Important Milestones in Psychiatry and Psychiatric Nursing

Ancient to 18th Century

✅ Hippocrates (460–370 BC) – Proposed that mental disorders are due to natural causes, not supernatural forces.

✅ St. Mary of Bethlehem Hospital (Bedlam) (16th Century, London) – One of the first mental asylums, infamous for inhumane treatment.

✅ Philippe Pinel (1793, France) – Introduced “Moral Treatment”, removed chains from mentally ill patients.

✅ Dorothea Dix (1841, USA) – Led the Mental Hygiene Movement, advocating humane treatment of psychiatric patients.

19th Century

✅ Emil Kraepelin (1883, Germany) – Classified mental illnesses scientifically, differentiated schizophrenia from manic-depressive illness.

✅ Sigmund Freud (1895, Austria) – Developed psychoanalysis, introduced the concepts of id, ego, and superego.

20th Century

✅ Clifford Beers (1908, USA) – Published A Mind That Found Itself, leading to the Mental Hygiene Movement.

✅ Eugen Bleuler (1912, Switzerland) – Coined the term Schizophrenia.

✅ Electroconvulsive Therapy (ECT) (1933, Italy) – Introduced by Ugo Cerletti and Lucio Bini.

✅ National Mental Health Act (1946, USA) – Established National Institute of Mental Health (NIMH).

✅ Lithium as Mood Stabilizer (1949, Australia) – John Cade discovered lithium for bipolar disorder.

✅ First Antipsychotic (1952, France) – Chlorpromazine (Thorazine) revolutionized psychiatric treatment.

✅ Hildegard Peplau (1955, USA) – Psychiatric Nursing recognized as a specialty, introduced Interpersonal Relations Theory.

✅ Community Mental Health Centers Act (1963, USA) – Started deinstitutionalization, shifting care to community settings.

✅ DSM-III (1980, USA) – Standardized psychiatric diagnosis.

✅ Decade of the Brain (1990s, USA) – Focus on neuroscience and mental health research.

21st Century

✅ DSM-5 (2013, USA) – Modern psychiatric classification system.

✅ Mental Healthcare Act (2017, India) – Decriminalized suicide and focused on patient rights.

Important Milestones in Indian Psychiatry & Psychiatric

Ancient to 19th Century

✅ Atharva Veda (1500 BC) – First Indian text mentioning mental illness as an imbalance of bodily forces.

✅ Charaka Samhita (600 BC) – Charaka, the father of Indian medicine, classified mental disorders as Manas Roga and described treatments like meditation and herbal medicine.

✅ Ashtanga Hridaya (7th Century AD) – Vagbhata emphasized psychotherapy, yoga, and herbal treatments for mental health.

✅ First Mental Hospital in India (1745, Bombay) – Established by the British East India Company.

✅ Lunatic Asylums Act (1858) – British introduced laws to regulate mental asylums in India.

✅ Central Mental Hospital, Yerwada (1889, Pune) – One of the largest mental hospitals in India.

20th Century

✅ Indian Lunacy Act (1912) – First official law for mental health care in India.

✅ First Diploma in Psychiatric Nursing (1921, Ranchi Mental Hospital) – Started formal training in psychiatric nursing.

✅ All India Institute of Mental Health (1954, Bengaluru) – Later became NIMHANS (National Institute of Mental Health and Neurosciences), India’s leading mental health institute.

✅ Chlorpromazine Introduced in India (1957) – Marked the beginning of psychopharmacology in Indian psychiatry.

✅ Mental Health Act (1987) – Replaced the Indian Lunacy Act (1912) and focused on patients’ rights and treatment reforms.

✅ Postgraduate Course in Psychiatric Nursing (1997, NIMHANS) – India’s first Master’s program in Psychiatric Nursing.

21st Century

✅ Revised Mental Health Program (2002, India) – Strengthened community mental health care.

✅ Mental Healthcare Act (2017, India) –

• Decriminalized suicide under IPC Section 309.
• Established the right to mental health care.

✅ Tele Mental Health Programme (2022, India) – Launched to expand mental health access via telemedicine.

Classification of Mental Disorders

Mental disorders are classified based on internationally recognized systems. The two major classification systems used worldwide are:

1️⃣ ICD-11 (International Classification of Diseases, 11th Revision) – By WHO
2️⃣ DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) – By American Psychiatric Association

1. Classification Based on ICD-11 (WHO, 2019)

ICD-11 is widely used in India and globally for medical coding and diagnosis.

