Neurotic Disorders in Mental Health Nursing –

Neurotic disorders are mental disorders without psychosis, where a person remains in touch with reality but experiences distress and impaired functioning. These disorders are mainly characterized by excessive anxiety, fear, or distressing thoughts.

1️⃣ Definition of Neurotic Disorders

✅ Neurosis is a group of functional mental disorders where the individual has distress but retains insight into their condition.
✅ It does not involve hallucinations, delusions, or gross personality disorganization.
✅ Also known as “Non-Psychotic Disorders” or “Anxiety Spectrum Disorders.”

2️⃣ Classification of Neurotic Disorders (ICD-11 & DSM-5)

According to ICD-11 & DSM-5, neurotic disorders fall under the category of Anxiety and Stress-Related Disorders:

🔹 Major Types of Neurotic Disorders:

1️⃣ Generalized Anxiety Disorder (GAD)
2️⃣ Phobic Disorders (Specific Phobia, Social Phobia, Agoraphobia)
3️⃣ Panic Disorder
4️⃣ Obsessive-Compulsive Disorder (OCD)
5️⃣ Post-Traumatic Stress Disorder (PTSD)
6️⃣ Somatic Symptom Disorder (Hypochondriasis, Conversion Disorder)
7️⃣ Dissociative Disorders
8️⃣ Adjustment Disorder

3️⃣ Detailed Explanation of Each Neurotic Disorder

1️⃣ Generalized Anxiety Disorder (GAD)

✅ Persistent and excessive worry about daily life events.
✅ Symptoms: Restlessness, fatigue, muscle tension, sleep disturbances.
✅ Treatment: CBT, SSRIs, Benzodiazepines, Relaxation therapy.

2️⃣ Phobic Disorders

✅ Specific Phobia: Intense irrational fear of an object or situation (e.g., heights, snakes).
✅ Social Phobia: Fear of social interactions or public speaking.
✅ Agoraphobia: Fear of open or crowded places.
✅ Treatment: Exposure therapy, systematic desensitization, beta-blockers.

3️⃣ Panic Disorder

✅ Sudden episodes of intense fear (“panic attacks”).
✅ Symptoms: Rapid heartbeat, shortness of breath, dizziness.
✅ Treatment: CBT, SSRIs, benzodiazepines.

4️⃣ Obsessive-Compulsive Disorder (OCD)

✅ Obsessions: Repeated intrusive thoughts (e.g., fear of contamination).
✅ Compulsions: Repetitive behaviors (e.g., excessive handwashing).
✅ Treatment: CBT (Exposure and Response Prevention), SSRIs (Fluoxetine, Fluvoxamine).

5️⃣ Post-Traumatic Stress Disorder (PTSD)

✅ Occurs after experiencing trauma (e.g., war, accident, assault).
✅ Symptoms: Flashbacks, nightmares, emotional numbness, hypervigilance.
✅ Treatment: Trauma-focused CBT, EMDR, SSRIs, Prazosin (for nightmares).

6️⃣ Somatic Symptom & Related Disorders

✅ Conversion Disorder (Functional Neurological Disorder)

• Neurological symptoms (paralysis, blindness) without medical cause.
  ✅ Illness Anxiety Disorder (Hypochondriasis)
• Excessive worry about having a serious illness despite normal medical tests.
  ✅ Treatment: Psychotherapy, reassurance, behavioral therapy.

7️⃣ Dissociative Disorders

✅ Dissociative Amnesia: Sudden memory loss without brain injury.
✅ Dissociative Identity Disorder (DID): Presence of two or more distinct personalities.
✅ Depersonalization/Derealization Disorder: Feeling detached from oneself or surroundings.
✅ Treatment: CBT, grounding techniques, hypnosis, trauma therapy.

8️⃣ Adjustment Disorder

✅ Emotional distress following a major life change (e.g., divorce, job loss).
✅ Symptoms: Anxiety, depression, social withdrawal.
✅ Treatment: Supportive therapy, stress management, counseling.

4️⃣ Nursing Management of Neurotic Disorders

✅ Assessment:

• History of stressors, anxiety levels, coping mechanisms.
• Use of Hamilton Anxiety Rating Scale (HAM-A) for GAD.
• Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for OCD.

✅ Nursing Interventions:

• Establish therapeutic communication.
• Encourage relaxation techniques (deep breathing, meditation).
• Educate on coping skills and stress management.
• Support medication adherence (SSRIs, benzodiazepines).
• Provide psychoeducation for patients and families.

📝 Frequently Asked Questions in Competitive Exams:

✔ Most Common Neurotic Disorder? – Generalized Anxiety Disorder (GAD)
✔ Best Treatment for OCD? – CBT + SSRIs (Fluoxetine, Fluvoxamine)
✔ Which Disorder Involves Flashbacks? – PTSD
✔ Phobia Treatment? – Exposure Therapy (Systematic Desensitization)
✔ Which Disorder Shows Physical Symptoms Without Medical Cause? – Conversion Disorder.

Eating Disorders –

Eating disorders are serious mental health conditions that involve disturbed eating behaviors, distorted body image, and extreme weight concerns. They affect physical health, psychological well-being, and social functioning.

1️⃣ Classification of Eating Disorders (DSM-5 & ICD-11)

Eating disorders are classified under Feeding and Eating Disorders in DSM-5 and ICD-11.

