MENTAL HEALTH NURSING
Date: -31/01/2024

⏩Q.1 🔸a) Explain the Mental Health and Mental Illness

Mental Health:
Mental health refers to a state of well-being in which an individual is aware of their abilities, can cope with the normal stresses of life, works productively and efficiently, and can contribute to their community. It involves maintaining emotional, psychological, and social well-being.

Mental Illness:
Mental illness refers to a range of mental health conditions that affect an individual’s mood, thinking, and behavior. Examples include schizophrenia, depression, and eating disorders. These conditions can disrupt a person’s ability to function effectively in daily life.

🔸b ) List out mental health team members.

Mental Health Team Members and Their Roles

Mental Health Team:
A mental health team is composed of various members who work together to promote mental health and provide care for mental illness. The team typically includes:

1. Psychiatrist:
   A psychiatrist is a medical doctor who has received specialized training in psychiatry. They diagnose mental disorders and provide treatment. Psychiatrists prescribe various types of therapy and attend therapy sessions.
2. General Physician:
   A general physician is typically an MBBS graduate with one year of experience as a house officer in medicine and surgery.
3. Clinical Psychologist:
   A clinical psychologist has a degree in psychology, either at the undergraduate or postgraduate level. They assist in providing hospital and community mental health services, assess patients’ mental health needs, and provide psychological therapy.
4. Mental Health Nurse:
   A mental health nurse has a degree or diploma in psychiatric nursing, usually completed over three or four years. They address patients’ nursing needs and provide holistic nursing care.
5. Psychiatric Social Worker:
   A psychiatric social worker typically holds a diploma in social work, completed over two or three years. They provide social services, counseling, and advice to referred patients.
6. Nurse Assistant:
   A nurse assistant should have completed graduation and have relevant education related to the job.
7. Dietician:
   A dietician holds a bachelor’s or master’s degree in nutrition. They provide nutritional counseling for disorders such as anorexia nervosa and bulimia nervosa.
8. Occupational Therapist:
   An occupational therapist has a degree or postgraduate degree in occupational therapy. They help individuals cope with daily life situations and provide rehabilitation services.
9. Art Therapist:
   An art therapist has a degree and postgraduate training in art therapy. They encourage patients to engage in creative artwork to express their emotional conflicts and feelings.
10. Speech Therapist:
    A speech therapist holds a degree and postgraduate qualification in speech therapy. They provide speech therapy to address speech disorders in children.
11. Psychodrama Therapist:
    A psychodrama therapist has graduated and post-graduated in group therapy. They encourage individuals to express their feelings and emotions through role-playing.
12. Recreational Therapist:
    A recreational therapist has graduated and post-graduated in recreational or activity therapy. They provide recreational therapy to help patients shift their focus away from their thoughts, feelings, and emotions.

🔸c) Describe trends and issues in Psychiatric nursing.

Trends and Issues in Psychiatric Nursing

1. Shift from Institutional to Community-Based Care:
There is a trend toward providing mental health care in community settings such as primary care clinics, schools, and workplaces rather than in institutional settings. This shift aligns with the recognition that individuals with mental health issues can live and thrive in the community with appropriate support.

2. Increased Focus on Early Intervention and Prevention:
Psychiatric nurses play a key role in intervention and prevention programs. This includes working with children and adolescents at risk of developing mental health issues and supporting families and caregivers.

3. Greater Emphasis on Holistic Care:
Psychiatric nurses are adopting a more holistic approach to care that considers physical, social, and spiritual well-being. This approach involves helping patients manage their physical health while also addressing their social and emotional needs.

4. Utilization of Technology:
Psychiatric nurses are increasingly using technology to provide care for individuals with mental health conditions. This includes telehealth and telepsychiatry, which allow nurses to provide care to patients in remote or underserved areas.

5. Collaboration with Other Healthcare Professionals:
Psychiatric nurses are working more closely with other healthcare professionals, such as doctors, social workers, and psychologists. This team-based approach recognizes the importance of a collaborative effort in addressing the complex needs of individuals with mental health issues.

6. Integration of Mental Health and General Health Care:
Mental health care is increasingly being provided as part of community health services, integrating with general health care services.

7. Inadequate Staff Availability:
There is a trend of insufficient staffing in the mental health field, which can affect the quality of care provided.

8. Focus on Holistic Care:
There is an increasing focus on holistic care in mental health, emphasizing the need for qualified mental health care providers who offer comprehensive care.

9. Increased Awareness of Mental Health:
There is growing awareness about mental health among the public, which contributes to the demand for better mental health services.

10. Comprehensive Approach:
A comprehensive approach to mental health care is becoming more common, with an emphasis on integrating various aspects of care.