Major Categories of Mental Disorders (ICD-11)

✅ Neurodevelopmental Disorders

• Intellectual Disability
• Autism Spectrum Disorder (ASD)
• ADHD (Attention-Deficit Hyperactivity Disorder)
• Learning Disabilities

✅ Schizophrenia and Other Primary Psychotic Disorders

• Schizophrenia
• Schizoaffective Disorder
• Delusional Disorder
• Acute and Transient Psychotic Disorder

✅ Mood Disorders (Affective Disorders)

• Major Depressive Disorder
• Bipolar Disorder (Bipolar I, Bipolar II, Cyclothymia)
• Dysthymia (Persistent Depressive Disorder)

✅ Anxiety and Fear-Related Disorders

• Generalized Anxiety Disorder (GAD)
• Panic Disorder
• Social Anxiety Disorder
• Specific Phobias (e.g., Agoraphobia, Claustrophobia)

✅ Obsessive-Compulsive and Related Disorders

• Obsessive-Compulsive Disorder (OCD)
• Hoarding Disorder
• Body Dysmorphic Disorder

✅ Stress-Related Disorders

• Post-Traumatic Stress Disorder (PTSD)
• Acute Stress Disorder
• Adjustment Disorder

✅ Dissociative Disorders

• Dissociative Identity Disorder (DID)
• Dissociative Amnesia
• Depersonalization-Derealization Disorder

✅ Somatic Symptom and Related Disorders

• Somatic Symptom Disorder
• Illness Anxiety Disorder (Hypochondriasis)
• Conversion Disorder

✅ Eating Disorders

• Anorexia Nervosa
• Bulimia Nervosa
• Binge-Eating Disorder

✅ Sleep-Wake Disorders

• Insomnia Disorder
• Narcolepsy
• Restless Leg Syndrome

✅ Substance Use and Addictive Disorders

• Alcohol Use Disorder
• Opioid Use Disorder
• Cannabis Use Disorder
• Gambling Disorder

✅ Personality Disorders

• Borderline Personality Disorder (BPD)
• Antisocial Personality Disorder (ASPD)
• Narcissistic Personality Disorder
• Avoidant Personality Disorder

✅ Neurocognitive Disorders

• Dementia (Alzheimer’s, Vascular Dementia)
• Delirium

2. Classification Based on DSM-5 (APA, 2013)

DSM-5 is commonly used in USA and research studies. The classification is similar to ICD-11, with slight variations.

🔹 Major Categories in DSM-5:

• Neurodevelopmental Disorders
• Schizophrenia Spectrum and Other Psychotic Disorders
• Bipolar and Related Disorders
• Depressive Disorders
• Anxiety Disorders
• Obsessive-Compulsive and Related Disorders
• Trauma- and Stressor-Related Disorders
• Dissociative Disorders
• Somatic Symptom and Related Disorders
• Feeding and Eating Disorders
• Elimination Disorders
• Sleep-Wake Disorders
• Sexual Dysfunctions
• Gender Dysphoria
• Disruptive, Impulse-Control, and Conduct Disorders
• Substance-Related and Addictive Disorders
• Neurocognitive Disorders
• Personality Disorders
• Paraphilic Disorders

Key Differences: ICD-11 vs DSM-5

Feature	ICD-11 (WHO)	DSM-5 (APA)
Use	Global (India, Europe, WHO guidelines)	USA-based, Research Studies
Update Year	2019	2013
Focus	Public Health, Clinical Use	Detailed Symptoms, Research Use
Personality Disorders	Dimensional approach	Categorical approach

For Competitive Exams:

• ICD-11 is more commonly used in India.
• DSM-5 is detailed and research-oriented.
• Both systems classify mental disorders into broad categories like psychotic disorders, mood disorders, anxiety disorders, etc.

Most Commonly Asked

✅ Schizophrenia, Bipolar Disorder, Depression
✅ Anxiety Disorders (GAD, OCD, PTSD)
✅ Personality Disorders (BPD, Antisocial, Narcissistic)
✅ Neurodevelopmental Disorders (ADHD, Autism)
✅ Substance Use Disorders (Alcohol, Opioids)
✅ Dementia, Delirium

Different Types of Psychotherapy –

Psychotherapy is a scientifically-based treatment for mental health disorders that involves talk therapy, behavioral interventions, and cognitive restructuring. The major types of psychotherapy are as follows:

1. Cognitive Behavioral Therapy (CBT)

✅ Developed by Aaron Beck
✅ Based on the idea that thoughts, feelings, and behaviors are interconnected
✅ Helps identify and change negative thought patterns (cognitive distortions)
✅ Used for: Depression, Anxiety, OCD, PTSD, Eating Disorders, Insomnia
✅ Techniques: Cognitive restructuring, thought stopping, exposure therapy