🔹 Major Types of Eating Disorders:

1️⃣ Anorexia Nervosa (AN)
2️⃣ Bulimia Nervosa (BN)
3️⃣ Binge-Eating Disorder (BED)
4️⃣ Avoidant/Restrictive Food Intake Disorder (ARFID)
5️⃣ Pica
6️⃣ Rumination Disorder
7️⃣ Other Specified Feeding and Eating Disorders (OSFED)

2️⃣ Detailed Explanation of Each Eating Disorder

1️⃣ Anorexia Nervosa (AN)

✅ Definition:

• Characterized by extreme food restriction, fear of weight gain, and distorted body image.
  ✅ Two Subtypes:
• Restricting Type – Severe calorie restriction, excessive exercise.
• Binge/Purge Type – Self-induced vomiting, laxative abuse.
  ✅ Signs & Symptoms:
• BMI < 17.5 kg/m² (or significantly low body weight)
• Amenorrhea (absence of menstruation)
• Lanugo (fine body hair growth due to malnutrition)
• Bradycardia, hypotension, osteoporosis
  ✅ Treatment:
• Nutritional rehabilitation, Cognitive Behavioral Therapy (CBT), SSRIs (Fluoxetine).

2️⃣ Bulimia Nervosa (BN)

✅ Definition:

• Repeated episodes of binge eating followed by compensatory behaviors (vomiting, fasting, excessive exercise).
  ✅ Key Features:
• Binge eating (eating large amounts of food in a short period).
• Purging behaviors (self-induced vomiting, laxatives, diuretics).
• Fear of gaining weight despite normal or overweight BMI.
  ✅ Physical Complications:
• Russell’s Sign (Calluses on knuckles due to induced vomiting).
• Dental erosion (acid from vomiting damages teeth).
• Electrolyte imbalance (hypokalemia → cardiac arrhythmias).
  ✅ Treatment:
• CBT, Fluoxetine (FDA-approved for bulimia), Nutritional counseling.

3️⃣ Binge-Eating Disorder (BED)

✅ Definition:

• Recurrent episodes of excessive eating without purging.
  ✅ Key Features:
• Eating large amounts of food in a short time.
• Feeling a lack of control over eating.
• Eating rapidly, even when not hungry.
• Leads to obesity, diabetes, hypertension.
  ✅ Treatment:
• CBT, Lisdexamfetamine (FDA-approved drug for BED), SSRIs.

4️⃣ Avoidant/Restrictive Food Intake Disorder (ARFID)

✅ Definition:

• Severe restriction in food intake due to sensory sensitivity, fear of choking, or low appetite (without body image concerns).
  ✅ Key Features:
• Common in children and individuals with autism.
• Leads to malnutrition, weight loss, failure to thrive.
  ✅ Treatment:
• Behavioral therapy, Exposure therapy.

5️⃣ Pica

✅ Definition:

• Persistent eating of non-nutritive, non-food substances for at least 1 month.
  ✅ Common Items Eaten:
• Soil, chalk, ice (pagophagia), paper, soap, hair.
  ✅ Associated With:
• Iron deficiency anemia, pregnancy, autism spectrum disorder.
  ✅ Treatment:
• Iron supplementation, Behavioral therapy.

6️⃣ Rumination Disorder

✅ Definition:

• Repeated regurgitation and re-chewing of food after eating, without nausea.
  ✅ Common In:
• Infants, people with intellectual disabilities.
  ✅ Treatment:
• Behavioral modification, Parent education.

3️⃣ Nursing Management of Eating Disorders

✅ Assessment:

📌 Body weight, BMI, nutritional intake.
📌 Psychosocial factors – anxiety, depression, self-esteem.
📌 Lab investigations:

• Electrolytes (hypokalemia in bulimia).
• ECG (risk of arrhythmias in anorexia).

✅ Nursing Interventions:

📌 Develop a trusting therapeutic relationship.
📌 Encourage supervised, structured eating.
📌 Monitor vital signs and lab values for malnutrition risks.
📌 Educate on healthy eating habits and body positivity.
📌 Encourage therapy (CBT, DBT, group therapy).
📌 Prevent purging behaviors (restrict bathroom use after meals).

4️⃣ Key Differences Between Anorexia, Bulimia, and Binge-Eating Disorder

Feature	Anorexia Nervosa (AN)	Bulimia Nervosa (BN)	Binge-Eating Disorder (BED)
Weight	Underweight	Normal or overweight	Overweight/Obese
Behavior	Restriction of food	Binge + Purge	Binge (No Purge)
Compensatory Action	Fasting, Excessive Exercise	Vomiting, Laxatives	None
Common Complications	Amenorrhea, Osteoporosis	Dental erosion, Electrolyte imbalance	Obesity, Diabetes

5️⃣ Frequently Asked Questions in Competitive Exams:

✔ Most Common Eating Disorder? – Binge-Eating Disorder (BED)
✔ Classic Sign of Bulimia? – Russell’s Sign (calluses on knuckles)
✔ Electrolyte Imbalance in Bulimia? – Hypokalemia (low potassium → cardiac arrhythmia)
✔ Drug Approved for Bulimia & BED? – Fluoxetine (for Bulimia), Lisdexamfetamine (for BED)
✔ Complication of Anorexia? – Lanugo, Amenorrhea, Osteoporosis

Sexual Disorders

Sexual disorders are conditions that affect a person’s sexual desire, arousal, behavior, or function. These disorders can cause distress, impaired relationships, and psychological disturbances.

1️⃣ Classification of Sexual Disorders (DSM-5 & ICD-11)

Sexual disorders are classified under “Sexual Dysfunctions and Paraphilic Disorders” in DSM-5 and ICD-11.

🔹 Major Categories of Sexual Disorders:

1️⃣ Sexual Dysfunctions
2️⃣ Paraphilic Disorders
3️⃣ Gender Dysphoria

2️⃣ Sexual Dysfunctions

✅ Definition: Disorders affecting sexual response cycle (desire, arousal, orgasm).
✅ Types of Sexual Dysfunctions:

Disorder	Men	Women	Key Features
Hypoactive Sexual Desire Disorder	✔	✔	Lack of sexual interest or desire.
Sexual Aversion Disorder	✔	✔	Extreme fear or disgust toward sexual activity.
Erectile Dysfunction (ED)	✔	❌	Inability to achieve or maintain an erection.
Female Sexual Arousal Disorder	❌	✔	Difficulty achieving or maintaining arousal.
Premature Ejaculation (PE)	✔	❌	Ejaculation within 1 minute of penetration.
Delayed Ejaculation	✔	❌	Delay or absence of ejaculation despite adequate stimulation.
Female Orgasmic Disorder	❌	✔	Inability to achieve orgasm despite adequate stimulation.
Dyspareunia (Painful Intercourse)	✔	✔	Pain during sexual intercourse.
Vaginismus	❌	✔	Involuntary vaginal muscle spasms preventing penetration.

