relatives to stay with them continuously.
    • Administer the medications prescribed by the doctor, monitor for side effects, and keep records and reports. Generally, antidepressant drugs are administered as prescribed.
    • Conduct a Mental Status Examination (MSE) to assess the patient’s suicidal thoughts and plans, and determine their level of risk, while documenting all findings.
    • If the patient requires Electroconvulsive Therapy (ECT), assist with and prepare for the procedure.

    2.Physical Need Nursing Management

    a.Safe Environment

    • The patient should be kept under continuous observation, with one nurse dedicated to their care at all times.
    • Glass items, ropes, pajamas, petticoat strings, net ties, etc., should be removed from the room.
    • Avoid using long bed sheets as they can be used for hanging.
    • Use paper dishes for food.
    • Electrical connections should not be left exposed.
    • Medications and instruments should be kept locked in the ward.
    • Ensure that the patient does not ingest more than one medication at a time, and monitor this closely.
    • Provide a room close to the nursing station.
    • Explain various coping mechanisms for life to the patient.

    3. Personal Hygiene :– Encourage the patient to maintain his personal hygiene. Encourage him to change his clothes, take a bath, comb his hair, etc.

    4.Nutritional lead

    • Ask to diet little and often
    • Giving no flour mill diet with omelette, salad, vegetables etc
    • Serve food when everyone is eating
    • Ask the patient for his food preference
    • Record input and output

    4.Psycho Social Need :-

    Trusting Relationship

    Talk to the patient Listen to him calmly Bring out the positive things in him Let the patient visit his relative Try to create a positive attitude in him

    Reducing suicidal ideation

    Encourage the patient to talk about his/her suicidal ideation and how to commit suicide etc.

    Increase in self esteem

    Calling the patient by his name Acknowledging his positive points and positive achievements

    Improve socialization

    The patient should never be left alone asking them to get out of bed slowly to meet people

    Recreational Need

    Identify the patient’s favorite hobby or game Give him enough time for outdoor games even if he completes his hobby Give him success if he wins If he loses Accept without any disturbance

    Spiritual Activities

    b. Briefly explain the qualities of psychiatric nursing. 04

    Qualities of the Psychiatric Nurse

    1.Empathy

    A good nurse needs to understand that each patient is unique and experiences life differently. It is beneficial to comprehend each patient’s situation, show empathy towards their specific circumstances, and avoid giving unnecessary or generic advice. Imagining what the patient is going through and acknowledging how they feel can be useful in understanding their situation better.

    Patients may feel more comfortable if the nurse supports their emotions before addressing their medical condition. It is helpful to avoid discussing similar experiences or the outcomes of their treatment with them. By actively listening to your patient, you can fully understand their story and demonstrate empathy. This approach allows you to appreciate how they are feeling and validate their emotions.

    2.Non-Judgmental Attitude

    While it may be common for people to judge others based on their own interpretations, it is important for nurses to remain non-judgmental when managing patients. Evaluating individuals based on their background, beliefs, or appearance can create a disconnect and prevent you from gaining their trust. Patients want to feel that they can trust you and that you are supporting them without taking their circumstances into account.

    Providing non-judgmental care allows nurses to accept patients in any situation. This approach can encourage you to offer the best care equally to all patients. If your views differ from those of the patients, it is advisable to express them respectfully and courteously if necessary.

    3.Excellent Communication

    Nurses need excellent communication skills to effectively talk with patients and their relatives about conditions such as depression or personality disorders. Actively listening to patients is beneficial, as even small disclosures can reveal a lot about their mental state. Newly admitted patients may experience issues related to changes in their environment. Therefore, it is important to provide as much support as possible through close communication. Speak clearly with patients and ensure they understand what you are asking. Observing their facial expressions and body language is also helpful, as it can guide how to continue the conversation.

    4.Compassion

    Showing empathy means being sensitive to a person’s problems and doing whatever you can to improve their situation. Acts of kindness can significantly impact a patient’s mood, and they may cling to such care. For nurses, demonstrating compassion is beneficial due to the sensitive nature of their work.