2. Dialectical Behavior Therapy (DBT)

✅ Developed by Marsha Linehan
✅ Modified form of CBT for emotion regulation and distress tolerance
✅ Used for: Borderline Personality Disorder (BPD), Suicidal Tendencies, PTSD
✅ Four Components: Mindfulness, Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness

3. Psychoanalysis & Psychodynamic Therapy

✅ Developed by Sigmund Freud
✅ Focuses on unconscious conflicts, childhood experiences, and defense mechanisms
✅ Used for: Personality Disorders, Depression, Anxiety
✅ Techniques: Free association, dream analysis, transference interpretation

4. Humanistic Therapy (Person-Centered Therapy)

✅ Developed by Carl Rogers
✅ Focuses on self-growth, self-actualization, and personal potential
✅ Used for: Self-esteem issues, Depression, Anxiety
✅ Techniques: Active listening, unconditional positive regard, empathy

5. Rational Emotive Behavior Therapy (REBT)

✅ Developed by Albert Ellis
✅ Based on ABC Model:

• A (Activating event) → B (Beliefs) → C (Consequences)
  ✅ Used for: Depression, Anxiety, Stress Management
  ✅ Techniques: Disputing irrational thoughts, reframing negative beliefs

6. Exposure Therapy

✅ Based on Behavior Therapy
✅ Gradually exposes individuals to feared stimuli in a controlled manner
✅ Used for: Phobias, PTSD, OCD, Panic Disorder
✅ Techniques: Systematic desensitization, flooding

7. Acceptance and Commitment Therapy (ACT)

✅ Focuses on accepting distressing thoughts rather than changing them
✅ Used for: Chronic pain, Anxiety, Depression, OCD
✅ Techniques: Mindfulness, Cognitive Defusion, Value-based living

8. Interpersonal Therapy (IPT)

✅ Focuses on improving interpersonal relationships and communication skills
✅ Used for: Depression, Social Anxiety, PTSD
✅ Techniques: Role-playing, conflict resolution, social skills training

9. Eye Movement Desensitization and Reprocessing (EMDR)

✅ Developed by Francine Shapiro
✅ Uses bilateral eye movement to process traumatic memories
✅ Used for: PTSD, Trauma, Phobias

10. Play Therapy

✅ Used for children with emotional and behavioral disorders
✅ Helps express feelings through play activities
✅ Used for: ADHD, PTSD, Anxiety in children

11. Family Therapy

✅ Focuses on improving communication and relationships within the family
✅ Used for: Addiction, Marital Conflicts, Adolescent Issues
✅ Types: Structural Family Therapy (Minuchin), Systemic Therapy

12. Group Therapy

✅ Involves a therapist working with multiple patients at the same time
✅ Used for: Addiction, Depression, Anxiety, Social Skills Training
✅ Types: Psychoeducational groups, Support groups, Cognitive groups

Most Frequently Asked in Competitive Exams 📚

✔ CBT & DBT → Depression, Anxiety, BPD
✔ Psychoanalysis → Freud, Unconscious Mind, Defense Mechanisms
✔ REBT → Albert Ellis, ABC Model
✔ EMDR → PTSD Treatment
✔ Exposure Therapy → Phobia, OCD
✔ Play Therapy → Child Psychology
✔ Family Therapy → Structural Model (Minuchin)

Levels of Prevention in Mental Health Disorders –

Mental health prevention follows the three-tier model of prevention proposed by Leavell and Clark (1965). These levels aim to reduce the incidence, severity, and impact of mental health disorders.

1️⃣ Primary Prevention (Prevention Before Onset)

Goal: Prevent the occurrence of mental illness in healthy individuals.

✅ Target Group: General population (before the disease develops).
✅ Focus: Health promotion & risk factor reduction.

Examples in Mental Health:

• Mental health awareness programs in schools, workplaces, and communities.
• Stress management techniques (yoga, mindfulness, coping strategies).
• Preventing substance abuse through education campaigns.
• Parenting programs to promote positive child development.
• Early childhood interventions for emotional and social well-being.
• Preventing bullying in schools to reduce adolescent mental disorders.

2️⃣ Secondary Prevention (Early Detection & Treatment)

Goal: Identify and treat mental illness at an early stage to prevent worsening.

✅ Target Group: Individuals at risk or showing early signs of mental illness.
✅ Focus: Screening, early diagnosis, crisis intervention.

Examples in Mental Health:

• Screening programs for depression, anxiety, and substance use disorders.
• Early intervention services for schizophrenia and bipolar disorder.
• Suicide prevention helplines and mental health crisis support.
• Workplace mental health screening and counseling.
• Mental health check-ups in schools and primary health centers.
• Counseling for people exposed to trauma, abuse, or violence.