✅ Treatment of Sexual Dysfunctions
📌 Psychotherapy (CBT, Sex Therapy)
📌 Medications: Sildenafil (Viagra) for ED, SSRIs for premature ejaculation.
📌 Hormone Therapy: Testosterone for low libido.
📌 Pelvic Floor Exercises (Kegel’s Exercises) for vaginismus.

3️⃣ Paraphilic Disorders

✅ Definition: Recurrent sexual urges, fantasies, or behaviors involving non-consensual, inappropriate, or harmful stimuli.
✅ Types of Paraphilic Disorders:

Disorder	Definition
Voyeuristic Disorder	Sexual arousal from watching unsuspecting people (Peeping Tom behavior).
Exhibitionistic Disorder	Sexual arousal from exposing genitals to non-consenting strangers.
Frotteuristic Disorder	Sexual arousal from touching or rubbing against non-consenting persons.
Pedophilic Disorder	Sexual attraction to prepubescent children.
Sexual Masochism Disorder	Sexual arousal from being humiliated, beaten, or bound.
Sexual Sadism Disorder	Sexual arousal from inflicting pain or suffering on others.
Fetishistic Disorder	Sexual fixation on non-living objects or body parts (e.g., feet, leather).
Transvestic Disorder	Sexual arousal from dressing as the opposite gender.

✅ Treatment of Paraphilic Disorders
📌 Cognitive-Behavioral Therapy (CBT) – Identifying and modifying deviant thoughts.
📌 SSRIs (Selective Serotonin Reuptake Inhibitors) – Reduce compulsive sexual urges.
📌 Anti-Androgen Therapy – Reduces testosterone levels in severe cases.

4️⃣ Gender Dysphoria (GD)

✅ Definition: Distress due to mismatch between an individual’s assigned sex and their experienced gender identity.
✅ Key Features:
📌 Persistent desire to transition to another gender.
📌 Discomfort with one’s biological sex.
📌 Social distress, depression, and anxiety related to gender identity.

✅ Management of Gender Dysphoria
📌 Psychotherapy and Gender-Affirming Counseling.
📌 Hormone Therapy (Testosterone for Trans-men, Estrogen for Trans-women).
📌 Sex Reassignment Surgery (Gender Confirmation Surgery).

5️⃣ Nursing Management of Sexual Disorders

✅ Assessment:
📌 Sexual history and psychosocial assessment.
📌 Identify medical or psychological causes.
📌 Use standardized scales (e.g., International Index of Erectile Function – IIEF).

✅ Interventions:
📌 Provide a non-judgmental, confidential environment.
📌 Educate about normal and abnormal sexual behaviors.
📌 Encourage healthy coping mechanisms.
📌 Refer to specialists for therapy and medical management.

6️⃣ Frequently Asked Questions in Competitive Exams

✔ Most common male sexual dysfunction? – Erectile Dysfunction (ED).
✔ Most common female sexual dysfunction? – Female Sexual Arousal Disorder.
✔ Which paraphilic disorder involves watching unsuspecting people? – Voyeurism.
✔ Which disorder involves rubbing against strangers? – Frotteuristic Disorder.
✔ Treatment for premature ejaculation? – SSRIs (e.g., Fluoxetine, Paroxetine).
✔ Hormone used for gender transition in transgender individuals? – Testosterone (for Trans-men), Estrogen (for Trans-women).

Psychiatric Emergency

1️⃣ Definition of Psychiatric Emergency

✅ Psychiatric Emergency refers to a severe disturbance in mood, thought, or behavior that requires immediate medical and psychiatric intervention to prevent harm to self or others.

✅ Common Features of Psychiatric Emergencies:
📌 Sudden onset of symptoms
📌 High risk of violence or suicide
📌 Severe disorientation or confusion
📌 Potential for self-harm or aggression towards others

2️⃣ Classification of Psychiatric Emergencies

Psychiatric emergencies can be classified into the following major categories:

🔹 A. Suicide and Self-Harm

✅ Suicidal Attempt or Suicidal Ideation

• Patient expresses a desire to end life or has already attempted suicide.
• High-Risk Factors: Depression, substance abuse, previous suicide attempts, hopelessness.
• Immediate Management:
  • Ensure patient safety (remove harmful objects, constant supervision).
  • Administer antidepressants/antipsychotics if indicated.
  • Crisis intervention therapy.

✅ Self-Harm (Non-Suicidal Self-Injury – NSSI)

• Deliberate injury to oneself without suicidal intent (e.g., cutting, burning).
• Management:
  • Psychological evaluation, coping strategies, and therapy (DBT, CBT).

🔹 B. Violent and Aggressive Behavior

✅ Acute Psychosis

• Severe thought disturbances, hallucinations, delusions, disorganized behavior.
• Common in schizophrenia, drug-induced psychosis, severe mood disorders.
• Management:
  • Ensure safety, avoid confrontation.
  • Administer antipsychotics (Haloperidol, Olanzapine, Risperidone).
  • Use de-escalation techniques.

✅ Manic Excitement

• Severe hyperactivity, irritability, grandiosity, aggression.
• Seen in Bipolar Disorder (Manic Phase).
• Management:
  • Sedation with mood stabilizers (Lithium, Valproate) or benzodiazepines (Lorazepam).
  • Calm, structured environment.

✅ Catatonia (Excited or Stuporous Type)

• Severe psychomotor disturbance (excessive movement or immobility).
• Seen in schizophrenia, mood disorders.
• Management:
  • IV Lorazepam (for benzodiazepine-responsive catatonia).
  • Electroconvulsive Therapy (ECT) for severe cases.