11. Importance of Nursing in Mental Health Care:
Nurses play a crucial role in primary psychiatric care and in addressing mental health problems, providing both mental and physical support to patients.

12. Research and Training:
Many research studies have been conducted on the treatment of mentally ill patients. Training for nurses is being enhanced to ensure they provide effective care based on the latest research findings.

🔸OR🔸

🔸a) What is Bipolar mood disorder?

Bipolar mood disorder, also known as “manic-depressive disorder,” is characterized by alternating periods of manic episodes and depressive episodes in the patient. There are extreme shifts in mood, energy, and functioning. In brief, bipolar mood disorder involves alternating periods of depression and mania. It is a common, severe, and persistent mental illness.

🔸b) Write down the characteristics of mania.

• Euphoric mood
• Irritability
• Increased activity level
• Talkativeness
• Speaking rapidly and loudly
• Risky behavior
• Decreased need for sleep
• Racing thoughts
• Flight of ideas
• Distractibility
• Inflated self-esteem or grandiosity
• Increased energy level
• Agitation
• Poor decision-making

🔸c) Describe the nursing management of depression.

1. Therapeutic Needs Nursing Management

• Provide the patient with a comfortable environment and encourage relatives to stay with them continuously.
• Administer medications as prescribed by the doctor. Monitor for side effects and maintain records and reports. Generally, antidepressant drugs are administered.
• Conduct a Mental Status Examination (MSE) to assess suicidal thoughts, plans, and their severity. Record all observations.
• Assist with and prepare the patient for Electroconvulsive Therapy (ECT) if needed.

1. Physical Needs Nursing Management a. Safe Environment

• Keep the patient under continuous observation with one nurse dedicated to their care.
• Remove glass articles, cords, pajama strings, net ties, etc., from the room to avoid potential hazards.
• Avoid using long bed sheets as they can be used for hanging.
• Use paper dishes for food to prevent potential harm.
• Ensure electrical connections are secure and not exposed.
• Store medications and instruments in locked areas.
• Monitor to ensure the patient does not take more than one medication at a time.
• Place the room near the nursing station.
• Explain various coping mechanisms for life to the patient.

1. Personal Hygiene

• Encourage the patient to maintain personal hygiene by changing clothes, taking baths, combing hair, etc. Compliment them with positive reinforcement, such as saying, “You look great today.”

1. Nutritional Needs

• Advise the patient to have small, frequent meals.
• Provide a full meal diet including omelets, salads, vegetables, etc.
• Serve food along with others during mealtimes.
• Ask the patient about their food preferences.
• Record input and output.

1. Psycho-Social Needs

• Trusting Relationship: Communicate with the patient, listen calmly, and highlight positive aspects of their personality. Allow visits from relatives to foster a positive attitude.
• Reducing Suicidal Ideation: Encourage the patient to discuss their suicidal thoughts and methods. Understand the lethality of the methods they consider and inform them about the consequences of suicide, including the impact on family members.
• Increasing Self-Esteem: Address the patient by their name, and acknowledge and praise their positive traits and achievements.
• Improving Socialization: Avoid isolating the patient. Gradually encourage them to interact with others and spend time outside the bed. Recreational Needs:
• Identify the patient’s favorite hobbies or games. Provide adequate time for outdoor games while ensuring they can pursue their hobbies. Reward them for wins and accept losses without any disturbance.

⏩Q-2 🔸a) Describe the mental status examination.

Mental Status Examination (MSE) is a standardized and systematic process used for assessing the psychiatric patient’s mental state. It involves examining various aspects such as behavior, concentration, thought processes, attention, and emotional function, which helps in drawing conclusions about the patient’s mental state.

Definition: Mental Status Examination (MSE) involves evaluating an individual’s intellectual, cognitive abilities, mood, and thought processes.

Before MSE, it is essential to assess vital signs:

• Blood pressure
• Heart rate
• Respiratory rate
• Temperature

Topics assessed in MSE:

1.GENERAL APPEARANCE AND BEHAVIOR:

• Appearance: Observing the patient’s general appearance, such as whether they appear elderly, young, etc.
• Consciousness: Determining if the patient is alert, drowsy, in stupor, or comatose.
• Hygiene: Assessing the patient’s personal cleanliness and whether they maintain appropriate hygiene.
• Sleep: Checking if the patient sleeps well and the duration of their sleep.
• Posture: Observing the patient’s posture during the examination, including whether they are open and responsive or slumped.
• Eye Contact: Noting if the patient maintains eye contact, for how long, and if they avert their gaze.
• Gait: Observing how the patient walks, whether confidently or hesitantly.
• Facial Expressions: Noting the patient’s facial expressions and emotional cues.
• Eating Pattern: Checking if the patient eats appropriately and whether they overeat.

