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PHC-MHN-Psychiatric Emergencies and Crisis-SYNOPSIS

🚨🧠 Psychiatric Emergency – Overactive Patient

📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Mental Health Nursing Exams

🔰 What is a Psychiatric Emergency?

A psychiatric emergency is a sudden disturbance in thought, behavior, or mood that poses an immediate threat to the patient or others, requiring urgent intervention.

🚨 What is Overactive Behavior in Psychiatric Emergency?

An overactive psychiatric patient is one who shows excessive physical and emotional activity, which may lead to aggression, violence, impulsiveness, or self-harm.

🧭 Common Causes of Overactive Behavior:

  • 🧠 Mania (Bipolar Disorder)
  • 🧠 Schizophrenia (especially paranoid type)
  • 🧠 Drug intoxication (e.g., cocaine, alcohol withdrawal)
  • 🧠 Delirium / Psychosis
  • 🧠 Personality Disorders (Antisocial, Borderline)
  • 🧠 Dementia with agitation

🟥 Clinical Manifestations:

  • 🔥 Hyperactivity and restlessness
  • 🔊 Loud, rapid speech
  • 💢 Aggression or violence toward self/others
  • 😠 Irritability and impulsiveness
  • 🤯 Hallucinations or delusions
  • 🚫 Non-cooperation or resistance to care
  • 🌀 Disorganized behavior

👩‍⚕️ Nursing Management of Overactive Psychiatric Patient:

🟩 1. Ensure Safety (Top Priority)

🔹 Protect patient, staff, and others
🔹 Remove harmful objects
🔹 Place in low-stimulus, calm room if possible

🟨 2. De-escalation Techniques

🔹 Use calm, non-threatening voice
🔹 Maintain safe distance, avoid sudden touch
🔹 Show empathy and avoid arguments
🔹 Use simple, clear instructions
🔹 Attempt verbal reassurance and redirection

🟧 3. Pharmacological Interventions

🔹 Rapid tranquilization (e.g., IM Lorazepam, Haloperidol)
🔹 Monitor vitals post-medication
🔹 Administer meds only on order from psychiatrist/doctor

🟥 4. Use of Physical Restraint (If Necessary)

🔹 Only if patient becomes violent or uncontrollable
🔹 Must be:

  • Legally authorized
  • Time-limited
  • Monitored every 15–30 mins
  • Documented in detail

🟦 5. Continuous Observation & Documentation

🔹 Keep close observation (1:1 if required)
🔹 Monitor behavior, response to meds, vitals
🔹 Record all nursing actions and incidents

🟩 6. Psychosocial Support (Post-crisis)

🔹 Help patient understand episode
🔹 Offer counseling, therapy referrals
🔹 Involve family in follow-up care

📚 Golden One-Liners for Revision:

  • 🟨 Overactive behavior = emergency + safety risk
  • 🟨 Use verbal de-escalation before physical or drug use
  • 🟨 Rapid tranquilization = IM haloperidol + lorazepam
  • 🟨 Restraint is last resort + legally regulated
  • 🟨 Priority = safety, calm environment, close monitoring

✅ Top 5 MCQs for Practice:

Q1. What is the nurse’s first action for an overactive and aggressive patient?

🅰️ Apply restraints immediately
🅱️ Give sedatives
✅ 🅲️ Ensure safety of the patient and others
🅳️ Start counseling
Correct Answer: 🅲️ Ensure safety of the patient and others
Rationale: Safety is always the first priority.

Q2. Which drug is commonly used for rapid tranquilization in psychiatric emergencies?

🅰️ Paracetamol
🅱️ Diazepam
✅ 🅲️ Haloperidol
🅳️ Amoxicillin
Correct Answer: 🅲️ Haloperidol
Rationale: Haloperidol is a standard antipsychotic used for managing agitation.

Q3. When can physical restraint be used?