🔹 C. Substance-Related Psychiatric Emergencies

✅ Alcohol Withdrawal Delirium (Delirium Tremens – DTs)

• Occurs 2-3 days after stopping alcohol in chronic alcoholics.
• Symptoms: Tremors, confusion, hallucinations, autonomic instability.
• Management:
  • IV Benzodiazepines (Diazepam, Lorazepam).
  • IV fluids, thiamine (to prevent Wernicke’s encephalopathy).

✅ Drug-Induced Psychosis

• Caused by intoxication or withdrawal from substances (LSD, cocaine, amphetamines).
• Symptoms: Hallucinations, paranoia, aggression.
• Management:
  • Supportive care, antipsychotics (Haloperidol).
  • Benzodiazepines for agitation.

🔹 D. Medical Emergencies in Psychiatry

✅ Neuroleptic Malignant Syndrome (NMS) – Life-Threatening Reaction to Antipsychotics

• Symptoms:
  • Hyperthermia (fever > 38°C).
  • Rigidity (Lead pipe rigidity).
  • Autonomic instability (hypertension, tachycardia).
• Management:
  • Stop the offending drug immediately.
  • Administer Dantrolene (muscle relaxant), Bromocriptine (dopamine agonist).

✅ Serotonin Syndrome – Excessive Serotonin Activity

• Occurs due to overdose or interaction of SSRIs, MAOIs, or TCAs.
• Symptoms:
  • Hyperthermia, tremors, sweating, confusion.
  • Neuromuscular hyperactivity (clonus, hyperreflexia).
• Management:
  • Stop the offending drug.
  • Benzodiazepines for agitation.
  • Cyproheptadine (Serotonin antagonist).

3️⃣ Nursing Management of Psychiatric Emergencies

✅ Assessment:
📌 Take detailed history (psychiatric, medical, substance use).
📌 Assess risk of suicide, violence, or self-harm.
📌 Monitor vital signs (especially in substance-related emergencies).

✅ Immediate Interventions:
📌 Ensure patient and staff safety (use restraints only if necessary).
📌 Administer medications (as per protocol).
📌 Provide a calm, structured environment.
📌 Arrange psychiatric consultation for further treatment.

✅ Long-Term Management:
📌 Psychoeducation for patient and family.
📌 Referral to rehabilitation centers (for substance use disorders).
📌 Follow-up mental health support.

4️⃣ Frequently Asked Questions in Competitive Exams

✔ Most common psychiatric emergency? – Suicidal attempt.
✔ Best drug for acute agitation? – Haloperidol or Lorazepam.
✔ Classic sign of Delirium Tremens? – Visual hallucinations, tremors, autonomic instability.
✔ First-line treatment for Neuroleptic Malignant Syndrome (NMS)? – Stop the drug, give Dantrolene.
✔ Best treatment for acute mania? – Lithium or Valproate.

Psychoactive Substance Disorders –

Psychoactive substance disorders involve excessive or compulsive use of substances that alter mood, perception, and behavior, leading to dependence, withdrawal symptoms, and psychiatric complications.

1️⃣ Classification of Psychoactive Substance Disorders (DSM-5 & ICD-11)

Psychoactive substance disorders fall under Substance-Related and Addictive Disorders in DSM-5 and ICD-11.

🔹 Major Types of Substance Disorders:

1️⃣ Substance Use Disorders (SUDs)
2️⃣ Substance-Induced Disorders (Intoxication, Withdrawal, Psychosis, Delirium, etc.)

2️⃣ Substance Use Disorders (SUDs)

✅ Definition:

• A pattern of harmful substance use leading to significant distress or impairment.
• Characterized by tolerance, dependence, and withdrawal symptoms.

✅ Commonly Abused Substances & Their Effects:

Substance	Examples	CNS Effect	Withdrawal Symptoms
Alcohol	Beer, Wine, Whisky	CNS Depressant	Tremors, Seizures, Delirium Tremens
Opioids	Heroin, Morphine, Codeine	CNS Depressant	Sweating, Nausea, Muscle Pain
Cannabis	Marijuana, Hashish	CNS Depressant	Irritability, Anxiety, Sleep Problems
Cocaine	Crack, Powdered Cocaine	CNS Stimulant	Depression, Fatigue, Irritability
Amphetamines	Methamphetamine, Ecstasy	CNS Stimulant	Fatigue, Depression, Suicidal Ideation
Hallucinogens	LSD, PCP	Alters Perception	Flashbacks, Panic Attacks
Inhalants	Glue, Paint Thinners	CNS Depressant	Nausea, Dizziness, Brain Damage
Nicotine	Cigarettes, Tobacco	CNS Stimulant	Irritability, Increased Appetite
Sedatives & Hypnotics	Benzodiazepines, Barbiturates	CNS Depressant	Seizures, Anxiety, Insomnia

3️⃣ Substance-Induced Disorders

✅ Substance Intoxication:

• Acute effects of substance use leading to impaired consciousness, behavior, or perception.
• Example: Alcohol intoxication → Slurred speech, unsteady gait.

✅ Substance Withdrawal:

• Symptoms occurring after stopping or reducing substance use.
• Example: Opioid withdrawal → Sweating, muscle pain, anxiety.

✅ Substance-Induced Psychosis:

• Psychotic symptoms (hallucinations, delusions) due to substance use.
• Example: Cannabis-induced psychosis.

✅ Substance-Induced Delirium:

• Acute confusion due to intoxication or withdrawal.
• Example: Alcohol withdrawal delirium (Delirium Tremens).

4️⃣ Alcohol Use Disorder (AUD) – Most Common Substance Disorder

✅ Key Features:

• Increased tolerance (need more alcohol for the same effect).
• Withdrawal symptoms (tremors, seizures, hallucinations).
• Compulsive drinking despite negative consequences.

