2017

Q-1 a. What is Psychiatric emergency ? 03

Psychiatric emergencies involve behavioral disturbances and thought disturbances that require immediate treatment, including:
A. The patient understands the need for his own dish comfort
B. According to the patient’s signs, family friends or authorities consider it necessary
C. Due to the prognosis, the doctor and nurse must understand that it can be fatal if left untreated

Definition:
A sudden onset of emotional or physiological situations and an emotional disorder or socially inappropriate behavior is called a psychiatric emergency.
Example.. Suicidal episodes, acute psychotic reaction, acute alcoholism or acute anxiety.

b. List the classification of psychiatric emergencies. 04

Major Emergencies:

• Suicidal patient
• Agitated and violent patient

Minor Emergencies:

• Grief reaction
• Rap
• Disaster
• Panic attack

Medical Emergencies Seen in Psychiatric:

• Delirium due to life threatening conditions
• Neuroleptic malignant syndrome
• Serotonin syndrome
• Psychiatric medication overdose.
• Drug overdose or withdrawal.

c. Write nursing management of agitated and violent patient. 05

Patient Description:
The patient is disturbed, unmanageable, and psychotic. They exhibit irrational, uncooperative, delusional, paranoid, and hallucinatory behavior.

Treatment:

• Injection Chlorpromazine 100 mg IM (for sedation) or Injection Diazepam 10-20 mg IV slowly.
• Use a calm, quiet, firm, and unhurried approach.
• In some psychotic conditions where violence is observed, Electroconvulsive Therapy (ECT) may be administered.

Nursing Care:

• Maintain a non-threatening approach; do not challenge the patient.
• Communicate in a low, calm voice.
• If isolation is necessary, place the patient in a room with minimal furniture.
• Minimize visitors.
• Provide a high-calorie diet; offer finger foods.

Don’ts:

• Do not keep any objects that could be used as weapons near the patient.
• Do not sit too close to the patient.
• Do not allow provocative relatives or friends into the patient’s room.
• Avoid arguing with the patient.

OR

Q-1 a. What is depression? 03

Depression is a mood affecting disorder characterized by disturbance in mood, changes in thinking and behavior
Definition: Depression is defined as a disturbance of mood characterized by full or partial depressive syndrome or loss of interest in pleasure and social activities and past times with evidence of interference in social and occupational functioning.

b. Write signs & symptoms of depression. 04

types of depression- mild, acute and depressive stupor

1.Mild depression
symptoms:The patient is seen with moral standards The patient is meticulous i.e. the chap is perfect and styleless Disinterested Physical illness with out organic cause The patient experiences charm Lack of self-confidence Loss of interest Patient
Fill Alone Appetite and Sleep Decreist Look Like Cell Means Thirsakrit Person

2. Acute or severe depression symptoms
Body- aagad jukelu
Head flexed
Face immobile
Forehead furrows
Looks fixedly downwards
Loss of appetite
Loss of weight
Disturbed sleep

Feelings:

• Thought Retarded: Responses are brief and monosyllabic.
• Reply in Low Tone: Answering in a low tone requires considerable effort and uses up energy.
• Hypochondriacal: Focused on imaginary health issues.
• Suicidal Ideas: Decreased psycho-motor activity; lost in one’s own thoughts.
• Treatment: If not provided, the condition may progress to stupor.

3.Depressive stupor
Symptoms Most intensive form of depression A cute dementia, mute and sensorium clouded Patient seen intensively preoccupied Dream like hallucination Excessive ideas of death

c. Write about nursing care of patient with depression.

1.Therapeutic Need:

• Administering Medicines and Other Treatments:
  • Check the type of antidepressant drugs to be administered.
  • Ensure the patient is taking the medication.
  • Follow the right procedure for administering medication.
  • Observe for any side effects.
  • Provide both individual and group psychotherapy.