    Sometimes, individuals with mental health issues may feel unable to trust a professional to take their problems seriously. Intentional encouragement and support can trigger positive emotional responses and facilitate recovery. Nurses often perform simple acts of kindness to help patients feel more comfortable and build trust.

    5.Devotion to Duty

    For nurses, devotion to duty is crucial as they provide essential services. Dedication to duty means consistently delivering high-quality care regardless of the circumstances. It involves understanding the importance of building healthy, positive relationships with colleagues, patients, and their families to achieve the best possible outcomes and a smooth working experience. To achieve this, commitment to continuous professional development and staying updated with best practices is beneficial for nurses.

    Being dedicated to professional development allows nurses to provide better patient-centered care and excellent service. It is also important for these professionals to monitor their own emotional and mental well-being. Illness or emotional distress can hinder their ability to provide the best patient care.

    6.Calmness

    In situations where patients and relatives experience agitation, it is helpful if the nurse remains calm and tries to de-escalate the situation rather than reacting in a way that could increase the patient’s aggression and distress. Using communication techniques can help manage stressful situations, such as administering medication or controlling aggressive individuals to calm both patients and their relatives. It is beneficial to do this carefully to avoid triggering further issues.

    7.Emotional Intelligence

    Emotional intelligence is the ability to recognize and understand one’s own and others’ emotions. Learning how to manage emotions in oneself and patients, especially in complex situations, can benefit Registered Nurses (RNs). Observing and managing the patient’s emotions can help calm them in situations where they might become aggressive. This includes ensuring the safety of both the patient and others present.

    Demonstrating emotional intelligence can impact how you communicate with patients. You can show that you understand their situation and ask how you can help them feel better. If their request is not possible, it is best to apologize for being unable to meet their needs and offer an appropriate solution. Emotional intelligence helps you navigate various issues effectively.

    8.Adaptability

    The work environment often changes, and it is essential for nurses to quickly adapt to new dynamics. To consistently provide excellent care, nurses must accept and swiftly adjust to changing environments. They may encounter patients with various personalities, work with different mental health conditions, and manage diverse moods among their patients. Adaptability helps them adjust and stay effective when working with different groups. This skill is also useful when dealing with new procedures and policies.

    9.Patience

    Demonstrating patience is often necessary when interacting with patients and their relatives. Patients may be unable to communicate clearly or might be distressed, making it beneficial for professionals to handle such situations calmly and provide care with the same level of attention. Managing relatives can also present complex challenges, where patience and clear understanding are equally important.

    OR

    a. Describe the principles of psychiatric nursing. 08

    Patient is Accepted Exactly as He is

    Acceptance means being without prejudice or non-judgment of any kind. Acknowledgment conveys feelings of love and care. Acceptance does not mean absolute permission, but a setting of positive behaviors to respect him as an individual human being

    A. Being Non-judgmental and Non-punitive

    The patient’s behavior is not judged as right or wrong, good or bad. The patient is not punished for his unwanted behavior. Punishment such as direct chaining, restraining, keeping in separate rooms and indirect ignoring or deliberately ignoring or avoiding his presence. A nurse who shows acceptance does not reject the patient even when he behaves contrary to her expectations.

    B. Being Sincerely Interested in the Patient.

    • To be sincerely interested in another person means to have the other person’s interest in mind
    •  To study the patient’s behavior pattern
    • Allowing him to make his own choices and decisions as far as possible
    • Be aware of his likes and dislikes.
    • To be honest with him.
    •  Take the time to listen to what he has to say.
    • Avoid sensitive topics and issues.
    • Recognizing and reflecting feelings that the patient may express—when the patient

    C. Recognize and Reflecting on Feelings which Patient may Express

    When the patient talks, it is important to note not what the content is, but what the emotion behind the conversation may be, which should be recognized and reflected upon.

    D. Talking with Purpose

    Nurse-patient communication should revolve around the patient’s needs, desires, and interests. When issues are not clear, approaches such as reflection, open-ended questions, focusing on the topic, and presenting reality can be more effective.