✅ Complications:
📌 Wernicke’s Encephalopathy → Due to thiamine (Vitamin B1) deficiency → Confusion, ataxia, nystagmus.
📌 Korsakoff’s Psychosis → Memory loss, confabulation, irreversible brain damage.

✅ Management of Alcohol Dependence:
📌 Acute Withdrawal: Benzodiazepines (Diazepam, Lorazepam), IV fluids, Thiamine.
📌 Long-term Treatment: Disulfiram (causes alcohol intolerance), Naltrexone (reduces cravings).

5️⃣ Opioid Use Disorder (Heroin, Morphine, Codeine)

✅ Effects of Opioids:

• Euphoria, sedation, respiratory depression.
  ✅ Opioid Withdrawal Symptoms:
• Restlessness, sweating, diarrhea, muscle pain, yawning.
  ✅ Treatment:
• Naloxone (for overdose).
• Methadone, Buprenorphine (for long-term maintenance).

6️⃣ Cocaine & Amphetamine Use Disorder

✅ Effects:

• Euphoria, increased energy, hypertension, paranoia.
  ✅ Withdrawal Symptoms:
• Depression, hypersomnia, increased appetite, suicidal thoughts.
  ✅ Treatment:
• No specific antidote.
• Supportive care, benzodiazepines for agitation.

7️⃣ Cannabis Use Disorder

✅ Effects:

• Euphoria, relaxation, increased appetite, impaired memory.
  ✅ Withdrawal Symptoms:
• Irritability, sleep disturbances, loss of appetite.
  ✅ Treatment:
• Supportive therapy, cognitive-behavioral therapy (CBT).

8️⃣ Hallucinogen Use Disorder (LSD, PCP)

✅ Effects:

• Hallucinations, altered perception, paranoia.
  ✅ Withdrawal Symptoms:
• Flashbacks, panic attacks.
  ✅ Treatment:
• Supportive care, benzodiazepines for agitation.

9️⃣ Nursing Management of Substance Use Disorders

✅ Assessment:

📌 Detailed substance use history.
📌 Assess withdrawal symptoms, motivation to quit.
📌 Monitor vitals (BP, HR, respiratory rate).

✅ Nursing Interventions:

📌 Ensure patient safety (risk of seizures, aggression).
📌 Monitor for withdrawal symptoms (e.g., Delirium Tremens).
📌 Administer detox medications as prescribed.
📌 Provide psychoeducation on relapse prevention.
📌 Encourage counseling (CBT, Motivational Interviewing).
📌 Refer to rehabilitation centers (AA, NA).

🔟 Prevention of Substance Use Disorders

✅ Primary Prevention:

• Awareness programs in schools and communities.
• Drug education on harmful effects.
  ✅ Secondary Prevention:
• Screening for substance use in high-risk individuals.
• Early intervention programs.
  ✅ Tertiary Prevention:
• Rehabilitation and relapse prevention.
• Counseling for long-term recovery.

🔟 Frequently Asked Questions in Competitive Exams

✔ Most commonly abused substance worldwide? – Alcohol
✔ Drug used to reverse opioid overdose? – Naloxone
✔ Most common drug withdrawal with seizures? – Alcohol (Delirium Tremens)
✔ Treatment for alcohol dependence? – Disulfiram, Naltrexone, Acamprosate
✔ Common complication of chronic alcohol use? – Wernicke-Korsakoff Syndrome
✔ Which drug causes withdrawal symptoms like yawning, sweating, muscle pain? – Opioids

Psychotic Disorders

Psychotic disorders are severe mental health conditions characterized by loss of contact with reality, including hallucinations, delusions, disorganized thinking, and impaired functioning.

1️⃣ Definition of Psychotic Disorders

✅ Psychotic disorders involve disruptions in thinking, perception, emotions, and behavior.
✅ Key features:
📌 Hallucinations (false sensory perceptions)
📌 Delusions (fixed, false beliefs)
📌 Disorganized thinking and speech
📌 Severe impairment in daily life

2️⃣ Classification of Psychotic Disorders (DSM-5 & ICD-11)

Psychotic disorders are categorized under Schizophrenia Spectrum and Other Psychotic Disorders in DSM-5 and Primary Psychotic Disorders in ICD-11.

🔹 Major Types of Psychotic Disorders:

1️⃣ Schizophrenia
2️⃣ Schizophreniform Disorder
3️⃣ Brief Psychotic Disorder (BPD)
4️⃣ Schizoaffective Disorder
5️⃣ Delusional Disorder
6️⃣ Substance-Induced Psychotic Disorder
7️⃣ Psychotic Disorder Due to a Medical Condition

3️⃣ Detailed Explanation of Each Psychotic Disorder

1️⃣ Schizophrenia

✅ Definition: A chronic mental disorder with episodes of psychosis, cognitive dysfunction, and social withdrawal.
✅ Key Features:
📌 Positive Symptoms (Excess of normal function)

• Hallucinations (auditory most common)
• Delusions (paranoid, grandiose)
• Disorganized speech and behavior
  📌 Negative Symptoms (Deficit of normal function)
• Avolition (lack of motivation)
• Alogia (poverty of speech)
• Anhedonia (inability to feel pleasure)
  📌 Cognitive Symptoms
• Impaired memory, poor concentration

✅ Onset: Late adolescence to early adulthood (15-25 years).
✅ Treatment:
📌 Antipsychotics (Haloperidol, Olanzapine, Risperidone)
📌 Psychotherapy (CBT, family therapy)
📌 Social skills training and rehabilitation

2️⃣ Schizophreniform Disorder

✅ Similar to schizophrenia but lasts between 1-6 months.
✅ Symptoms resolve completely in some cases.
✅ Treatment: Antipsychotics, supportive therapy.