2.Physical Need:

• To Prevent Suicidal Ideation and Attempts:
  • Do not leave the patient alone.
  • Keep sharp instruments, glass, or any other objects that could be used for self-harm away from the patient.
  • Check if the patient is collecting any drugs.
  • Encourage the patient to talk about their suicidal thoughts.
• To Improve Nutritional Intake:
  • Provide the patient with small, frequent meals.
  • Allow the patient to choose their food.
  • Serve food in an attractive manner, e.g., offering options like steamed eggs or omelets.
  • Compliment the patient when they are eating.
  • Offer a high amount of roughage, green leafy vegetables, and salads.
  • Encourage the patient to eat completely.
• To Encourage Personal Hygiene:
  • Explain the importance of maintaining personal hygiene and assist as needed.
  • Ensure the patient brushes their teeth and provide the necessary items.
  • Provide clothing and toiletry articles.
  • Monitor and assist with daily routines like brushing, bathing, changing clothes, and combing hair.
  • Guide the patient to use the toilet for bowel movements and ensure adequate time spent.
  • Ensure nails are trimmed and clean.
  • Encourage wearing clean and pressed clothes daily.
• To Balance Activity and Rest:
  • Encourage the patient to engage in activities during the day.
  • Encourage taking a bath before bed.
  • Provide a glass of warm milk.
  • Ensure a clean and comfortable bed.
  • Explain that daily activities will cause some fatigue, which will help them sleep better at night.

3.psychological needs
a. To reduce a feeling of dependency and helpl essness

a. Allowing the Patient to Make Decisions:

• Allow the patient to make their own decisions, for example, deciding when to take a bath.
• Encourage the patient to perform activities such as eating and shaving independently, without assistance.
• Address the patient by their name and show respect.
• Listen carefully if the patient makes light comments about themselves, such as feeling unliked by others.

b. To Improve Self-Concept:

• Plan activities that will help enhance the patient’s self-concept.
• Encourage the patient to engage in activities they feel confident about.
• Acknowledge and encourage the patient’s progress, such as praising their role in distributing breakfast on the ward.
• Discuss with the patient how things have changed and improved.
• Explain to relatives that patients should be allowed to face difficult decision-making situations themselves.

c. To Improve Communication:

• Initiate conversations with a friendly approach.
• Encourage the patient to engage in discussions.
• Help the patient understand their emotional response in specific situations, for example, why they did not respond when someone’s son came first in class.
• If the patient feels they have made a mistake, reassure them that everyone makes mistakes and provide examples.
• Accept the patient’s responses, even if they are angry.
• Encourage the patient to communicate with their relatives in a constructive manner. For instance, if the patient says they miss their children and wonders why they were not brought along, discuss it with them positively.

d. To improve socialization

Accept whatever feelings the patient comes to the hospital with List how much everyone respects the patient Encourage the patient to gradually get out of bed and interact with other patients

e. To reduce the feeling of guilt and apathy

Helping the patient verbalize his feelings of guilt Asking the patient to attend group therapy Allowing another patient to talk about his experiences Asking the patient to keep his surroundings clean and wash his own dirty clothes

1.Recreational need

Seeing what the patient is interested in Allowing the patient to visit other patients and encouraging them to play cards or Ludo

2.Spiritual need

Asking the patient to do his daily prayers Helping him read a religious book of his choice Asking the patient to confess

3.Discharge paln
a. To reduce depressive feelings

Getting the patient to talk about his anxiety after discharge Helping the patient to express pre-illness difficulties at work Discussing plans to help at home after discharge Instructing the patient and relatives to continue medication and follow-up

Q-2 a. Describe the Principles of Mental Health Nursing. 08

1. Patient is Accepted Exactly as He Is

Acceptance means being free from any biases or judgments. It expresses a sense of love and care. Acceptance does not imply complete approval, but rather involves providing a positive behavior setting to respect the person as an individual.

A. Being Non-judgmental and Non-punitive

• Patient behavior is not judged as right or wrong, good or bad.
• The patient is not punished for undesirable behavior.
• Avoid direct punishment like restraints, isolation, or ignoring the patient’s presence.
• A nurse who shows acceptance does not reject the patient’s behavior even if it is contrary to expectations.

B. Being Sincerely Interested in the Patient

• Showing genuine interest involves considering the other person’s welfare.
• Study the patient’s behavior patterns.
• Allow the patient to make their own choices and decisions as much as possible.
• Be aware of their likes and dislikes.
• Be honest with the patient.
• Give time to listen to what the patient says.
• Avoid sensitive or controversial topics.
• Recognize and reflect on the feelings the patient may express.

C. Recognize and Reflect on Feelings Which Patient May Express

• When the patient talks, focus not just on the content but on the feelings behind the conversation. Identify and reflect these feelings.

D. Talking with Purpose

• Conversations with the patient should revolve around their needs, desires, and interests.
• When issues are unclear, use reflective approaches, open-ended questions, and focus on the issues to address reality effectively.