🅰️ When patient refuses food
🅱️ When nurse feels insulted
✅ 🅲️ When the patient is violent and poses a risk
🅳️ When patient does not cooperate
Correct Answer: 🅲️ When the patient is violent and poses a risk
Rationale: Restraints must be used only as a last option for safety.

Q4. Which communication technique is best for calming an overactive patient?

🅰️ Yelling to control behavior
🅱️ Giving multiple instructions quickly
✅ 🅲️ Speaking calmly and using simple words
🅳️ Ignoring the patient
Correct Answer: 🅲️ Speaking calmly and using simple words
Rationale: De-escalation begins with clear, calm communication.

Q5. What is the role of the nurse after restraining a violent patient?

🅰️ Leave patient alone
🅱️ Do not document
✅ 🅲️ Monitor and reassess regularly
🅳️ Remove all medication
Correct Answer: 🅲️ Monitor and reassess regularly
Rationale: Continuous observation ensures patient safety and legal compliance.

🧠🛏️ Psychiatric Emergency – Underactive Patient

📘 Important for GNM/BSc Nursing, AIIMS, NHM, NORCET, GPSC & Mental Health Nursing Exams

🔰 What is an Underactive Psychiatric Emergency?

An underactive psychiatric patient exhibits severely reduced physical, mental, and emotional activity, often appearing withdrawn, unresponsive, or mute, and may pose a life risk due to immobility, refusal to eat, or self-neglect.

✅ It is a psychiatric emergency requiring urgent intervention to prevent complications like malnutrition, pressure sores, or suicide.

🧭 Common Conditions Causing Underactive Behavior:

  • 🧠 Severe Depression with psychomotor retardation
  • 🧠 Catatonia (esp. in schizophrenia)
  • 🧠 Stupor / Akinetic mutism
  • 🧠 Post-ictal state (after seizure)
  • 🧠 Drug overdose or CNS depressants
  • 🧠 Neurological conditions (e.g., encephalitis)

🟥 Clinical Manifestations:

  • 💤 Lethargy, mutism, stupor
  • 🚶‍♀️ Little to no movement (akinesia)
  • ❌ Refusal to eat or drink
  • 😶 No communication or eye contact
  • 🛏️ Lying in bed for hours, immobile
  • 🆘 Risk of dehydration, DVT, pressure ulcers, aspiration

👩‍⚕️ Nursing Management of Underactive Psychiatric Patient:

🟩 1. Ensure Medical Stability and Safety

🔹 Check vitals, hydration, glucose levels
🔹 Prevent bed sores, aspiration, and falls
🔹 Turn the patient every 2 hours if immobile

🟨 2. Assessment and Monitoring

🔹 Evaluate for depression, catatonia, or overdose
🔹 Conduct mental status exam
🔹 Monitor fluid intake/output, nutrition, and sleep

🟧 3. Emergency Medical & Psychiatric Treatment

🔹 Start IV fluids or feeding if needed
🔹 Medications:

  • Catatonia → Lorazepam trial or ECT
  • Depression → Antidepressants under supervision

🟥 4. Communication and Emotional Support

🔹 Use gentle verbal stimulation
🔹 Talk to the patient even if they don’t respond
🔹 Maintain calm, supportive presence

🟦 5. Referral for ECT (Electroconvulsive Therapy)

🔹 Effective for:

  • Catatonic schizophrenia
  • Severe suicidal depression

🟩 6. Nutrition and Hydration Support

🔹 May require NG tube feeding or IV fluids
🔹 Monitor for electrolyte imbalance

🟨 7. Documentation and Legal Compliance

🔹 Record all observations, interventions, and patient response
🔹 Ensure informed consent or involve nominated representative (NR) if needed

📚 Golden One-Liners for Quick Revision:

  • 🟨 Underactive patients are at risk of death from neglect
  • 🟨 Common in severe depression and catatonia
  • 🟨 Lorazepam trial or ECT may be life-saving
  • 🟨 Focus = safety, nutrition, hydration, skin care
  • 🟨 Speak gently and observe for response signs

✅ Top 5 MCQs for Practice:

Q1. Which of the following conditions is commonly associated with underactive behavior?