2.SPEECH/TALKING PATTERN:

• Assessing the speed and manner of the patient’s speech, whether they speak rapidly or slowly.
• Observing if the patient responds with fear or agitation.
• Noting if the patient speaks loudly or softly.
• Evaluating the accuracy of the patient’s responses.
• Checking for repetitive speech (clang associations) or mumbling.
• Observing if the patient speaks in a roundabout way (circumstantial) or provides tangential responses.

3.MOOD/AFFECT:

• Determining the patient’s mood, whether they are sad, anxious, depressed, angry, euphoric, fearful, restless, or irritable.
• Observing if the mood changes and how frequently.
• Checking if the patient’s responses align with their mood.

4.THOUGHT:

• Assessing if the patient’s thoughts are positive or negative.
• Noting if thoughts are rapid or shifting frequently (flight of ideas).
• Observing for unclear or disorganized thoughts.
• Identifying neologisms (newly coined words without meaning).

5.PERCEPTION:

• Hallucinations: Checking if the patient experiences sensory perceptions without external stimuli (auditory, visual, olfactory, gustatory, or tactile).
• Illusions: Assessing if the patient has false perceptions of external stimuli.
• Deja vu: Determining if the patient feels that they have experienced something before that they have not.
• Jamais vu: Observing if the patient forgets familiar people or places.

6.COGNITIVE FUNCTION:

• Assessing if the patient is conscious or in a state of stupor or coma.
• Evaluating their knowledge of past events and their orientation to time, place, and person.

7.MEMORY:

• Immediate Memory: Asking the patient to repeat recent information.
• Remote Memory: Checking if the patient remembers personal history such as marriage dates or age.
• Recent Memory: Evaluating recall of recent events, such as meals or waking times.

8.INTELLIGENCE:

• Assessing the patient’s ability to read and write, and evaluating their educational background and academic performance.

9.INSIGHT:

• Evaluating the patient’s awareness and understanding of their own condition.
• Assessing the internal reasoning or insight based on the patient’s responses to questions about their condition.

10.JUDGMENT:

• Assessing the patient’s judgment based on their knowledge, educational level, and decision-making abilities.

11.ATTENTION/CONCENTRATION:

• Asking the patient to perform tasks such as serial subtraction (e.g., subtracting 7 from 100 repeatedly) or reverse counting.
• Asking questions about the month, week, and days to evaluate their ability to focus and concentrate.

🔸b) Write down the Nursing management during electro convulsive therapy.

👉Nursing Care Before Giving ECT

Conduct a Physical Examination and Required Investigations:

• Perform a physical examination and arrange necessary investigations such as ECG, Hb, urine albumin/sugar, and X-ray.

Explain the Procedure and Obtain Written Consent:

• Explain the ECT procedure to the patient’s close relatives and obtain written consent. Avoid informing the patient about the ECT procedure until absolutely necessary.

Remove Metallic Articles:

• Remove metallic items such as watches, bangles, rings, and other ornaments.

Maintain NBM (Nil by Mouth):

• Ensure that the patient is NBM (Nil by Mouth) for 6-8 hours before the ECT procedure.

Remove Artificial Dentures:

• Remove artificial dentures to prevent respiratory blockage.

Remove Hair Oil, Lipstick, Makeup, and Nail Polish:

• Remove hair oil, lipstick, makeup, and nail polish to monitor cyanosis status effectively.

Empty Bladder and Bowel:

• Ensure the patient empties their bladder and bowel before the procedure.

Apply Allergy/ID Bands:

• Apply allergy and identification bands to the patient. Ensure the patient’s diet does not include fatty foods, meat, or fried foods.

Maintain Personal Hygiene:

• Instruct the patient to maintain personal hygiene and assess their anxiety level.

Change into Hospital Clothes:

• Have the patient remove tight clothing and change into hospital attire.

Provide Support and Address Fear:

• Offer support to the patient and help alleviate their fear.

Administer Muscle Relaxants:

• Administer muscle relaxants as prescribed to reduce the patient’s anxiety.

👉Nursing Care During ECT

Assist with Transportation:

• Help the patient move from the stretcher or wheelchair to the ECT table.

Position the Patient Comfortably:

• Place the patient in a comfortable dorsal position and use a small pillow under the lumbar region.

Administer Medications:

• Provide short-acting anesthetic drugs or muscle relaxants as prescribed.

Support and Restrain:

• Support the patient’s shoulders and arms, and restrain the thighs to prevent fractures.

Monitor Vital Signs:

• Record the patient’s blood pressure, pulse, and check oxygen levels.

Protect the Mouth:

• Place a mouth gag and tongue depressor between the teeth to prevent tongue biting.

Prepare the Electrode Area:

• Clean the area where electrodes will be placed using alcohol swabs or gel.