E. Listening

• Listening is an active process requiring time and energy from the nurse.
• The nurse should listen empathetically and show genuine interest.

F. Permitting Patient to Express Strongly Held Feelings

• Strong emotions can be very explosive. Allow the patient to express intense feelings without rejection or punishment.

2. Use Self-Understanding as Therapeutic Tools

• The mental health nurse should have a clear self-awareness and be capable of recognizing their own emotions and responses.

3. Consistency is Used to Contribute to Patients’ Security

• Consistency means that staff should implement safety measures during ward routines to ensure the patient’s security.

4. Reassurance Should Be Given in a Subtle and Acceptable Manner

• Reassurance builds the patient’s self-confidence. The nurse should understand and analyze the patient’s situation to provide appropriate reassurance.

5. Patient’s Behavior is Changed Through Emotional Experience and Not by Rational Interpretation

• Advising or rationalizing is not as effective in changing behavior as methods like role-play and social drama.

6. Unnecessary Increase in Patient’s Anxiety Should Be Avoided

• To avoid unnecessary anxiety in the patient:
  • The nurse should not display their own anxiety.
  • Avoid focusing on the patient’s flaws.
  • Prevent the patient from facing repeated failures.
  • Avoid setting unrealistic demands on the patient.

7. Objective Observation of Patient to Understand His Behavior

• Objective observation allows evaluation of what the patient wants or needs. The nurse should avoid mixing personal feelings and judgments with observations.

8. Maintain Realistic Nurse-Patient Relationship

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

9. Avoid Physical and Verbal Force as Much as Possible

• The nurse should avoid any form of punishment and should not inflict psychological trauma. Observing the patient’s behavior can prevent unpredictable behavior. The nurse should act quickly but not show their own discomfort to the patient. If restraints are necessary, explain the reasons. Allow the patient to interact positively with others as their behavior improves.

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

• Behaviors in individuals often have underlying reasons. The nurse should understand these underlying causes rather than just focusing on symptoms. The nursing care should address the patient as a whole person, not just their symptoms.

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

• Explanations about routines and procedures should be tailored to the psychiatric patient’s level of understanding to alleviate their anxiety. Every individual has the right to know about the procedures applied to them, regardless of their mental state.

12. Many Procedures Are Modified but Basic Principles Remain Unaltered

• Procedures may be modified based on the patient’s needs and method changes, but basic principles like patient safety, security, therapeutic relationships, and procedures remain the same.

b. Write the scope of conimunity mental health services. 04

1. Psychiatric Hospitals

Psychiatric hospitals or nursing homes are a part of mental health services for mentally ill patients, their family members, etc. These hospitals provide various types of treatments for mentally disabled individuals.

2. Partial Hospitalization

Partial hospitalization is defined as a “time-limited, ambulatory, active treatment program that provides therapeutically intensive, coordinated, and structured clinical services in a stable treatment environment.” This approach, or method of treatment, serves as an alternative to full hospitalization and offers flexibility in handling many conditions.

Partial hospitalization or day treatment works best for individuals whose symptoms are controlled. They enter care directly after being discharged from community or 24-hour care. Partial hospitalization provides intermediate-level care for mental illness. It is most effective for patients who are ready for treatment and rehabilitation that can comfortably transition them back to the community.

Once psychiatric treatment stabilizes the patient’s condition, they may progress to a less intensive care setting. Day care centers, day hospitals, and day treatment programs are examples of partial hospitalization settings. These settings help mentally ill patients develop support networks from friends and family that can assist in monitoring their condition when they are not in the hospital, allowing them to return home at night and on weekends.

3. Halfway Houses

Halfway houses, also known as recovery houses or sober houses, aim to maintain a healthy environment rather than a state of illness. The goal is generally to allow individuals to start reintegrating into society while still receiving supervision and support; it is believed that this reduces the risk of relapse compared to immediate release into society.

Some halfway houses are exclusively for individuals recently released from jail or prison, others are for those with long-term mental health disorders, and most are for individuals with substance abuse issues. These quiet halfway houses are often voluntary residential sites, and many residents may not have a criminal record. Often, there is resistance from neighborhoods where halfway houses are trying to be established.

4. Quarterway Houses

Quarterway houses are typically located on hospital campuses but do not provide regular psychiatric hospital services. There may not be regular nursing staff or routine rounds, and most activities are managed by the patients themselves. In India, quarterway houses are available at institutions like NIMHANS Bangalore.