🅰️ Mania
🅱️ Panic disorder
✅ 🅲️ Catatonic schizophrenia
🅳️ Alcohol withdrawal
Correct Answer: 🅲️ Catatonic schizophrenia
Rationale: Catatonia can lead to stupor, mutism, and immobility.

Q2. What is the major risk for a completely immobile underactive patient?

🅰️ Obesity
✅ 🅱️ Pressure sores and aspiration
🅲️ Aggression
🅳️ Hyperactivity
Correct Answer: 🅱️ Pressure sores and aspiration
Rationale: Immobility causes complications like bed sores and choking.

Q3. Which emergency treatment is used for catatonia?

🅰️ Diazepam
🅱️ Fluoxetine
✅ 🅲️ Lorazepam and/or ECT
🅳️ Risperidone only
Correct Answer: 🅲️ Lorazepam and/or ECT
Rationale: Lorazepam and ECT are first-line for catatonic states.

Q4. The nurse observes a psychiatric patient lying mute, still, and refusing food. What is the immediate action?

🅰️ Leave them alone
🅱️ Give verbal punishment
✅ 🅲️ Monitor vitals and start IV fluids if ordered
🅳️ Restrain the patient
Correct Answer: 🅲️ Monitor vitals and start IV fluids if ordered
Rationale: This prevents complications from malnutrition/dehydration.

Q5. What communication approach is ideal for an underactive psychiatric patient?

🅰️ Loud, commanding tone
🅱️ Repeated questioning
✅ 🅲️ Calm voice with patience
🅳️ Avoid talking to them
Correct Answer: 🅲️ Calm voice with patience
Rationale: Gentle interaction encourages patient trust and recovery.

⚠️🧠 Psychiatric Emergency – Violent Behavior

📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Mental Health Nursing Exams

🔰 What is Violent Behavior in Psychiatry?

Violent behavior is an immediate, aggressive, and potentially harmful action by a psychiatric patient that poses a threat to self, others, or property.
✅ It is considered a psychiatric emergency requiring urgent, skilled intervention to prevent harm.

🧭 Common Causes of Violent Behavior:

  • 🔥 Acute psychosis (e.g., paranoid schizophrenia)
  • 🔥 Mania with irritability
  • 🔥 Alcohol or substance intoxication/withdrawal
  • 🔥 Delirium or organic brain syndrome
  • 🔥 Personality disorders (especially antisocial/borderline)
  • 🔥 History of trauma or abuse

🟥 Clinical Features of Violent Behavior:

  • 😡 Verbal threats and shouting
  • ✊ Pacing, clenched fists, and threatening posture
  • 🚫 Refusal to cooperate
  • 💢 Destroying objects, hitting others
  • 🤯 Hallucinations commanding violence
  • 🆘 Attempted harm to self/others

👩‍⚕️ Nursing Management of Violent Behavior:

🟩 1. Ensure Safety First

🔹 Protect patient, staff, and other patients
🔹 Remove sharp or dangerous objects
🔹 Call for help or security if needed
🔹 Keep exit accessible to staff

🟨 2. De-escalation Techniques

🔹 Speak calmly, clearly, and respectfully
🔹 Avoid eye contact or physical closeness
🔹 Do not argue or threaten
🔹 Give space and time for patient to express emotions

🟧 3. Pharmacological Management (Rapid Tranquilization)

🔹 Common drugs:

  • Haloperidol (5 mg IM)
  • Lorazepam (2 mg IM)
  • Or combination
    🔹 Monitor for side effects and vitals

🟥 4. Physical Restraint (Last Resort)

🔹 Use only if absolutely necessary
🔹 Requires physician order
🔹 Follow protocols strictly:

  • Explain to patient
  • Use minimum force
  • Monitor every 15–30 minutes
  • Document everything