Support the Head:

• Ensure the patient’s head is in hyperextension with chin support to prevent jaw fractures.

Assist with Electrode Placement:

• Help place the electrodes and provide support to all major joints.

Monitor Electrical Parameters:

• Monitor voltage, frequency, and duration of the ECT.

Monitor Seizure Activity:

• Use the cuff method to monitor seizure activity.

Administer Oxygen:

• Provide 100% oxygen during the seizure activity.

Transfer to Recovery Room:

• Transfer the patient to the recovery room once they have recovered from anesthesia.

👉Nursing Care After ECT

Positioning:

• Place the patient in a side-lying position to prevent aspiration of secretions.

Monitor Vital Signs:

• Continuously monitor the patient’s vital signs and provide side rails to prevent injury.

Provide Oxygenation:

• Continue to provide oxygen until spontaneous respiration resumes.

Assess for Confusion and Restlessness:

• Evaluate the patient for confusion and restlessness.

Administer Medications:

• Provide medications as prescribed and monitor for side effects.

Documentation:

• Document the procedure and mention any significant events.

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👉Insulin Shock Therapy

• Overview:
• Insulin shock therapy, a form of psychiatric treatment, was a popular method in the 1940s and 1950s. It involved administering high doses of insulin to induce hypoglycemic coma in patients with schizophrenia. This caused convulsions in the body. The method was believed to suppress brain activity and reduce mental conditions. However, due to long-term effects of the treatment, it has been phased out in psychiatric facilities in the US.
• History:
• Introduced in 1933, insulin shock therapy was widely used during the 1940s and 1950s.
• Also Known As:
• It is also referred to as insulin coma therapy and was the first biological treatment for schizophrenia.

🔸OR🔸

🔸a) Define mental retardation and write down the causes of mental retardation.

Mental Retardation

Mental retardation, also referred to as “intellectual disabilities,” is a developmental condition characterized by significantly below-average cognitive and problem-solving skills. This condition is also known as “cognitive developmental delay.”

It involves limitations in intellectual functioning and adaptive behavior, affecting the child’s ability to learn, think, solve problems, reason, and understand concepts compared to their peers.

These limitations can range from mild to profound.

1) Biomedical Factors

A) Prenatal Factors

• Aminoaciduria
• Galactosemia
• Inherited degenerative disorders of the central nervous system
• Chromosomal disorders such as Down syndrome, Turner syndrome
• Developmental defects such as microcephaly, cranial stenosis, cretinism, porencephaly

B) Maternal Factors

• Drug use
• Infections such as rubella, toxoplasmosis, cytomegalovirus infection, herpes, and syphilis
• Placental insufficiency
• Toxemia of pregnancy
• Antepartum hemorrhage
• Exposure to radiation during pregnancy

C) Neonatal Factors

• Birth injury
• Prematurity
• Low birth weight
• Birth trauma
• Birth asphyxia
• Perinatal asphyxia
• Prolonged and difficult birth
• Intracerebral hemorrhage
• Preeclampsia

D) Postnatal Factors

• Infections in the central nervous system such as meningitis, encephalitis
• Head injury
• Cerebrovascular thrombosis
• Kernicterus
• Hypoglycemia
• Hypoxia

👉2) Social Factors

– Low socioeconomic condition
– Psychological factors
– Advanced age of the mother

🔸b) Explain Myths of Mental Retardation

The following are common myths and misconceptions about mental retardation:

– Intellectual Disability is the same as mental illness:
Intellectual disability is a developmental condition characterized by alterations in intellectual functioning. It is not the same as mental illness.

– People with Intellectual Disability cannot learn new skills:
Individuals with intellectual disability can learn many new things and acquire new skills. This often requires different teaching methods and additional effort.

– Intellectual Disability is always severe:
Intellectual disability is not always severe; it can range from mild to profound.

– Intellectual Disability is caused by poor parenting:
Intellectual disability is not caused by poor parenting. It can be attributed to various factors such as genetic factors, environmental influences, complications during pregnancy and birth.

– People with Intellectual Disability are always happy and friendly:
Individuals with intellectual disability experience a full range of emotions and personalities, including sadness, frustration, anger, and joy.

– Intellectual Disability cannot be detected until the child starts school:
Intellectual disability can be detected earlier through developmental screening and assessment during early childhood.

– People with Intellectual Disability cannot hold jobs:
Many individuals with intellectual disability are capable of working and can hold various types of jobs.

– People with Intellectual Disability can be easily identified by looking at them:
Intellectual disability cannot always be identified by appearance. Mild intellectual disability can be difficult to recognize, and identifying individuals with it can be challenging.