    E. Listening

    Listening is an active process. Nurses should invest time and energy to truly hear what the patient is saying. They should listen empathetically and show genuine interest.

    F. Permitting Patient to Express Strongly Held Feelings

    Allowing patients to express strong emotions can be highly cathartic. It is better to permit patients to articulate their intense feelings without fear of rejection or punishment.

    2.Use Self understanding as therapeutic tools

    The psychiatric nurse must have a realistic self-concept and be able to identify her own feelings and responses.

    3.Consistency is used to contribute to patients security

    This means that staff should take measures for patient safety during ward routines.

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

    Reassurance builds the patient’s confidence. The nurse needs to explain and analyze the patient’s situation to provide reassurance.

    5.Patient’s Behavior is Changed through Emotional Experience and not by Rational Interpretation Use Self understanding as therapeutic tools

    Counseling or rationalizing patients is not effective in changing behavior. Role-play and social-drama etc. can change his behavior 

    6.Unnecessary Increase in Patient’s Anxiety should be Avoided

    The following points should be taken care of to avoid unnecessary anxiety in the patient

    • The nurse should not show her concern.
    • Pointing out the patient’s shortcomings.
    • The patient faces repeated failures.
    • Placing demands on the patient that he obviously cannot meet.

    7. Objective Observation of Patient to Understand His Behavior

    This allows for the assessment of what the patient is trying to convey. The nurse should avoid mixing personal feelings and judgmental opinions with the observation.

    8. Maintain Realistic Nurse-Patient Relationship

    A realistic or professional relationship focuses on the individual’s personal and emotional needs rather than the needs of the patient and nurse.

    9. Avoid Physical and Verbal Force as Much as Possible

    Nurses should not administer any form of punishment. Since patients may be suffering from psychological trauma, it is crucial to study their behavior to prevent unpredictable actions. Nurses should carry out procedures promptly and should not show their own discomfort to the patient. If the patient is restrained, the reason should be explained. Allow the patient to interact with others when there is a positive change in behavior.

    10. Nursing Care is Centered on the Patient as a Person and Not on the Control of Symptoms

    The behavior observed in a person often has underlying causes. The nurse should understand why the symptoms of behavior occur rather than just focusing on the symptoms themselves. Patients may display different behavioral symptoms in similar situations, so nursing care should focus on the patient as a whole rather than just the symptoms.

    11. All Explanations of Procedures and Other Routines are Given According to the Patient’s Level of Understanding

    Routine and procedures should be explained to psychiatric patients based on their understanding and needs to alleviate their concerns. Everyone has the right to know about the procedures performed on them, and it should not be assumed that mental health conditions exempt them from understanding.

    12. Many Procedures are Modified but Basic Principles Remain Unaltered

    While many procedures may be modified according to the patient’s needs and methods may change, the basic principles remain the same. These include patient care aspects such as safety, security, therapeutic relationships, and procedures.

    b. Briefly explain the barriers of communication. 04

    1. Not Listening

    When the patient speaks and the nurse does not listen or pays attention, the communication process fails. The nurse-patient relationship deteriorates, and problems arise if the patient also does not listen to the nurse.

    2. Rejecting Response

    When a patient speaks and their concerns are rejected, such as by saying “Let’s end this conversation,” the patient may feel invalidated and may stop sharing their thoughts.

    3. Reassurance

    Avoid giving false reassurances, such as saying “Everything will be fine” or “You’ll manage alone in the hospital.” Such statements can disrupt the patient’s treatment and may lead to unrealistic expectations.

    4. Probing

    Avoid probing the patient for information inappropriately. Forcing the patient to disclose certain information can lead to resistance and may create additional questions.

    5. Advising

    Do not give unnecessary advice to the patient.

    6. Changing Topics

    If the patient is discussing a particular topic, do not change the topic without reason. Listen to the patient calmly.

    7. Blaming

    Do not place any blame on the patient, such as saying, “You did this, so that happened.”