🟦 5. Continuous Observation and Documentation

🔹 Observe behavior, speech, triggers
🔹 Record medications given, time, and effect
🔹 Monitor for recurrence or escalation

🟩 6. Post-Crisis Counseling and Care

🔹 Once calm, debrief the patient
🔹 Explore reasons for violence
🔹 Involve psychiatrist, social worker, or family
🔹 Plan future behavioral therapy or medication adjustment

📚 Golden One-Liners for Revision:

  • 🟨 Violent behavior = high risk for injury or death
  • 🟨 De-escalation is first line approach
  • 🟨 Rapid tranquilization = Haloperidol + Lorazepam IM
  • 🟨 Restraint = last resort + legal documentation required
  • 🟨 Continuous monitoring is critical in violent cases

✅ Top 5 MCQs for Practice:

Q1. What is the first priority when managing a violent psychiatric patient?

🅰️ Give medication
🅱️ Restrain immediately
✅ 🅲️ Ensure safety of all involved
🅳️ Call family
Correct Answer: 🅲️ Ensure safety of all involved
Rationale: Preventing harm is always the first step.

Q2. Which combination is commonly used for rapid tranquilization?

🅰️ Paracetamol + Diazepam
🅱️ Haloperidol + Amoxicillin
✅ 🅲️ Haloperidol + Lorazepam
🅳️ Risperidone + Aspirin
Correct Answer: 🅲️ Haloperidol + Lorazepam
Rationale: These are standard drugs used IM for calming severe aggression.

Q3. When should physical restraint be used?

🅰️ When the nurse is tired
🅱️ When patient refuses food
✅ 🅲️ When patient becomes violent and uncontrollable
🅳️ When the patient asks for it
Correct Answer: 🅲️ When patient becomes violent and uncontrollable
Rationale: Restraints are used only if other methods fail.

Q4. Which of the following is an important part of de-escalation?

🅰️ Yelling loudly
🅱️ Arguing with patient
✅ 🅲️ Speaking calmly with open body language
🅳️ Standing too close to patient
Correct Answer: 🅲️ Speaking calmly with open body language
Rationale: Calm communication reduces aggression.

Q5. What is essential after using restraints on a violent patient?

🅰️ Ignore the patient
🅱️ Avoid documentation
✅ 🅲️ Monitor continuously and document legally
🅳️ Give physical punishment
Correct Answer: 🅲️ Monitor continuously and document legally
Rationale: Legal protection and patient safety depend on this.

⚠️🧠 Psychiatric Emergency – Suicide

📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Mental Health Nursing Exams

🔰 What is Suicide in Psychiatry?

Suicide is a deliberate act of self-harm or self-inflicted death resulting from severe emotional distress, mental illness, or hopelessness.
✅ It is a psychiatric emergency that demands immediate intervention to save life.

🧭 Types of Suicidal Behavior:

  • 🟥 Suicidal Ideation: Thinking or planning suicide
  • 🟥 Suicidal Threats: Verbal or written expressions
  • 🟥 Suicidal Attempts: Actual effort made to die
  • 🟥 Completed Suicide: Successful fatal act

⚠️ Common Psychiatric Conditions Linked to Suicide:

  • 🔹 Major depression
  • 🔹 Bipolar disorder
  • 🔹 Schizophrenia
  • 🔹 Substance abuse
  • 🔹 Borderline personality disorder
  • 🔹 PTSD
  • 🔹 Chronic physical illness (e.g., cancer, HIV)

🚩 Warning Signs of Suicide:

  • 🗣️ Talking about death or suicide
  • 😞 Expressing hopelessness
  • 😔 Withdrawing from social contact
  • 📝 Giving away belongings or writing a will
  • 😐 Sudden calmness after depression
  • ⚰️ Previous suicide attempts
  • 💊 Hoarding pills, weapons

👩‍⚕️ Nursing Management of Suicidal Patient:

🟩 1. Immediate Safety Measures

🔹 Do not leave the patient alone
🔹 Remove sharp objects, belts, medications, ropes
🔹 Place in a safe and secure environment

🟨 2. Risk Assessment

🔹 Ask direct but gentle questions:
“Are you thinking about hurting yourself?”
🔹 Evaluate:

  • Plan?
  • Method?
  • Access to means?
  • Past attempts?