⏩Q-3 Write short answer (any two) 6+6 =12

🔸a) Factors Affecting Personality Development

1. Education: Education significantly impacts personality. It is one of the most powerful ways to shape personality development. There is often a noticeable difference in personality between educated and non-educated individuals.
2. Family Environment: A child learns from their parents and follows their examples. Therefore, the family environment affects personality. A positive family environment tends to result in an extroverted personality, while a negative family environment may lead to an introverted personality.
3. School Environment: Since a child spends a considerable amount of time at school, the school environment plays a crucial role in shaping personality.
4. Childhood Memories: Childhood memories are vital for personality development. Positive childhood experiences contribute to a well-developed personality, while negative experiences may have adverse effects.
5. Environmental Factors: The surrounding environment influences personality development. Factors such as living conditions, social surroundings, and community impact how personality develops.
6. Culture: The culture an individual follows is an important factor that affects their personality. Cultural norms and values shape behavior and personality traits.
7. Biological Factors: Biological factors such as gender, hormones, and brain structure can influence personality development.
8. Media and Technology: In the current era, media and technology are highly influential. The way an individual interacts with and uses media and technology can impact their personality.

🔸b) Write down causes of mental disorder-

Causes of Mental Disorders

1. Genetic or Hereditary Factors:
– Individuals with a family history of mental illness are at a higher risk of developing similar disorders. Mental disorders can be transmitted through genes within families. Genetic factors often play a significant role in the development of mental disorders. Experts believe that many mental illnesses are associated with abnormalities in multiple genes rather than a single gene.

2. Hormones or Neurotransmitters:
– Some mental illnesses are linked to imbalances in chemicals in the brain known as neurotransmitters. When these neurotransmitters do not function properly, the brain fails to receive coordinated messages, which can affect mood and behavior. The dysregulation of neurotransmitters can contribute to various mental disorders.

3. Toxin Exposure:
– Exposure to toxins, such as lead poisoning and various gases, can also have an impact on mental health.

4. Infections:
– Certain infections can be associated with mental disorders. For example, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) links bacterial infections with obsessive-compulsive disorder (OCD).

5. Brain Injury:
– Injuries or defects in the brain can lead to mental illnesses. Damage to the brain or structural abnormalities can affect cognitive and emotional functioning.

6. Nutrition:
– Deficiencies in essential nutrients, particularly vitamins and minerals, can contribute to mental disorders. For example, a deficiency in vitamin B12 can affect mental health.

7. Prenatal Factors:
– Conditions and events during pregnancy or delivery can also impact mental health. Factors such as maternal stress, exposure to toxins, or complications during birth may influence the development of mental disorders in the child.

🔸c) Write down difference between psychosis and neurosis

Psychosis:

• Psychosis is a major personality disorder.
• It affects personality in those who experience it.
• Organic causes or genetic factors are responsible for psychosis.
• Patients with psychosis often lack insight.
• True hallucinations are observed.
• Delusions are present.
• Judgment and reasoning are impaired in such individuals.
• Treating patients with psychosis can be difficult.
• Examples include schizophrenia.

Neurosis:

• Individuals with neurosis do not have affected personalities.
• Organic causes or genetic factors are not responsible for neurosis.
• Patients with neurosis have insight into their condition.
• True hallucinations are absent.
• Delusions are absent.
• Judgment and reasoning abilities are intact in neurosis.
• Treating patients with neurosis is relatively easier.
• Examples include Post-Traumatic Stress Disorder (PTSD).

🔸d) Write down Principles of Psychiatric Nursing:

Patient is Accepted Exactly as He Is:

• Acceptance means being free from any biases or judgments. It involves expressing feelings of love and care. Acceptance does not imply complete approval, but it sets a positive approach to respect the individual as a human being.

Being Non-judgmental and Non-punitive:

• The patient’s behavior is not judged as right or wrong, good or bad. There should be no punishment for undesirable behavior. This includes avoiding direct punishments like restraint or isolation, and not neglecting or ignoring the patient. A nurse showing acceptance will not reject the patient even if their behavior is contrary to expectations.

Being Sincerely Interested in the Patient:

• Genuine interest means considering the other person’s well-being. This involves studying the patient’s behavior patterns, allowing them to make their own choices and decisions where possible, being aware of their likes and dislikes, being authentic, listening carefully, and avoiding sensitive or controversial topics.

Recognizing and Reflecting on Feelings Which Patient May Express:

• It is crucial to note not just what the patient is saying, but also the emotions behind their words and reflect these feelings back to the patient.

Talking with Purpose:

• Conversations with the patient should revolve around their needs, desires, and interests. When problems are not clear, approaches like reflection, open-ended questions, and focusing on the issues are more effective.

Listening:

• Listening is an active process requiring time and energy. The nurse should listen with empathy and show genuine interest in what the patient is saying.