5. Self-Help Groups

In this context, ‘self-help’, ‘mutual-help’, and ‘peer-support’ are used interchangeably. Self-help groups for mental health are voluntary organizations of people who share a common desire to overcome mental illness or otherwise enhance their cognitive or emotional well-being. There are many international mental health self-help organizations. Despite different approaches, many psychosocial processes within these groups are similar, and they share similar relationships with mental health professionals. Self-help group members provide mutual support and practical solutions for issues encountered in daily life with mental illness or substance abuse. They also help members become socially connected.

6. Suicide Prevention Centers

Suicide incidents are increasing day by day. The rate of suicide is higher during board exams, which may be due to the inability to cope with exams or failure in exams. Suicide prevention centers can help reduce these incidents.

Suicide prevention can be achieved through tele-counseling or personal counseling for individuals in need. In India, there are suicide prevention centers such as Sneha in Chennai and Sahara in Mumbai that are doing very effective work in reducing such incidents.

Q.3 Write Short answers (ANY TWO) 2×6=12

a. The Mental Health Act

Mental Health Act 1987

History:

• The draft of the Mental Health Act was prepared by Parliament in 1987.
• It was implemented in April 1993 across all states and Union Territories of India.
• It replaced the Indian Lunacy Act of 1912.
• The Indian Lunacy Act of 1912 had earlier replaced the Indian Lunatic Asylum Act of 1858.

Definition:

The act is designed to “consolidate and amend the laws relating to the treatment and care of mentally ill persons, and for matters connected therewith or incidental thereto.”

The Mental Health Act is divided into 10 chapters and 98 sections.

Objectives:

1. Establish central and state authorities for licensing and supervision of psychiatric hospitals.
2. Establish psychiatric hospitals and nursing homes.
3. Oversee the operations of these hospitals.
4. Provide for the custody of mentally ill individuals who are unable to care for themselves and are a danger to themselves or others.
5. Protect society from dangerous expressions of mental illness.
6. Regulate the admission and discharge processes of mentally ill individuals.
7. Protect the rights of detained individuals.
8. Prevent unnecessary detention of citizens.
9. Cover the cost of maintenance for mentally ill individuals.
10. Provide legal aid to impoverished mentally ill offenders at state expense.
11. Revise the problematic definitions of mental illness in Indian Lunacy Act.

Licensing:

• No individual shall establish or maintain a psychiatric hospital or nursing home without a valid license from the central or state government.

Application for License:

• An individual intending to establish or maintain a psychiatric hospital or nursing home must apply to the licensing authority for a license if they do not already have a valid license.

License Duration and Renewal:

• Licenses are non-transferable or inheritable. Each license remains valid for five years from the date of issuance unless revoked earlier.

Admission and Detention in Psychiatric Hospitals:

1. Voluntary Admission:
2. Admission under Special Circumstances:
3. Reception Orders:

1. Voluntary Admission:

• Voluntary admission is made at the request of a guardian.
• Upon receiving the request, the Medical Officer-in-Charge must examine the individual within 24 hours and, if satisfied, may accept the request for voluntary admission.
• Each voluntary patient must adhere to the rules set by the Medical Officer.

2. Admission under Special Circumstances:

• Mentally ill individuals who do not express a desire or are unable to express a desire for admission can be admitted to a mental hospital and maintained as a patient based on an application made by their relatives or friends if the Medical Officer-in-Charge deems it necessary for the individual’s welfare.

3. Reception Orders:

• Applications for reception orders can be made by:
• The Medical Officer-in-Charge
• The spouse or other relative of the mentally ill person If the Medical Officer-in-Charge is satisfied that:
• The mentally ill person requires treatment in a psychiatric hospital for more than six months
• It is in the interest of the person’s health and safety or for the protection of others
• The application should be duly signed and verified with two medical certificates from different medical practitioners, one of whom should be in government service.

Discharge from Psychiatric Hospitals:

• Discharge by Medical Officer:
• On application, or on request, the Medical Officer may discharge a person if it is found that the person is mentally healthy.
• Discharge should be recommended by two medical practitioners, including at least one psychiatrist.
• A written order by the Medical Officer will direct the discharge from the psychiatric hospital.
• Voluntary Discharge:
• Any person who believes they have recovered from their mental illness while detained under a court order may apply to the magistrate for discharge.
• The application must be supported by a certificate from the Medical Officer or psychiatrist.
• After proper inquiry, the magistrate may order the discharge or dismiss the application.