3️⃣ Brief Psychotic Disorder (BPD)

✅ Psychotic symptoms lasting <1 month, followed by complete recovery.
✅ Commonly triggered by extreme stress (e.g., trauma, postpartum period).
✅ Treatment: Short-term antipsychotics and supportive care

4️⃣ Schizoaffective Disorder

✅ Combination of schizophrenia and mood disorder (depression or bipolar).
✅ Symptoms:

• Psychosis (hallucinations, delusions)
• Mood symptoms (mania or depression)
  ✅ Treatment:
• Antipsychotics (Olanzapine, Risperidone)
• Mood stabilizers (Lithium, Valproate)

5️⃣ Delusional Disorder

✅ Persistent delusions (>1 month) without other psychotic symptoms.
✅ Types of Delusions:

• Persecutory (paranoia) – “People are spying on me.”
• Grandiose – “I am a millionaire.”
• Erotomanic – “A celebrity is in love with me.”
• Jealous – “My partner is cheating on me.”
• Somatic – “My body is infected with parasites.”
  ✅ Treatment:
• Antipsychotics (low dose)
• CBT for delusion management

6️⃣ Substance-Induced Psychotic Disorder

✅ Psychotic symptoms due to drug use (LSD, cannabis, cocaine, amphetamines, alcohol withdrawal).
✅ Management:

• Stop the substance, supportive care.
• Short-term antipsychotics for severe cases.

7️⃣ Psychotic Disorder Due to a Medical Condition

✅ Psychosis caused by conditions like brain tumors, infections, epilepsy, metabolic disorders.
✅ Management: Treat the underlying medical condition.

4️⃣ Nursing Management of Psychotic Disorders

✅ Assessment:

📌 Mental Status Examination (MSE) to assess hallucinations, delusions, thought processes.
📌 Risk assessment for suicide, violence, or self-neglect.
📌 Monitor medication side effects (e.g., extrapyramidal symptoms, metabolic syndrome).

✅ Nursing Interventions:

📌 Ensure patient safety (reduce risk of harm).
📌 Do not argue with delusions or hallucinations; instead, focus on reality.
📌 Encourage medication adherence.
📌 Provide structured activities to improve social skills.
📌 Educate family members about relapse prevention.

5️⃣ Treatment of Psychotic Disorders

✅ First-Line Treatment: Antipsychotics (Neuroleptics)

• Typical Antipsychotics (1st Generation)
  📌 Haloperidol, Chlorpromazine (more side effects)
• Atypical Antipsychotics (2nd Generation)
  📌 Olanzapine, Risperidone, Clozapine (fewer side effects)

✅ Adjunctive Therapy:
📌 Cognitive Behavioral Therapy (CBT) – Helps challenge irrational thoughts.
📌 Social Skills Training – Improves communication and daily functioning.
📌 Rehabilitation Programs – Helps patients integrate into society.

✅ Electroconvulsive Therapy (ECT)

• Used in severe catatonia or treatment-resistant schizophrenia.

6️⃣ Complications of Psychotic Disorders

📌 Suicide Risk – 10% of schizophrenia patients die by suicide.
📌 Substance Abuse – Common in psychotic disorders.
📌 Violence and Aggression – More common in untreated cases.
📌 Medication Side Effects:

• Extrapyramidal Symptoms (EPS) – Tremors, rigidity, akathisia.
• Tardive Dyskinesia – Involuntary movements (from long-term antipsychotic use).
• Neuroleptic Malignant Syndrome (NMS) – Life-threatening reaction to antipsychotics (high fever, rigidity, altered mental status).

7️⃣ Frequently Asked Questions in Competitive Exams

✔ Most common psychotic disorder? – Schizophrenia.
✔ Most common hallucination in schizophrenia? – Auditory hallucinations.
✔ Drug of choice for schizophrenia? – Atypical antipsychotics (Risperidone, Olanzapine).
✔ Key feature of Delusional Disorder? – Fixed delusions without hallucinations.
✔ Best treatment for treatment-resistant schizophrenia? – Clozapine.
✔ What is Neuroleptic Malignant Syndrome (NMS)? – Severe reaction to antipsychotics, treated with Dantrolene.

Depression, Mania, and Bipolar Disorder

Mood disorders are psychiatric conditions characterized by extreme disturbances in mood, energy, and activity levels. The major mood disorders include Depression, Mania, and Bipolar Disorder.

1️⃣ Classification of Mood Disorders (DSM-5 & ICD-11)

Mood disorders are classified under “Depressive Disorders” and “Bipolar and Related Disorders” in DSM-5 and ICD-11.

🔹 Major Types of Mood Disorders

1️⃣ Major Depressive Disorder (MDD)
2️⃣ Dysthymia (Persistent Depressive Disorder – PDD)
3️⃣ Mania
4️⃣ Hypomania
5️⃣ Bipolar Disorder (Bipolar I, Bipolar II, Cyclothymia)

2️⃣ Depression (Major Depressive Disorder – MDD)

✅ Definition:

• A psychiatric condition characterized by persistent sadness, loss of interest, and decreased energy for at least 2 weeks.
  ✅ Key Features:
  📌 Depressed mood most of the day.
  📌 Anhedonia (loss of interest or pleasure in activities).
  📌 Sleep disturbances (insomnia or hypersomnia).
  📌 Appetite changes (weight loss or gain).
  📌 Fatigue, loss of energy.
  📌 Feelings of worthlessness, guilt.
  📌 Difficulty concentrating, making decisions.
  📌 Suicidal thoughts or attempts.
  ✅ Mnemonic for Depression Symptoms (SIG E CAPS)
  📌 S – Sleep disturbances
  📌 I – Interest loss (Anhedonia)
  📌 G – Guilt or worthlessness
  📌 E – Energy loss (fatigue)
  📌 C – Concentration difficulties
  📌 A – Appetite changes
  📌 P – Psychomotor agitation or retardation
  📌 S – Suicidal thoughts

✅ Treatment of Depression:
📌 First-line drugs: SSRIs (Fluoxetine, Sertraline, Escitalopram)
📌 Atypical antidepressants: Mirtazapine, Bupropion
📌 Psychotherapy (CBT, IPT)
📌 Electroconvulsive Therapy (ECT) for severe depression or suicidal risk

3️⃣ Mania (Manic Episode)

✅ Definition:

• Abnormally elevated, irritable, or expansive mood with increased energy and activity for at least 1 week.
  ✅ Key Features:
  📌 Increased self-esteem or grandiosity.
  📌 Decreased need for sleep (feels rested with very little sleep).
  📌 Excessive talkativeness (pressured speech).
  📌 Flight of ideas (rapid shifting of thoughts).
  📌 Distractibility.
  📌 Involvement in risky activities (gambling, spending sprees, hypersexuality).