🟧 3. Maintain 24-Hour Observation (1:1 Monitoring)

🔹 Use suicide precautions
🔹 Observe behavior continuously
🔹 Document every 15–30 minutes

🟥 4. Build Therapeutic Communication

🔹 Use empathetic, non-judgmental approach
🔹 Encourage expression of feelings
🔹 Offer hope and emotional support
🔹 Avoid false reassurance

🟦 5. Medication and Therapy Support

🔹 Administer antidepressants, mood stabilizers, antipsychotics as prescribed
🔹 Refer for:

  • Cognitive Behavioral Therapy (CBT)
  • Crisis intervention
  • Family therapy

🟩 6. Involve Family and Support System

🔹 Educate on warning signs
🔹 Encourage active family involvement
🔹 Help build protective factors (hope, relationships)

🟨 7. Legal and Ethical Aspects (MHCA 2017)

🔹 Suicide attempt is decriminalized (Section 115)
🔹 Assumed to be due to mental illness
🔹 Patient must receive treatment, not punishment

📚 Golden One-Liners for Revision:

  • 🟨 Suicide attempt = psychiatric emergency
  • 🟨 Never leave suicidal patient alone
  • 🟨 Suicide warning signs must be actively asked
  • 🟨 Section 115 of MHCA 2017: Suicide is not a crime
  • 🟨 Suicide precautions = remove all lethal objects

✅ Top 5 MCQs for Practice:

Q1. What is the nurse’s top priority for a suicidal patient?

🅰️ Provide group therapy
🅱️ Ask family to monitor
✅ 🅲️ Ensure constant observation and safety
🅳️ Start discharge planning
Correct Answer: 🅲️ Ensure constant observation and safety
Rationale: Suicidal patients must be monitored closely to prevent harm.

Q2. What does MHCA 2017 state about suicide attempts?

🅰️ It is punishable by jail
✅ 🅱️ It is presumed to be due to mental illness and is decriminalized
🅲️ It is a social sin
🅳️ Only females are protected
Correct Answer: 🅱️ It is presumed to be due to mental illness and is decriminalized
Rationale: Section 115 provides legal protection and mandates care.

Q3. Which of the following is a warning sign of suicide?

🅰️ Improved appetite
🅱️ Planning vacation
✅ 🅲️ Giving away personal belongings
🅳️ Talking about promotion
Correct Answer: 🅲️ Giving away personal belongings
Rationale: This may indicate preparation for suicide.

Q4. What is the most appropriate way to assess suicide risk?

🅰️ Avoid the topic
🅱️ Wait for the patient to talk
✅ 🅲️ Ask direct questions respectfully
🅳️ Assume the patient is fine
Correct Answer: 🅲️ Ask direct questions respectfully
Rationale: Asking directly helps identify risk and plan safety.

Q5. A suicidal patient expresses guilt and hopelessness. What is the best nursing response?

🅰️ “You’ll be fine tomorrow.”
🅱️ “Ignore your feelings.”
✅ 🅲️ “I’m here to support you. Tell me more.”
🅳️ “You should be thankful.”
Correct Answer: 🅲️ “I’m here to support you. Tell me more.”
Rationale: Empathy builds trust and encourages expression.

💊⚠️ Adverse Drug Reactions (ADRs)

📘 Important for GNM/BSc Nursing, AIIMS, NHM, NORCET, GPSC & Pharmacology/Nursing Exams

🔰 What Are Adverse Drug Reactions (ADRs)?

An Adverse Drug Reaction (ADR) is a harmful, unintended, and undesired effect of a drug that occurs at normal doses used for prevention, diagnosis, or treatment.
✅ ADRs may range from mild rashes to life-threatening reactions like anaphylaxis.