3️⃣ Tertiary Prevention (Rehabilitation & Relapse Prevention)

Goal: Reduce complications, improve quality of life, and prevent relapse.

✅ Target Group: Individuals with diagnosed mental disorders.
✅ Focus: Rehabilitation, relapse prevention, community integration.

Examples in Mental Health:

• Rehabilitation programs for chronic mental illnesses (schizophrenia, bipolar disorder).
• Community mental health services to provide continuous support.
• Medication adherence programs to prevent relapse in psychiatric patients.
• Vocational training for mentally ill patients to reintegrate into society.
• Support groups (AA, NA, peer counseling) for addiction recovery.
• Psychosocial rehabilitation for individuals recovering from severe depression or PTSD.

📝 Frequently Asked Questions in Competitive Exams:

✔ Primary Prevention: Health promotion, stress management, public education
✔ Secondary Prevention: Early screening, crisis intervention, suicide prevention helplines
✔ Tertiary Prevention: Rehabilitation, community mental health, relapse prevention

Mental Health Programs in India –

India has launched various mental health programs to address psychiatric disorders and improve mental well-being. Below are the most important mental health programs that are frequently asked in competitive exams:

1️⃣ National Mental Health Programme (NMHP) – 1982

✅ Launched by: Government of India
✅ Objective: To provide mental health care at the primary health care (PHC) level.
✅ Key Components:

• Integration of mental health services into general healthcare.
• Training of primary healthcare staff in mental health management.
• District Mental Health Programme (DMHP) for expanding services.

✅ Important Milestones of NMHP:

• 1982 – Launch of NMHP.
• 1996 – Introduction of District Mental Health Programme (DMHP).
• 2003 – Strengthening of psychiatric hospitals under Manpower Development Scheme.
• 2017 – NMHP revised under the Mental Healthcare Act, 2017.

2️⃣ District Mental Health Programme (DMHP) – 1996

✅ Objective: Extend mental health services to the district level.
✅ Services Provided:

• Outpatient mental health services at district hospitals.
• Awareness programs to reduce stigma.
• Training of general healthcare workers to manage common mental illnesses.

3️⃣ Mental Healthcare Act, 2017

✅ Key Features:

• Right to mental health care for every citizen.
• Decriminalization of suicide under IPC Section 309.
• Ban on inhumane treatments like chaining of patients.
• Advance Directive: Patients can choose their preferred treatment in advance.
• Establishment of Mental Health Review Boards (MHRB) to protect patient rights.

✅ Why It’s Important?

• It replaces the Mental Health Act, 1987.
• It aligns Indian mental health laws with international human rights standards.

4️⃣ Manodarpan Initiative (2020, COVID-19 Response)

✅ Launched by: Ministry of Education
✅ Objective: Address mental health concerns among students due to the pandemic.
✅ Services:

• Psychological support through counseling helplines.
• Online mental health resources for students, teachers, and parents.

5️⃣ National Tele Mental Health Programme (2022)

✅ Launched by: Government of India (Union Budget 2022-23).
✅ Objective: Provide free mental health counseling via telemedicine.
✅ Key Features:

• 24×7 helpline for mental health support.
• E-consultation with mental health professionals.
• Hub-and-spoke model: NIMHANS Bengaluru is the nodal center.

6️⃣ KIRAN Helpline (2020)

✅ Toll-Free Number: 1800-599-0019
✅ Objective: Offer 24×7 mental health support to individuals in distress.
✅ Target Group: Individuals suffering from depression, anxiety, suicide risk, and stress-related disorders.

7️⃣ Mental Health Awareness and Suicide Prevention Programs

✅ Programs by NIMHANS & NGOs:

• SAATH (Suicide Prevention Program, Gujarat).
• Vandrevala Foundation Mental Health Helpline.
• AASRA (Mumbai-based suicide prevention organization).

✅ Suicide Prevention Helplines in India:

• Vandrevala Foundation: 1860 266 2345
• iCall: +91 9152987821
• AASRA: 91-22-27546669

📝 Most Frequently Asked Questions in Competitive Exams:

✔ National Mental Health Programme (1982) – First major mental health initiative in India.
✔ District Mental Health Programme (1996) – Expansion of mental health services to districts.
✔ Mental Healthcare Act (2017) – Right to mental health care, decriminalization of suicide.
✔ Manodarpan (2020) – Student mental health program during COVID-19.
✔ National Tele Mental Health Programme (2022) – India’s first national tele-counseling initiative.
✔ KIRAN Helpline (2020) – 24×7 helpline for mental health support.