Absence Leave:

• Applications for absence leave can be made to the Medical Officer-in-Charge by:
• The mentally ill person’s spouse or other relatives
• The person who made the admission application The application must include a bond ensuring:
• Proper care of the mentally ill person
• Prevention of harm to themselves or others
• Return of the mentally ill person to the hospital after the leave
• The Medical Officer-in-Charge may grant leave for a period not exceeding 60 days.

Antipsychotic Drugs

Antipsychotic drugs, also known as neuroleptics or tranquilizers, are used to treat psychotic disorders. Their primary use is for treating schizophrenia, but they are also useful for other psychotic disorders such as mania and bipolar disorder.

Classification of Antipsychotic Drugs:

1. First Generation:

• Also known as typical antipsychotic drugs, discovered in 1950. They are competitive inhibitors blocking D2 dopamine receptors.
• Examples:
  • Phenothiazines: Chlorpromazine, Perphenazine, Trifluoperazine, Thioridazine
  • Thioxanthenes: Chlorprothixene, Thioxthixene, Flupenthixol, Zuclopenthixol
  • Butyrophenones: Haloperidol
  • Dibenzothiazepine: Quetiapine

1. Second Generation:

• Also known as atypical antipsychotic drugs, which block both serotonin and dopamine receptors.
• Examples:
  • Clozapine
  • Risperidone
  • Olanzapine
  • Quetiapine
  • Ziprasidone

1. Third Generation:

• Example: Aripiprazole
• Acts as a partial agonist of dopamine.

Mechanism of Action:

• Antipsychotic drugs block D2 dopamine receptors in the brain, reducing the effects of dopamine and thus decreasing its effects. Excess dopamine release in the mesolimbic pathway causes psychotic symptoms. By blocking these receptors, antipsychotic drugs reduce dopamine production.
• Atypical antipsychotics block both dopamine and serotonin receptors.

Indications:

• Schizophrenia
• Bipolar disorder
• Delusional disorder
• Psychotic depression
• Asperger’s syndrome
• Post-traumatic stress disorder
• Anxiety
• Insomnia
• Autism
• Obsessive-compulsive disorder

Contraindications:

• Hypersensitivity
• Severe hypotension
• Liver, renal, and cardiac insufficiency
• CNS depression
• Cardiac dyscrasia
• Parkinson’s disease
• Comatose state
• Bone marrow depression

Side Effects:

• Extrapyramidal symptoms
• Hypotension
• Tachycardia
• Lethargy
• Drowsiness
• Seizures
• Nightmares
• Constipation
• Hyperprolactinemia
• Blurred vision
• Weight gain
• Sexual dysfunction

Nursing Responsibilities:

• Ensure the “Five Rights” of medication administration.
• Conduct a psychological assessment before administering antipsychotic drugs.
• Check for extrapyramidal symptoms.
• Monitor blood pressure.
• Assess vital signs.
• Check blood prolactin levels.
• In female patients, check for milk production in the breasts.
• Monitor for any adverse effects and discomfort.
• Maintain records and reports.

Extrapyramidal Symptoms:

• Acute Dystonia: Muscle spasms in neck, eyes, tongue, and jaw with involuntary muscle contractions.
• Akathisia: A movement disorder characterized by inner restlessness, making it difficult to sit or stand still.
• Pseudo Parkinsonism: Muscle rigidity and stiffness.
• Tardive Dyskinesia: Involuntary and irregular muscle movements, especially in the face.

Neuroleptic Malignant Syndrome:

• A life-threatening condition with symptoms like fever, muscle rigidity, autonomic dysfunction, and disturbed mental status.

c. Attitude and misconceptions towards mentally ill.