    8. Directing

    Avoid giving excessive directives to the patient during treatment, such as telling them to change their clothes or do other tasks.

    9. Preaching

    Avoid preaching or giving moral judgments, such as saying, “Your way of living is wrong.”

    10. Patronizing

    Do not exhibit overly paternalistic behavior during communication with the patient.

    11. Challenging the Patient

    Avoid challenging the patient. For example, if a patient asserts their identity or status, such as saying “I am the Prime Minister of India,” do not respond with skepticism or dismissiveness. Such statements should be taken seriously.

    12. Using Denial

    If a patient shares something, do not dismiss it as insignificant. For example, if a patient says, “I feel dead,” do not respond with, “Don’t joke” or “Just leave.” Such statements should be taken seriously.

    Q.3 Write Short Answers (Any Two) 2X6=12

    a. Explain the modern psychiatric nursing.

    Modern Psychiatric Nursing Development

    • In 1873, Linda Richards graduated from the New England Hospital for Women and Children in Boston.
    • She improved nursing care in psychiatric hospitals.
    • Richards is recognized as the first American psychiatric nurse; she believed that “mentally ill individuals should receive at least as much care as those who are physically ill.”
    • The first textbook on psychiatric nursing, Nursing Mental Diseases by Harriet Bailey, was published in 1920.
    • In 1913, Johns Hopkins Nursing School was the first to include a psychiatric nursing course in its curriculum.
    • In 1953, Maxwell Jones introduced the concept of the therapeutic community.
    • By 1960, the focus shifted to implementing primary prevention, community care, and counseling.
    • The name “psychiatric nursing” was changed to “mental health nursing.”
    • In 1980, scientific advancements emerged in the fields of psychobiology, brain imaging techniques, neurotransmitters, neuronal receptors, and molecular genetics related to psychiatry.

    b. Describe social and economical factors affecting on mental health.

    Social and Economic Factors Impacting Mental Health

    Social and economic factors affect mental health in various ways. Here are some key points that impact mental well-being:

    1. Socioeconomic Status (SES) Impact:
      Low SES increases stress, limits income and other resources, and elevates mental strain. Explanation:
      Economic inequality leads to financial strain, which results in inadequate access to necessary health care and education.
    2. Employment and Job Insecurity Impact:
      Unemployment, job insecurity, and underemployment increase stress and anxiety, which can lead to depression. Explanation:
      A stable job provides financial security, reducing anxiety and mental stress, allowing individuals to meet their basic needs.
    3. Social Support and Relationships Impact:
      Strong social connections can help maintain mental health, while isolation can lead to mental instability and a higher risk of depression. Explanation:
      Supportive relationships contribute to social and mental well-being, helping individuals maintain mental health.
    4. Education Impact:
      Limited education directly affects a person’s mental state. Explanation:
      Educated individuals tend to secure better employment, meet their economic needs, and maintain better cognitive function, which contributes to mental health.
    5. Housing and Neighborhood Conditions Impact:
      Poor living conditions and an unsocial neighborhood increase anxiety and stress, which can deteriorate mental health. Explanation:
      Housing problems, violence in the environment, and lack of community resources negatively affect individuals, leading to mental health issues.
    6. Discrimination and Stigma Impact:
      Discrimination based on race, gender, or sexual orientation leads to mental disturbance. Explanation:
      Discrimination causes chronic stress, anxiety, and depression, while stigma prevents individuals from seeking help, exacerbating mental health issues.
    7. Access to Healthcare Impact:
      Limited access to health services results in inadequate treatment, leading to mental health disorders. Explanation:
      Financial barriers, such as lack of money, prevent individuals from obtaining adequate health care, which can result in mental disorders.
    8. Economic Downturns and Recession Impact:
      Economic downturns cause stress, anxiety, and social strain, which negatively impact mental health. Explanation:
      Economic instability creates unnecessary fear and challenges in mental health.

    Understanding these social and economic factors helps us identify and address factors affecting health early, allowing for treatment and restoring individuals to normal conditions.

    c. Explain the types of sexual deviation and disorders.