Permitting Patient to Express Strongly Held Feelings:

• Allowing the patient to express intense emotions without judgment or punishment is important. Strong emotions can be explosive, and providing a safe space for expression is beneficial.

Use Self-understanding as Therapeutic Tools:

• The psychiatric nurse should have a genuine understanding of self and be capable of recognizing and managing their own emotions and responses.

Consistency is Used to Contribute to Patient’s Security:

• This means that staff should follow consistent routines and safety measures during ward operations to ensure patient security.

Reassurance Should Be Given in a Subtle and Acceptable Manner:

• Reassurance helps build the patient’s confidence. The nurse needs to understand and analyze the patient’s situation to provide appropriate reassurance.

Patient’s Behavior is Changed through Emotional Experience and not by Rational Interpretation:

• Advising or rationalizing alone is not effective in changing behavior. Behavioral changes are often achieved through methods like role-play and social drama.

Unnecessary Increase in Patient’s Anxiety Should Be Avoided:

• To prevent unnecessary anxiety, the nurse should avoid displaying their own concerns, focusing on patient’s flaws, exposing patients to repeated failures, and making demands that the patient cannot reasonably meet.

Objective Observation of Patient to Understand His Behavior:

• Observations should be objective to assess what the patient wants or needs without mixing personal feelings or judgments.

Maintain Realistic Nurse-Patient Relationship:

• The relationship should focus on the patient’s personal and emotional needs rather than the needs of the nurse or the professional relationship itself.

Avoid Physical and Verbal Force as Much as Possible:

• Physical or verbal punishment should be avoided as it can exacerbate psychological trauma. The nurse should study the patient’s behavior to prevent uncertain behavior and avoid showing discomfort. If restraint is necessary, the reasons should be explained, and positive behavioral changes should be encouraged.

Nursing Care is Centered on the Patient as a Person and not on the Control of Symptoms:

• Nursing care should focus on the individual as a person rather than merely addressing symptoms. Understanding the underlying causes of behaviors is crucial.

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

• Explanations should be tailored to the patient’s level of understanding to reduce anxiety and ensure that all individuals, regardless of mental state, are informed about procedures and routines.

Many Procedures are Modified but Basic Principles Remain Unaltered:

• While procedures may be adjusted based on patient needs, the basic principles of care, including safety, security, therapeutic relationships, and procedural standards, remain constant.

⏩Q-4 Write short notes. 12

🔸a) Positive and Negative Symptoms of Schizophrenia

Positive Symptoms:
Positive symptoms are those that represent an excess or distortion of normal functioning. They include:

• Delusions: False beliefs that are strongly held despite evidence to the contrary, such as believing that one is being persecuted, or that others are plotting against them.
• Hallucinations: False perceptions, such as hearing voices or seeing things that are not present.
• Aggression: Lack of control over emotions, leading to aggressive or violent behavior.
• Agitation: Nervousness or restlessness, often manifesting as fidgeting or pacing.
• Suspiciousness: A tendency to be overly suspicious or paranoid.
• Hostility: Hostile or antagonistic behavior towards others.
• Excitement: Excessive and inappropriate enthusiasm or excitement.
• Grandiosity: An exaggerated sense of one’s own importance or abilities, such as believing oneself to be a significant figure like a prime minister.
• Conceptual Disorganization: Difficulty organizing thoughts and ideas coherently.

Negative Symptoms:
Negative symptoms involve a reduction or loss of normal functions and abilities. They include:

• Affective Flattening: Reduced emotional expression or range of emotions.
• Alogia: Reduced speech output, reflecting reduced thought productivity.
• Anhedonia: Loss of interest or pleasure in activities that were previously enjoyable.
• Avolition: Decrease in motivation to initiate and sustain purposeful activities.
• Social Withdrawal: Isolation from family, friends, and social activities.
• Neglect of Personal Hygiene: Failure to maintain personal grooming and hygiene.

🔸b) Alcoholism

Alcoholism is a type of addiction characterized by a physical and psychological dependence on alcohol, leading to compulsive drinking. It is also known as Alcohol Use Disorder (AUD).

👉Symptoms of Alcoholism:

1. Lack of Control: Inability to control the amount or frequency of alcohol consumption.
2. Compulsive Desire: A strong and persistent urge to drink alcohol, often leading to drinking more than intended.
3. Continued Use Despite Negative Effects: Persisting in alcohol consumption despite experiencing physical, mental, or social harm.
4. Time Spent on Alcohol: Excessive time spent obtaining, consuming, or recovering from the effects of alcohol.
5. Destructive Impact: Negative impact on social, professional, and personal aspects of life due to alcohol use.