1. Mental illness is not real:
   Some people believe that mental illnesses are not legitimate medical conditions and that those who experience them are merely seeking attention or are dramatic. In reality, mental illnesses are medical conditions with biological and psychological bases.
2. Only “weak” people suffer from mental issues:
   One of the most common misconceptions about mental illness is that it only affects those who are emotionally weak or lack purpose in life. Since these conditions primarily result from chemical imbalances in the brain, they can affect anyone, including successful individuals.
3. Mental illness is not treatable:
   In reality, mental illnesses can be diagnosed, treated, and managed with appropriate care.
4. Mental illness is a permanent and unchangeable condition:
   While some mental health conditions may require ongoing management, many individuals with mental illness can recover, manage their symptoms, and lead fulfilling lives. With proper treatment, support, and self-care, people can experience improvements in their mental health and overall well-being.
5. People with mental illness are violent or dangerous:
   The reality is that most people with mental illnesses are not violent. Those with mental health conditions are more likely to be victims of violence or self-harm than to cause harm to others.
6. People with mental illness are unable to lead productive and fulfilling lives:
   This belief ignores the fact that many people with mental health conditions successfully manage their symptoms, obtain education, maintain careers, sustain relationships, and contribute to their communities.
7. Mental disorders are rare:
   Mental health conditions are actually very common. According to the World Health Organization, approximately 1 in 4 people will experience a mental health issue at some point in their lives. Mental illness affects individuals of all ages, genders, and socio-economic backgrounds.
8. People with mental disorders are lazy:
   In reality, it is the mental illnesses that make it difficult for individuals to function effectively. Half of those who leave work due to disability are actually suffering from psychological conditions.
9. People with mental illness have nothing positive to contribute:
   This belief disregards the valuable contributions that individuals with mental illness can make to society.
10. Only elderly people suffer from mental illnesses like depression:
    Mental health conditions such as depression can affect people of all ages, not just the elderly.

Q-4 Write Short Answers:(ANY THREE) 3×4=12

a. Types of Schizophrenia –

Types of schizophrenia
F 20-0 paranoid schizophrenia
F 20-1 hebephrenic schizophrenia
F 20-2 catatonic schizophrenia
F 20-3 undifferentiated schizophrenia
F 20-4 post – schizophrenic disorder
F 20-5 residual schizophrenia
F 20-6 simple schizophrenia
F 20-8 other schizophrenia
F 20-9 schizophrenia unspecified

Simple(undifferentiated) schizophrenia

Onset very slow

Onset is initially mostly during adolescence

B. Sign and symptoms
-Marked disturbance of interest in human relation, emotions and activity

Words of a particular type do not fit Fremian’s criteria Hallucinations and derivations are seen in rare cases Associative looseness is seen Unrealistic goals Interest is seen in early age but no interest in school or occupation in later age Does not take into account the criticisms of others Changes job frequently becomes lazy

• Hebephrenic schizophrenia
  a. Age and pattern of development
• Onset is insidious
• age varies between 12-15 years

Here’s the translation of the provided text:

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Signs and Symptoms

In comparison to other types of schizophrenia, there is a higher degree of personality disintegration in this form. Common symptoms include emotional indifference, carelessness, sadness, foolishness, inappropriate laughter, and a lack of respect for oneself. These individuals may laugh or smile inappropriately without any reason. Other common symptoms include:

• Visual hallucinations or delusions of fantasy.
• Bizarre behavior.
• Tendency to regress, such as exhibiting childlike behavior, soiling themselves, and not paying attention to personal hygiene.
• Eating with fingers, public masturbation (i.e., self-stimulation).

This type of behavior is known as hebephrenic schizophrenia.

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Catatonic Schizophrenia

a. Age and Pattern of Development

• Onset is very acute and sudden, typically occurring between the ages of 15 and 25 years.

b. Signs and Symptoms

• Two types of clinical pictures are observed.

1. Catatonic stupor
2. Catatonic excitement

1.Catatonic stupor:

Depression and Catatonia

In depression, the patient becomes uncommunicative, lost in their own thoughts, and exhibits emotional poverty and dreaminess. Symptoms include:

• Mutism: The patient may remain silent or unresponsive.
• Stupor: The patient might keep their face expressionless or continuously stare at one spot, or look downward.
• Fixed Postures: The patient may remain in a fixed position, such as standing still or sitting on the edge of the bed all day.
• Lapses: If not addressed, the patient may remain in the same position for days or weeks.

Negativism and Somatic Disturbances

• Negativism: The patient might refuse to eat or engage in activities. If not monitored, this can lead to significant issues.

2. Catatonic Excitement

In catatonic excitement, behavior is wild and unpredictable, with aggressive motor activity that lacks emotional expression. This is characterized by:

• Cold Approach: The person may suddenly attack others, break objects, tear their own clothes, and remain naked.
• Variety of Symptoms: It ranges from mutism to extreme agitation.
• Negativism: The patient may show oppositional behavior.
• Hallucinations: Auditory or visual hallucinations may be present.
• Sleeplessness: The patient may experience sleep disturbances.
• Sexual Behavior: There may be homosexual tendencies and antisocial behavior.
• Mood Fluctuations: Unlike mania, the patient does not consistently remain in a state of euphoria.