🧭 Classification of ADRs (Based on Mechanism):

🟩 Type A (Augmented)

  • Predictable, dose-related
  • Due to exaggerated pharmacologic effect
  • 🔹 Examples:
    • Bleeding with warfarin
    • Hypoglycemia with insulin

🟨 Type B (Bizarre)

  • Unpredictable, not dose-related
  • Often allergic or idiosyncratic
  • 🔹 Examples:
    • Anaphylaxis with penicillin
    • Stevens-Johnson syndrome with sulfa drugs

🟧 Type C (Chronic)

  • Occurs with long-term drug use
  • 🔹 Example:
    • Tardive dyskinesia from antipsychotics

🟥 Type D (Delayed)

  • Appears after a long time, even after stopping the drug
  • 🔹 Example:
    • Cancer due to chemotherapy

🟦 Type E (End of Use)

  • Withdrawal reactions
  • 🔹 Example:
    • Seizures after stopping benzodiazepines suddenly

🟪 Type F (Failure of Therapy)

  • Drug fails to produce intended effect
  • 🔹 Example:
    • Antibacterial resistance due to poor dosing

⚠️ Common Examples of ADRs:

DrugAdverse Reaction
PenicillinAnaphylaxis
AspirinGastric ulcer, bleeding
AminoglycosidesOtotoxicity, nephrotoxicity
PhenytoinGum hyperplasia
ClozapineAgranulocytosis
RifampicinOrange-colored urine
IsoniazidHepatotoxicity, peripheral neuropathy

👩‍⚕️ Nurse’s Responsibilities in ADRs:

🟩 1. Observation and Early Detection

🔹 Monitor for rash, swelling, vital changes, breathing difficulty, etc.
🔹 Identify any new symptoms after drug initiation

🟨 2. Documentation and Reporting

🔹 Record time of reaction, drug involved, symptoms
🔹 Use ADR reporting forms (e.g., Pharmacovigilance Programme of India – PvPI)

🟧 3. Immediate Management

🔹 Stop the offending drug
🔹 Administer emergency treatment (e.g., epinephrine for anaphylaxis)
🔹 Notify the doctor immediately

🟥 4. Patient Education

🔹 Educate about possible side effects
🔹 Advise on when to seek help
🔹 Instruct to avoid re-exposure to known allergens

🟦 5. Preventive Measures

🔹 Check drug history and allergies before administration
🔹 Follow 5 rights of medication administration (right drug, dose, route, time, patient)

📚 Golden One-Liners for Quick Revision:

  • 🟨 ADR = Unintended and harmful drug response at normal doses
  • 🟨 Type A = common, predictable; Type B = rare, unpredictable
  • 🟨 Anaphylaxis = medical emergency, treated with epinephrine
  • 🟨 Nurses play a key role in early detection and reporting of ADRs
  • 🟨 PvPI = Pharmacovigilance Programme of India for ADR reporting

✅ Top 5 MCQs for Practice:

Q1. Which of the following is a Type B (bizarre) adverse drug reaction?

🅰️ Hypoglycemia with insulin
🅱️ Diarrhea with antibiotics
✅ 🅲️ Anaphylaxis with penicillin
🅳️ Drowsiness with antihistamines
Correct Answer: 🅲️ Anaphylaxis with penicillin
Rationale: Type B reactions are unpredictable and immune-mediated.

Q2. Which drug can cause gum hyperplasia as an ADR?

🅰️ Carbamazepine
✅ 🅱️ Phenytoin
🅲️ Rifampicin
🅳️ Lithium
Correct Answer: 🅱️ Phenytoin
Rationale: Phenytoin is known to cause gum hypertrophy.

Q3. What is the immediate management of anaphylactic shock due to drug allergy?

🅰️ Start antibiotics
🅱️ Give paracetamol
✅ 🅲️ Administer epinephrine
🅳️ Apply ice pack
Correct Answer: 🅲️ Administer epinephrine
Rationale: Epinephrine is the drug of choice for anaphylaxis.