    Sexual disorders and deviations include conditions that deviate from culturally accepted norms or cause problems for individuals. It is important to approach this topic with sensitivity and to recognize the classification and understand the condition. Some of the categories are as follows.

    1.Paraphilias:

    Definition: Abnormal sexual interest and behavior is called paraphilia.

    Examples: pedophilia, exhibitionism, voyeurism, fetishism, sadism, masochism.

    2.Sexual Dysfunction

    Definition: Problems or disorders that interfere with (interfere with) the normal sexual response cycle.

    Examples: erectile dysfunction, premature ejaculation, female sexual arousal disorder, vaginismus.

    Gender Dysphoria: Definition Distress that may accompany the incongruity between one’s experienced or expressed gender and the gender assigned to them at birth.

    Examples: Transsexualism, Gender Identity Disorder.

    Hypersexuality (Compulsive Sexual Behavior Disorder):

    Definition: Excessive and uncontrollable preoccupation with sexual thoughts, fantasies, or behavior.

    Examples: compulsive masturbation (masturbation) excessive pornography, frequent anonymous sexual encounters.

    Paraphilic disorders:

    Paraphilic disorders:

    Definition: A paraphilia that causes significant problems or harm to the individual or poses a risk of harm to others.

    Examples: pedophilic disorder, exhibitionistic disorder, voyeuristic disorder.Z A paraphilia that causes significant problems or harm to the individual or poses a risk of harm to others.

    Examples: pedophilic disorder, exhibitionistic disorder, voyeuristic disorder.

    Sexual Pain Disorder:

    Definition: A condition characterized by physical pain during sexual activity.

    Examples: Dyspareunia (pain during intercourse), vonismus (involuntary muscle spasm that interferes with penetration).

    Hypoactive Sexual Desire Disorder (HSDD):

    Definition: Persistently low or absent sexual interest or desire.

    Examples: , lack of interest in sexual activity, lack of interest in sexual relations.

    Sexual Aversion Disorder:

    Definition: Aversion to and avoidance of sexual contact due to excessive fear, anxiety, or aversion.

    Examples: Experiencing extreme discomfort during sexual activity. It is crucial to note that sexual variation (the classification and understanding of sexual diversity and disorders) can differ across cultures and may evolve over time. Additionally, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is commonly used for classification, but it may be updated. Treatment approaches often include psychotherapy, behavioral interventions, and sometimes pharmacotherapy. For individuals with sexual health-related problems, it is important to seek help from qualified healthcare professionals who approach these issues with sensitivity and respect for diversity.

    d. Write withdrawal symptoms of drugs addiction.

    Withdrawal symptoms can be different for different people and can be mild or severe. Symptoms depend on:

    Withdrawal symptoms

    • the type of substance / behavior and how long you used it for
    • your age
    • your physical health
    • your mental and emotional state
    • the withdrawal process used

    Symptoms can include:

    • not being able to sleep
    • irritability
    • changing moods
    • depression
    • anxiety
    • aches and pains
    • cravings
    • tiredness
    • seeing things that are not there (hallucinations)
    • nausea and vomiting
    • diarrhoea
    • sweating
    • shaking

    You may also be hot and cold, have goosebumps, or have a runny nose

    Severe withdrawal symptoms, especially for drugs and alcohol, can include:

    Q.4 Write Short notes (Any Three) 3X4=12

    Hysteria vs. Epilepsy

    Hysteria:

    • Definition: Hysteria is a psychological disorder where repressed inner conflicts unconsciously convert into physical symptoms.
    • Occurrence: More commonly observed in adults.
    • Warning Signs: There are no warning signs before hysterical seizures.
    • Tongue Bite: Tongue biting is not observed in hysterical seizures.
    • Timing: Hysterical seizures can occur at any time during the day but are not observed during sleep.
    • Location: Hysterical seizures are usually observed in a safe place within the home.
    • Urine and Stool: Urine and stool are not passed during hysterical seizures.
    • Post-Seizure Confusion: Patients do not show confusion after a hysterical seizure.
    • Neurological Signs: Neurological signs are absent in hysteria.
    • Injury: Patients with hysteria do not typically show injuries.
    • Pain Response: Patients with hysteria respond to pain.
    • Consciousness: Patients do not show complete unconsciousness during hysterical seizures.