Paranoid Schizophrenia

A. Age and Pattern of Development

• The onset is gradual, though in some cases it can be acute.
• It typically occurs after the age of 30.

Sign and Symptoms

• Paranoid schizophrenia is the most common type of schizophrenia and is characterized by:
• Delusions: Common delusions include persecution, grandeur, and ideas of reference.
  • Delusion of Persecution: Believing that others are plotting against them.
  • Delusion of Grandeur: Believing they possess significant wealth or power.
  • Ideas of Reference: Believing that common elements of the environment are directly related to them.
• Hallucinations: Auditory hallucinations are very common, such as hearing voices giving commands or warnings, or commenting on the patient’s actions.
• Distrustful Behavior: Exhibiting a lack of trust in others, leading to social withdrawal.
• Attitude: A characteristic “shrugging off” or dismissive attitude, such as shrugging the shoulders and walking away from others.
• Defensive Reactions: Engaging in arguments, sarcasm, and refusal to accept suggestions.

Residual Schizophrenia

a. Sign and Symptoms

• This condition is diagnosed after the patient has previously had a diagnosis of schizophrenia but currently does not exhibit prominent symptoms.
• However, some residual symptoms may remain, including:
• Eccentric Behavior: Odd or unusual behavior.
• Emotional Blunting: Reduced emotional expression and responsiveness.
• Logical Thinking: The ability to think logically may be impaired.
• Social Withdrawal: The person may continue to withdraw from social interactions.
• Depression: Feelings of sadness or hopelessness.
• Fear and Breakdown: Experiences of fear and significant breakdowns, which might include nightmares.

b. Occupational therapy – Definition

The primary goal of occupational therapy is to enable people to participate in the activities of their daily life. Through occupational therapy, individuals are assisted in regaining their independence in daily living activities.

Some of the methods used in mental rehabilitation include housing placements (e.g., halfway homes, supervised housing) and vocational training (e.g., sheltered workshops, vocational counseling).

In mental health, the purpose of occupational therapy is to help individuals cope with the daily life challenges imposed by mental and emotional disorders.

Occupational therapists identify areas of difficulty and plan activities accordingly.

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Problem areas in psychiatric patients-

• Motor (eg psychomotor activity).
• Sensory (eg hallucinations, delusions)
• Cognitive (eg decision making, problem solving)
• Interpersonal (eg self-concept, emotions)
• Interpersonal (eg socialization, communication)
• Self-care (eg basic and instrumental activities of daily living)
• Productivity (eg work, job)
• Leisure (eg interests, enjoyable activities)

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

Learning Adaptive Activities

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

The nurse should perform an occupational assessment of the client

The client should be encouraged to become involved in occupational therapy

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

c. Role of nurse in community mental health services!

Nurses play an important role in providing community mental health services.
Nurses play many roles when providing community mental health services.

• Care provider
• Educator
• Leader
• Domiciliary role
• Liaison
• Counselor
• Coordinator
• Administrator
• Advocator
• Research work
• Care provider

A nurse provides care to a mentally ill patient and provides guidance to family members on how to care for the mentally ill patient at home.

Educator :

• The nurse provides education about how to promote mental health to people in the community.
• Makes people aware of the misconceptions about mental health in the community.
• Goes to the community and organizes various programs and educates people about the promotion of mental health and prevention of mental illness.

Laision :

• Listen means contact
• The nurse works as a liaison officer and acts as a link between the patient, his family members, the mental health care team, and other members.

Domiciliary :

• A nurse provides domiciliary services.
• He visits the community and knows the status of the people in the community.
• If a person with mental illness is detected, he is provided care and referred to a psychiatrist.

Cuonseller :

• A nurse provides counseling services to the patient, his family members, and the community.
• For example, if there is a traceful situation or life event, counseling services are provided.

Coordinator :

(Coordinator) The nurse works to coordinate between the various members of the mental health team so that good care can be provided and accessed by the people in the community.

Advocator :

A nurse works as an advocate. He helps the patient in taking decisions and fights for the patient’s rights.

Administrator :

The nurse plays the role of administrator. Such as where in the community to program and how to program and provide resources for that.

Evaluator :

(Evaluator)-Evaluates various programs done in the community and knows about their impact on the people.

Reserach :

A nurse plays an important role in research work by observing the diagnosis and treatment of patients and doing research on them.

d. Difference between endogenous depression and exogenous depression.