✅ Mnemonic for Mania Symptoms (DIG FAST)
📌 D – Distractibility
📌 I – Impulsivity (poor judgment, risk-taking)
📌 G – Grandiosity (inflated self-esteem)
📌 F – Flight of ideas (racing thoughts)
📌 A – Activity increase (goal-directed, hyperactive)
📌 S – Sleep decrease
📌 T – Talkativeness

✅ Treatment of Mania:
📌 Mood stabilizers: Lithium, Valproate, Carbamazepine
📌 Atypical antipsychotics: Olanzapine, Risperidone
📌 Benzodiazepines (for agitation and sleep disturbances)

4️⃣ Hypomania

✅ Definition:

• Less severe form of mania lasting at least 4 days, without significant impairment or psychotic features.
  ✅ Key Features:
  📌 Similar to mania but less severe.
  📌 No psychotic symptoms (hallucinations or delusions).
  📌 Does not cause severe impairment in daily activities.
  📌 Seen in Bipolar II Disorder.

5️⃣ Bipolar Disorder (Manic-Depressive Disorder)

✅ Definition:

• A psychiatric disorder with episodes of mania/hypomania and depression.

✅ Types of Bipolar Disorder:

Feature	Bipolar I Disorder	Bipolar II Disorder	Cyclothymia
Mood Episodes	Mania + Depression	Hypomania + Depression	Chronic mood swings
Manic Episodes	At least 1 manic episode	No full mania, only hypomania	Milder mood fluctuations
Depressive Episodes	Common but not required for diagnosis	Required for diagnosis	Depressive symptoms without full episodes
Duration	Manic episode ≥ 1 week	Hypomania ≥ 4 days	Mood swings for ≥ 2 years
Psychotic Features	Can be present	Absent	Absent

✅ Symptoms:
📌 Bipolar I Disorder → Mania followed by Depression.
📌 Bipolar II Disorder → Hypomania followed by Depression.
📌 Cyclothymia → Chronic mild mood swings (hypomanic and depressive symptoms).

✅ Treatment of Bipolar Disorder:
📌 Mood Stabilizers: Lithium (Gold standard), Valproate, Carbamazepine, Lamotrigine.
📌 Atypical Antipsychotics: Olanzapine, Risperidone, Quetiapine (for manic phase).
📌 Antidepressants (used cautiously to avoid manic switch).
📌 Electroconvulsive Therapy (ECT) for severe cases.

6️⃣ Nursing Management of Mood Disorders

✅ Assessment:
📌 Mood, energy level, sleep patterns, suicidal ideation.
📌 Use standardized tools (e.g., Hamilton Depression Rating Scale, Mood Disorder Questionnaire).

✅ Interventions for Depression:
📌 Encourage daily activities and social interaction.
📌 Ensure medication adherence.
📌 Suicide prevention strategies.
📌 Cognitive Behavioral Therapy (CBT) sessions.

✅ Interventions for Mania:
📌 Reduce environmental stimuli.
📌 Set limits on impulsive behaviors.
📌 Ensure safety (prevent self-harm, risky activities).
📌 Encourage rest and proper nutrition.

7️⃣ Frequently Asked Questions in Competitive Exams

✔ Most common mood disorder? – Major Depressive Disorder (MDD).
✔ First-line treatment for depression? – SSRIs (Fluoxetine, Sertraline).
✔ Key drug for Bipolar Disorder? – Lithium.
✔ What is the hallmark of Bipolar I? – Manic episodes.
✔ What is the hallmark of Bipolar II? – Hypomanic episodes + Major Depression.
✔ Best treatment for severe, treatment-resistant depression? – Electroconvulsive Therapy (ECT).
✔ Best treatment for acute mania? – Mood stabilizers + Atypical antipsychotics.

Organic Brain Disorders –

1️⃣ Definition of Organic Brain Disorders (OBDs)

✅ Organic Brain Disorders (OBDs) are mental disorders caused by structural, physiological, or biochemical changes in the brain due to disease, injury, or aging.
✅ Key Features:
📌 Cognitive impairment (memory loss, confusion, disorientation).
📌 Personality changes and behavioral disturbances.
📌 Decline in executive functioning (judgment, reasoning, problem-solving).
📌 Often progressive and irreversible (e.g., dementia) but can be reversible (e.g., delirium).

2️⃣ Classification of Organic Brain Disorders (ICD-11 & DSM-5)

OBDs are classified under Neurocognitive Disorders (NCDs) in DSM-5 and Organic, including symptomatic, mental disorders in ICD-11.