👉Health Effects of Alcoholism:

1. Memory and Brain Function: Impaired brain function, leading to decreased memory, cognitive abilities, and understanding.
2. Liver Diseases: Liver damage, such as fatty liver, alcoholic hepatitis, and liver cirrhosis.
3. Cardiovascular Diseases: Increased risk of heart diseases, including hypertension, heart failure, and stroke.
4. Digestive System Effects: Adverse effects on the stomach and intestines, leading to gastritis, pancreatitis, and ulcers.
5. Mental Health Effects: Increased risk of depression, anxiety, and other mental health disorders.
6. Kidney Diseases: Increased risk of kidney failure and other kidney-related issues.
7. Immune System Impact: Reduced immune system effectiveness, increasing susceptibility to other illnesses.

👉Treatment of Alcoholism:

1. Detoxification: Ceasing alcohol intake and detoxifying the body.
2. Therapy and Counseling: Behavioral therapy, group therapy, and mental health counseling.
3. Medical Intervention: Use of medications like Naltrexone, Acamprosate, and Disulfiram to reduce alcohol cravings.
4. Support Groups: Joining support groups such as Alcoholics Anonymous for motivation and support.

👉Conclusion: Alcoholism is a serious health issue with significant physical and mental health impacts. Early recognition and treatment are essential for recovery and managing alcohol addiction.

🔸c) Side Effects of Anti-Psychotic Drugs

Anti-psychotic drugs can have several side effects, including:

• Extra Pyramidal Symptoms: Motor control disturbances, including:
• Acute Dystonia: Muscle spasms in the neck, eyes, tongue, and jaw.
• Akathisia: Restlessness and inability to stay still.
• Pseudo Parkinsonism: Symptoms resembling Parkinson’s disease, such as muscle rigidity and tremors.
• Tardive Dyskinesia: Irregular, involuntary movements, often involving the face.
• Neuroleptic Malignant Syndrome: A severe, life-threatening condition characterized by fever, muscle rigidity, autonomic dysfunction, and altered mental status.
• Hypotension: Low blood pressure.
• Tachycardia: Rapid heart rate.
• Lethargy: Extreme fatigue or lack of energy.
• Drowsiness: Excessive sleepiness.
• Seizures: Convulsions or uncontrolled electrical disturbances in the brain.
• Nightmares: Disturbing dreams or night terrors.
• Constipation: Difficulty in bowel movements.
• Hyperprolactinemia: Elevated levels of prolactin hormone leading to various symptoms.
• Blurred Vision: Difficulty seeing clearly.
• Weight Gain: Increased body weight.
• Sexual Dysfunction: Problems with sexual performance or desire.

🔸d) Classification of Sexual Disorders

Sexual disorders and deviations include conditions that deviate from culturally accepted norms or cause problems for individuals. The classification includes:

Paraphilias:

• Definition: Abnormal sexual interests or behaviors.
• Examples: Pedophilia, exhibitionism, voyeurism, fetishism, sadism, masochism.

Sexual Dysfunction:

• Definition: Problems or disorders that interfere with the normal sexual response cycle.
• Examples: Erectile dysfunction, premature ejaculation, female sexual arousal disorder, vaginismus.

Gender Dysphoria:

• Definition: Distress experienced due to a discrepancy between one’s experienced gender and the gender assigned at birth.
• Examples: Transsexualism, gender identity disorder.

Hypersexuality (Compulsive Sexual Behavior Disorder):

• Definition: Excessive and uncontrollable preoccupation with sexual thoughts, fantasies, or behaviors.
• Examples: Compulsive masturbation, excessive pornography use, frequent anonymous sexual encounters.

Paraphilic Disorders:

• Definition: Paraphilias that cause significant distress or impairment or pose a risk to others.
• Examples: Pedophilic disorder, exhibitionistic disorder, voyeuristic disorder.

Sexual Pain Disorders:

• Definition: Conditions causing physical pain during sexual activity.
• Examples: Dyspareunia (pain during intercourse), vaginismus (involuntary muscle spasms that interfere with penetration).

Hypoactive Sexual Desire Disorder (HSDD):

• Definition: Persistent or recurrent lack of sexual interest or desire.
• Examples: Lack of interest in sexual activity, absence of sexual desire in relationships.

Sexual Aversion Disorder:

• Definition: Avoidance of sexual contact due to fear, anxiety, or aversion.
• Examples: Extreme discomfort during sexual activity, avoiding sexual contact.

Note: The classification and understanding of sexual disorders can vary across cultures and may evolve over time. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is commonly used for classification, though it may be updated. Treatment often involves psychotherapy, behavioral interventions, and sometimes pharmacotherapy. Seeking help from qualified healthcare professionals who approach these issues with sensitivity and respect is crucial.

🔸e) Occupational Therapy

Occupational Therapy aims to enable people to participate in their daily activities and roles by helping them regain independence and functional abilities.