Here is the translation of the provided text:

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Endogenous Depression vs. Exogenous Depression

• Endogenous Depression
  The term “endogenous” means “from within.”
  It is also known as “psychotic depression.”
  Endogenous depression does not arise from an external cause but is due to internal factors.
  It is more commonly seen in individuals with low socio-economic conditions.
  There is usually a lack of precipitating factors or only minimal ones present.
  Depression is more pronounced in the morning.
  It exhibits high intensity and psychomotor retardation.
  Individuals may have a mesomorphic personality type.
  There is typically a lack of interest in sexual activity.
  Severe thought disturbances are present, but suicidal thoughts are not usually observed.
  Insight is absent, meaning the patient may not be aware of their condition.
  Such patients prefer to be alone.
  Diagnosis can be made through interviews, psychoanalysis, sharp observation, and process recording.
  Drug therapy along with electroconvulsive therapy may be required.
  There is a higher chance of recurrence.
• Exogenous Depression
  The term “exogenous” means “from without.”
  It is also known as “neurotic depression.”
  Exogenous depression arises from an external cause, such as a stressful or traumatic event.
  It is more commonly seen in individuals with middle and high socio-economic conditions.
  Precipitating factors are present.
  Depression is less noticeable in the morning.
  It exhibits low intensity and psychomotor agitation.
  There is no specific type of personality commonly associated.
  Patients feel comforted by sexual activity.
  Suicidal thoughts are present.
  Insight is present, meaning the patient is aware of their condition.
  Such patients prefer to be in groups.
  Diagnosis can be made through interviews and observation.
  Treatment involves drug therapy, social therapy, and psycho therapy.
  The chance of recurrence is relatively low.

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Q-5 Define (ANY SEX) 2×6=12

a. Hallucination- The experience of perception (sensation) without any external stimulation is called hallucination. In which there is no stimulation, the patient experiences a perception which is not reality.

D. Auditory hallucinations are when the patient hears different external sounds that are not there in reality.

Here’s the translation of the provided text:

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b. Negativism

Negativism is the tendency to resist external commands, suggestions, or expectations, or internal stimuli, by doing the opposite or behaving in a way unrelated to the stimulus. This is commonly observed in schizophrenia, where the individual’s behavior is contrary to the commands or stimuli received, and this resistance is referred to as negativism.

c. Echopraxia

Echopraxia is when a patient mimics the actions of another person. For example, if the examiner raises one hand, the patient will also raise their hand in imitation. This behavior of copying actions is called echopraxia.

d. Phobia

Phobia is an anxiety disorder characterized by an intense, persistent, and excessive fear of a specific object or situation, which is not typically seen in individuals of the same age group.

e. Projection

Projection is a frequently used defense mechanism in which an individual attributes their own unacceptable thoughts, feelings, or desires to others. In projection, a person blames others for their own mistakes. For example, if an ex-student fails an exam, they might blame the examiner, claiming that the examiner did not grade the papers correctly.

f. Identification

Identification involves an individual copying another person’s voice, ideas, clothes, personality, mannerisms, appearance, and behavior, and trying to resemble that person. For instance, if someone wants to look like Shah Rukh Khan, they might imitate Shah Rukh Khan’s clothing, style, and voice.

g. Tolerance

Tolerance refers to the body’s adaptation to a substance (such as drugs) over time, requiring increasing amounts of the substance to achieve the same effects. When an individual develops tolerance, they need to consume more of the substance to experience the same impact, which is also known as the capacity for tolerance.

h. Seclusion

Seclusion means keeping a patient in isolation or confinement against their will. This is often done to prevent harm to others when the patient displays violent behavior, or when they engage in self-destructive activities. Keeping such individuals isolated is considered a good management practice and is referred to as seclusion.

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Q-6 A. Fill in the blanks:- 05

1.Fear of closed place is known as clustrophobia

2.Mental mechansims are also called as…………………… . Defence mechanisms

3.The maximum score of MMSE is………….૩૦

,4.Inability to experience pleasure in any activity is known as……..Anhedonia

5.International classification of disease, a book published by the (W.H.O)

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

1.An amount of current passed during ECT is 170-220 volts. False

2.Flooding therapy is used in OCD. False

3.Psychosis is å mild to moderate illness of the personality. False

4.Social phobia is defined as a strong, persiting fear on object or situtation. Right

5.Mental illness is riot due io the possession of evil spirits. Right