🔹 Major Types of Organic Brain Disorders

1️⃣ Delirium (Acute Confusional State)
2️⃣ Dementia (Major Neurocognitive Disorder)
3️⃣ Amnestic Syndrome (Memory Impairment Disorders)
4️⃣ Traumatic Brain Injury (TBI) and Post-Concussional Syndrome
5️⃣ Cerebrovascular Disorders (Vascular Dementia, Stroke-related cognitive impairment)
6️⃣ Neurodegenerative Disorders (Alzheimer’s, Parkinson’s, Huntington’s, etc.)
7️⃣ Substance-Induced Neurocognitive Disorders

3️⃣ Detailed Explanation of Each Organic Brain Disorder

1️⃣ Delirium (Acute Confusional State)

✅ Definition:

• Acute onset of disturbance in attention, awareness, and cognition.
• Fluctuating consciousness and impaired orientation.
  ✅ Causes (I WATCH DEATH mnemonic):
• Infections (UTI, pneumonia, sepsis).
• Withdrawal (alcohol, drugs).
• Acute metabolic disorders (hypoglycemia, hyponatremia).
• Trauma (head injury).
• CNS pathology (stroke, tumor, epilepsy).
• Hypoxia, Drugs (anticholinergics, sedatives), Endocrine (thyroid, adrenal), Acute vascular (shock), Toxins, Heavy metals.
  ✅ Symptoms:
  📌 Disorientation, confusion, fluctuating consciousness.
  📌 Hallucinations (mostly visual), restlessness, agitation.
  📌 Reversed sleep-wake cycle.
  ✅ Treatment:
  📌 Treat the underlying cause (infection, metabolic disorder, etc.).
  📌 Haloperidol or Olanzapine for agitation.
  📌 Reorientation techniques and environmental support.

2️⃣ Dementia (Major Neurocognitive Disorder)

✅ Definition:

• Chronic, progressive loss of cognitive function affecting memory, thinking, and behavior.
• Irreversible and worsens over time.
  ✅ Common Causes:
• Alzheimer’s Disease (most common cause – 60-80%).
• Vascular Dementia (multi-infarct dementia due to strokes).
• Lewy Body Dementia (associated with Parkinson’s-like symptoms).
• Frontotemporal Dementia (personality changes, disinhibition).
  ✅ Symptoms:
  📌 Memory loss (short-term first, then long-term).
  📌 Personality and mood changes.
  📌 Difficulty in problem-solving and language.
  📌 Wandering, aggression, hallucinations (late stage).
  ✅ Treatment:
  📌 Cholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine).
  📌 Memantine (NMDA receptor antagonist) for moderate to severe dementia.
  📌 Behavioral therapy, caregiver education, supportive environment.

3️⃣ Amnestic Syndrome (Memory Impairment Disorders)

✅ Definition:

• Severe memory loss without other cognitive impairments.
  ✅ Common Causes:
• Korsakoff’s Syndrome (due to thiamine deficiency in alcoholism).
• Head trauma, anoxia, stroke, brain infections.
  ✅ Symptoms:
  📌 Profound anterograde amnesia (inability to form new memories).
  📌 Confabulation (fabricated memories).
  ✅ Treatment:
  📌 Thiamine supplementation (for Korsakoff’s Syndrome).
  📌 Cognitive rehabilitation therapy.

4️⃣ Traumatic Brain Injury (TBI) and Post-Concussional Syndrome

✅ Definition:

• Brain damage due to head trauma leading to cognitive, emotional, and physical dysfunction.
  ✅ Common Causes:
• Road traffic accidents (RTA), falls, sports injuries, assaults.
  ✅ Symptoms:
  📌 Memory loss, difficulty concentrating.
  📌 Headache, dizziness, mood instability.
  ✅ Treatment:
  📌 Cognitive rehabilitation, supportive therapy.
  📌 Psychotherapy for emotional disturbances.

5️⃣ Cerebrovascular Disorders (Vascular Dementia, Stroke-Related Cognitive Impairment)

✅ Definition:

• Cognitive decline due to multiple strokes or cerebrovascular disease.
  ✅ Risk Factors:
• Hypertension, diabetes, smoking, atrial fibrillation.
  ✅ Symptoms:
  📌 Stepwise cognitive decline (worsens after each stroke).
  📌 Focal neurological deficits (weakness, slurred speech).
  ✅ Treatment:
  📌 Control risk factors (BP, diabetes, anticoagulants for AF).
  📌 Cholinesterase inhibitors (Donepezil, Rivastigmine).

6️⃣ Neurodegenerative Disorders (Alzheimer’s, Parkinson’s, Huntington’s, etc.)

✅ Alzheimer’s Disease:

• Most common cause of dementia, plaques and tangles in the brain.
• Early sign: Short-term memory loss.
  ✅ Parkinson’s Disease Dementia:
• Bradykinesia, tremors, rigidity + cognitive decline.
  ✅ Huntington’s Disease:
• Genetic disorder with chorea (involuntary movements) + dementia.

✅ Treatment:
📌 Alzheimer’s – Cholinesterase inhibitors (Donepezil, Rivastigmine).
📌 Parkinson’s – Levodopa, Dopamine agonists.
📌 Huntington’s – Tetrabenazine (for movement symptoms).

7️⃣ Substance-Induced Neurocognitive Disorders

✅ Causes:

• Chronic abuse of alcohol, benzodiazepines, inhalants, opioids, cocaine.
  ✅ Symptoms:
  📌 Memory impairment, mood disturbances, hallucinations.
  ✅ Treatment:
  📌 Detoxification, Cognitive rehabilitation.

4️⃣ Nursing Management of Organic Brain Disorders

✅ Assessment:
📌 Cognitive tests (MMSE – Mini-Mental State Examination).
📌 Neurological examination, imaging (MRI, CT brain).

✅ Nursing Interventions:
📌 Ensure patient safety (fall prevention, supervision).
📌 Provide reality orientation (clocks, calendars, familiar objects).
📌 Supportive environment, structured routine.
📌 Medication adherence and caregiver education.

5️⃣ Frequently Asked Questions in Competitive Exams

✔ Most common cause of dementia? – Alzheimer’s Disease.
✔ Best treatment for mild to moderate Alzheimer’s? – Donepezil, Rivastigmine.
✔ Classic sign of Delirium? – Fluctuating consciousness.
✔ Which vitamin deficiency causes memory loss in alcoholics? – Thiamine (Vitamin B1).
✔ Which dementia worsens stepwise? – Vascular Dementia.
✔ What is the first symptom of Alzheimer’s? – Short-term memory loss.