    Epilepsy:

    • Definition: Epilepsy is a neurological disorder characterized by seizures caused by electrical disturbances in the brain.
    • Occurrence: More commonly observed in children.
    • Warning Signs: Warning signs are present before epileptic seizures.
    • Tongue Bite: Tongue biting is observed in epileptic seizures.
    • Timing: Epileptic seizures can occur at any time during the day, including during sleep.
    • Location: Epileptic seizures can occur anywhere, both inside and outside the home.
    • Urine and Stool: Urine and stool may be passed during epileptic seizures.
    • Post-Seizure Confusion: Patients exhibit confusion and memory loss after epileptic seizures.
    • Neurological Signs: Neurological signs are present in epilepsy.
    • Injury: Patients with epilepsy may show injuries.
    • Pain Response: Patients with epilepsy do not typically respond to pain.
    • Consciousness: Patients show complete unconsciousness during epileptic seizures.

    Occupational Therapy

    Objective of Occupational Therapy:
    The primary goal of occupational therapy is to enable individuals to participate in their daily life activities. Occupational therapy helps individuals regain their independence in performing daily living activities.

    Methods Used in Mental Rehabilitation:
    Some methods used in mental rehabilitation include housing placement (e.g., halfway homes, supervised housing) and vocational training (e.g., sheltered workshops, vocational guidance).

    Purpose in Mental Health:
    In mental health, the purpose of occupational therapy is to assist people in coping with the challenges of daily life imposed by mental and emotional disorders.

    Role of Occupational Therapist:
    Occupational therapists identify areas of difficulty and plan activities accordingly.

    Areas of Difficulty in Mental Patients:
    In patients with mental disorders, occupational therapists focus on identifying specific problem areas and planning interventions to address these challenges.

    Areas of Difficulty in Occupational Therapy for Mental Patients:

    1. Motor (e.g., psychomotor activities): This involves difficulties with physical movements and coordination.
    2. Sensory (e.g., perceptions, hallucinations): This includes challenges related to sensory experiences such as altered perceptions or hallucinations.
    3. Cognitive (e.g., decision-making, problem-solving): This pertains to difficulties with mental processes like making decisions and solving problems.
    4. Interpersonal (e.g., self-awareness, emotions): This relates to issues with self-perception and emotional responses.
    5. Interpersonal (e.g., socialization, communication): This involves challenges with social interactions and communication skills.
    6. Self-care (e.g., basic and instrumental activities of daily living): This includes difficulties with performing essential daily activities and self-care routines.
    7. Productivity (e.g., work, employment): This pertains to issues related to work performance and job responsibilities.
    8. Leisure (e.g., interests, enjoyable activities): This involves challenges with engaging in hobbies and pleasurable activities.

    Occupational therapy approaches
    . New Teaching Ways of Approaching Tasks Breaking down and completing learning activities to achieve

    Learning Adaptive Activities

    Role of nurse… A nurse should work for the good health and well-being of the family group and communities.

    The nurse should perform an occupational assessment of the client

    The client should be encouraged to become involved in occupational therapy

    Within therapy, the therapist should help keep the client interested in activities that are the focus of the therapy.

    3. Side effect of Anti-depressive drugs-

    Here is the translation of the symptoms and issues:

    1. Nausea, vomiting, or diarrhea: Nausea, vomiting, or diarrhea
    2. Headache: Headache
    3. Drowsiness: Drowsiness
    4. Dry mouth: Dry mouth
    5. Insomnia: Insomnia (difficulty falling or staying asleep)
    6. Nervousness, agitation, or restlessness: Nervousness, agitation, or restlessness
    7. Dizziness: Dizziness
    8. Sexual problems, such as reduced sexual desire, difficulty reaching orgasm, or inability to maintain an erection (erectile dysfunction): Sexual problems, such as reduced sexual desire, difficulty reaching orgasm, or erectile dysfunction
    9. Impact on appetite, leading to weight loss or weight gain: Impact on appetite, leading to weight loss or weight gain
    1. Anorexia Nervosa – Anorexia Nervosa
    • The word anorexia means ‘absence of appetite’.
    • Anorexia nervosa is an eating disorder. In which the person avoids food, and has a desire to be thin and such people have a fear of gaining weight.
    • Such people eat less than 200 calories per day.