Occupational Therapy Techniques in Mental Rehabilitation:

• Housing Placement: Including supported housing options like halfway homes or supervised residences.
• Vocational Training: Providing job skills training, sheltered workshops, and vocational guidance.

Goals of Occupational Therapy in Mental Health:

• Assist Individuals: To manage daily challenges imposed by mental and emotional disorders.
• Identify Problem Areas: Occupational therapists identify specific areas of difficulty and plan activities accordingly.

Problem Areas in Mental Health Patients:

• Motor Skills: Psychomotor activities.
• Sensory Processing: Perception and delusions.
• Cognitive Skills: Decision-making and problem-solving.
• Interpersonal Skills: Self-concept, emotional regulation.
• Interpersonal Skills: Socialization and communication.
• Self-Care: Basic and instrumental activities of daily living.
• Productivity: Employment and work.
• Leisure: Interests and enjoyable activities.

Occupational Therapy Approaches:

• Task Breakdown: Learning new ways to approach tasks by breaking them down into manageable steps.
• Adaptive Activities: Teaching adaptive techniques to perform daily activities more effectively.

Role of Nurse:

• Work with Families and Communities: To promote good health and well-being.
• Conduct Occupational Assessments: Evaluate the client’s occupational needs and abilities.
• Encourage Involvement: Motivate clients to participate in occupational therapy.
• Assist Therapists: Support therapists in delivering therapeutic interventions.

⏩Q-5 Define following (any six) 12

🔸a) Memory

Memory refers to the ability to store and retain information over time and recall it when needed. It is the power to store experiences and bring them back into a conscious state when required after some time. Memory is a neurochemical process in which information is stored by the brain and can be retrieved when necessary.

🔸b) Autism

Autism is a neurodevelopmental disorder characterized by impaired communication. Individuals with autism often do not engage in verbal communication and become isolated from the external world, living in their own world.

🔸c) Delusion

Delusion refers to a false belief about external reality. In delusion, the individual holds a mistaken belief that evidence is being gathered against them and that a conspiracy is being orchestrated against them, which is outside of their educational and cultural background. Delusions are commonly seen in patients with schizophrenia, bipolar disorder, and severe depression.

🔸d) Ego

The ego is a component of personality that is responsible for decision-making and maintaining a balance between the id and the superego. The ego is a partially conscious part of the mind that develops around the age of three. It operates on the principle of reality.

🔸e) Defense Mechanism

A defense mechanism is a psychological strategy used by the mind to cope with reality and maintain self-image. It is a response or reaction to impacts affecting the individual. Defense mechanisms are psychological strategies used to handle reality and protect self-esteem. They are implemented through various means, and healthy individuals generally use defense mechanisms throughout their lives.

🔸f) Mania

Mania is a mood disorder characterized by elevated mood, increased psychomotor activity, and flight of ideas. A manic episode is a distinct period during which there is abnormally and persistently elevated, expansive, or irritable mood lasting at least one week.

🔸g) Phobia

A phobia is an excessive, irrational, and often incomprehensible fear of a specific object, person, or situation. It is a type of anxiety disorder that is not typically seen in individuals of the same age group. An example is the fear of heights (acrophobia).

🔸h) Projection

Projection is a commonly used defense mechanism in which unacceptable thoughts, feelings, and impulses are transferred onto others. In projection, individuals attribute their own faults to others. For example, a student who fails an exam may blame their failure on external factors or others rather than acknowledging their own shortcomings.

⏩Q-6(A) Fill in the blanks 05

1.Pathological impairment of memory is known as ——- Amnesia

2.In ECT ——voltage current is passed.70-120 voltage

3. Absence of pleasure feeling in any activity is called ——– Anhedonia

4,Lack of awareness of correct time, place and person is called——- Disorientation

5.——–is a choice of drug for patient with mania. Lithium

⏩(B) True or False 05

1.Indian lunacy act was passed in 1812. False

2.All mentally ill persons are dangerous.False

3.Person with unsound mind cannot give vote.True

4.Euphoria is seen in depression False

5.Elevation of mood is a primary symptom of mania. True

⏩(C) Match the following – 05

1.Agorophobia- 1.Anti-depressant drugs-

2.Haloperidol- 2. Anti-convulsant drugs –

3.Imipramine- 3.Fear of open place-

4.Gustatory Hallucination 4. Fear of High place-

5.Chorea 5.Anti-psychotic drugs-

6.Perception of tasting something that is not really there –

7.Unvoluntary muscular movement –

ANSWER :-

1) Agrophobia – 3.fear of open place
2) Haloperidol – 5. anti psychotic drug
3) Imipramine – 1.anti depressant drug
4) Gustatory hallucination – 6.perception of tasting something
5) chrorea – 7.involuntary muscular movement

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