    Types of Anorexia Nervosa:

    • 1) Restricting type
    • 2) Binge eating / Puring type

    1) Restricting type:
    In this type, a person avoids food and exercises excessively to lose weight.

    2) Binge eating/purging type:
    In this type, the person eats food but vomits by putting a finger in the mouth and uses laxatives, diuretics, enemas.

    Here is the translation of the signs and symptoms:

    1. Rapid weight loss
    2. Loss of muscle mass
    3. Thinning of bones
    4. Russell’s sign (scarring on knuckles from self-induced vomiting)
    5. Swelling in cheek
    6. Enlarged salivary gland
    7. Food refusal
    8. Dehydration
    9. Electrolyte imbalance
    10. Low blood pressure
    11. Abnormal heart rhythm
    12. Slow heart rate
    13. Anemia
    14. Constipation
    15. Headache
    16. Fatigue
    17. Lethargy
    18. Fainting
    19. Dry skin
    20. Brittle hair and nails
    21. Insomnia
    22. Infertility
    23. Amenorrhea (absence of menstruation)
    24. Irregular menses
    25. Alkalosis

    Investigation

    • complete blood count
    • electrolyte test
    • bone density test
    • thyroid function test
    • ECG
    • urine analysis
    • kidney function test
    • liver function test

    Treatment of Anorexia nervosa

    1) psychological therapy :-

    ~ family therapy
    Family therapy is important for children and adolescents. In which a family member improves the food habit of a patient with anorexia.

    ~ Motivational psychotherapy:
    The patient is encouraged to gain weight and adopt good food habits.

    ~ Cognitive behavioral therapy:
    Cognitive behavior therapy is used after weight restoration.

    ~ Behavioural therapy In this therapy, changes in the patient’s behavior are observed and focused on.

    2) Antidepressants drug Medicines from the Selective Serotonin Reuptake Inhibitors group are prescribed

    E.g. : fluoxetine

    3) nutritional supplements Calcium and vitamin D supplements are given along with zinc supplements.

    Nursing management

    • To monitor vital signs
    • Monitor weight.
    • To provide nutritional diet so that nutritional deficiency does not remain.
    • Giving a 3000 calorie diet throughout the day.
      Monitor complete blood count and serum electrolyte levels.
    • Reassure the patient.

    5. Mental Health Team-

    Mental Health Team:-Mental health is a very big concept that cannot be served by one person, so it requires a team, all of whom work according to their roles for promotion, prevention, treatment and rehabilitation of mental health.

    1. Psychiatrist

          A psychiatrist is a post-graduation doctor in psychiatry with 2-3 years of residency training. Psychiatrists are responsible for the diagnosis, treatment, and prevention of mental disorders, prescribe medications and somatic therapies, and act as mental health team leaders.

    1. Psychiatric Nurse Clinical Specialist

            Psychiatric nurse clinical specialists must have a master’s degree in nursing, actively participate in primary, secondary & tertiary prevention of mental disorders and provide individual, group and family psychiatry treatment in hospital and community settings. It also takes responsibility for teaching, administration and research.

    1. Psychiatric Registered Nurse

            Nurses pass through General Nursing and Midwifery program or B.Sc Nursing/Post-Basic B.Sc Nursing program along with additional qualification like Diploma in Mental Nursing. This nurse is skilled in caring for the mentally ill, providing holistic care by assessing the mental, social, physical, psychological and spiritual needs of the patient.

    1. Clinical Psychologist

           A Clinical Psychologist holds a U.G./Master’s degree or Doctorate degree in Clinical Psychology and is registered with the Association of Clinical Psychologists. It diagnoses psychological problems through various tests, interprets and evaluates the findings of these tests, and records changes in behavior.

    5. Psychiatry Social Worker

          Psychiatry Social Worker is Bachelor in Social Work and Post Graduate in Psychiatry Social Work. She/he assesses individual, family and community support systems, assists in discharge planning, counsels for job placement and is aware of state laws and legal rights of the patient and protects these rights.

    Psychiatric para-professionals

    1.Psychiatric Nursing Aids / Attendants:- 

       They have a high school education and are trained on the job. They help maintain a therapeutic environment and provide supervised care.

    2.ECT Technician 

        They undergo 6-9 months of training. Their job is to prepare ECT under the supervision of a psychiatrist or an anesthetist.

    3. Support staff

            They are volunteer housekeepers or clerical staff and participate in the patient’s therapy.

    1. Occupational therapist

    .         Occupational therapists undergo specialized training. Its main role is to use manual and creative techniques to assess the patient’s interpersonal responses. Patients are helped to develop skills in their chosen field and become financially independent. They are helped to work in sheltered workshops.

    1. Recreational Therapist Diversional Play Therapist

    The recreational therapist organizes activities to stimulate the patient’s muscle coordination, interpersonal relationships, and socialization. These approaches depend on need

    1. Creative Art Therapist:-

       He is an art graduate and encourages patients to express their work freely with colors and analyze the use of different colors, drawing of different scenes etc. This therapy helps with the diagnosis and also helps to bring out his repressed emotions.

    7. Diversional Play Therapist:-

        Observes the child/patient during his/her play. The child’s behavior during play, the type of toys and his reaction to the doll, hitting, calling or throwing is the focus of attention.

    1. Priests

          These are religious persons who may be asked to come to the hospital unit once a week (depending on the patient’s religious faith) and will have a spiritual talk with the patient.

    Q.5. Write Meaning (Any Six) 6X2=12

    Here is the translation of the terms:

    a. Obsession:
    Obsession refers to persistent and recurrent thoughts, impulses, or images that cause distressing feelings such as anxiety, fear, or discomfort.

    b. Agnosia:
    Agnosia is a condition where a person fails to recognize or interpret sensory stimuli such as objects, people, or sounds.

    c. Narcolepsy:
    Narcolepsy is a sleep disorder characterized by excessive daytime drowsiness and sudden sleep attacks, which can lead to serious problems in daily routines.

    d. Grief:
    Grief is the emotional response experienced when losing someone close or something highly valuable, leading to a sense of despair. It can be considered a type of depression.

    e. Phobia:
    Phobia is an irrational and excessive fear of a specific object, person, or situation that is generally disproportionate and not easily explained.

    Examples include: fear of cancer, fear of darkness, fear of unknown places, etc.

    f. Dilemma:
    A dilemma involves choosing between two or more alternatives when one is unable to make a decision about any of them.

    Examples include: deciding whether to earn money or not, whether to give something or not, whether to go or not, etc.

    g. Echolalia:
    Echolalia is a condition where a person repeats or mimics the words spoken by others.

    For example, if someone asks, “How are you?” the person with echolalia might respond by repeating, “How are you?” or “You are good?” by mimicking the question asked.

    h. Akinesia-

    Q.6 A. Fill in the blanks. 05

    1. Opium is a …….. drug Narcotic

    2. Fear of marriage is called………… Gamo Phobia

    3. ………… test is done in chronic organic psychosis. ………….M.R.I

    4. Disaster is a part of…………. Humanitarian

    5. ……….. is the most common feature in phobic disorder. ……..Anxiety

    Q.6 B. State whether following statements are True or False . 05

    1. EEG is done to detect electrical activity of the brain. Right

    2. Poverty of idea is a sign of schizophrenia.Right

    3. Psychosis caused due to brain injury is known as functional psychosis. False

    4. Alcohol is a CNS stimulant.False

    5. An amount of electrical current passed during ECT is 10–22 O volts False

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