Q4. Type C adverse drug reactions are usually associated with:

🅰️ Overdose
🅱️ Allergies
✅ 🅲️ Long-term use
🅳️ Early use
Correct Answer: 🅲️ Long-term use
Rationale: Type C reactions are dose- and time-related.

Q5. Which Indian program monitors adverse drug reactions?

🅰️ ICDS
🅱️ MGNREGA
✅ 🅲️ Pharmacovigilance Programme of India (PvPI)
🅳️ NDPS Act
Correct Answer: 🅲️ PvPI
Rationale: PvPI is the official ADR reporting program in India.

🚫💊 Withdrawal Symptoms

📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Mental Health Nursing Exams

🔰 What Are Withdrawal Symptoms?

Withdrawal symptoms are the physical and psychological reactions that occur when a person stops or reduces the intake of a habit-forming substance (e.g., alcohol, opioids, nicotine, benzodiazepines, etc.).

✅ These symptoms occur due to dependence and sudden absence of the drug from the body.

🧭 Causes of Withdrawal Symptoms:

  • 🔹 Physical dependence on a substance
  • 🔹 Abrupt discontinuation of drugs (without tapering)
  • 🔹 Long-term use of CNS depressants or stimulants
  • 🔹 Substance use disorders (addiction)

🟨 Common Substances & Their Withdrawal Symptoms:

🟥 1. Alcohol Withdrawal

🕒 Begins within 6–12 hours after stopping

Symptoms:

  • Tremors (shakes)
  • Nausea, vomiting
  • Anxiety, irritability
  • Sweating, tachycardia
  • Insomnia
  • Severe: Delirium tremens (DTs) – hallucinations, seizures

🟧 2. Opioid Withdrawal (e.g., heroin, morphine)

🕒 Begins within 12–24 hours

Symptoms:

  • Muscle aches
  • Runny nose, yawning
  • Abdominal cramps, diarrhea
  • Goosebumps (“cold turkey”)
  • Anxiety, sweating

🟩 3. Benzodiazepine Withdrawal (e.g., diazepam, lorazepam)

🕒 Begins within 1–4 days

Symptoms:

  • Anxiety, restlessness
  • Tremors
  • Insomnia
  • Seizures (can be life-threatening)
  • Confusion

🟦 4. Nicotine Withdrawal

🕒 Starts within 1–2 hours

Symptoms:

  • Irritability, frustration
  • Increased appetite
  • Craving
  • Anxiety
  • Sleep disturbances

🟪 5. Cocaine/Amphetamine Withdrawal

🕒 Begins within hours

Symptoms:

  • Depression
  • Fatigue, sleepiness
  • Increased appetite
  • Drug craving
  • Suicidal thoughts

👩‍⚕️ Nursing Management of Withdrawal:

✅ 1. Assessment and Monitoring

🔹 Monitor vitals, neurological signs
🔹 Use withdrawal assessment tools (e.g., CIWA-Ar for alcohol)

✅ 2. Safe Environment

🔹 Reduce stimuli
🔹 Maintain hydration and nutrition
🔹 Provide quiet room and support

✅ 3. Pharmacological Support

🔹 Alcohol: Benzodiazepines (e.g., diazepam, lorazepam)
🔹 Opioids: Methadone, buprenorphine
🔹 Benzos: Gradual tapering
🔹 Nicotine: Nicotine patches/gum
🔹 Cocaine: Supportive care, antidepressants

✅ 4. Psychological Support

🔹 Use reassurance, empathy
🔹 Provide counseling and motivation
🔹 Educate patient and family on relapse prevention

✅ 5. Referral to De-addiction Programs

🔹 Link to rehabilitation centers, support groups
🔹 Encourage long-term follow-up

📚 Golden One-Liners for Quick Revision:

  • 🟨 Withdrawal = effect of suddenly stopping addictive substance
  • 🟨 Alcohol withdrawal can lead to Delirium Tremens (DTs)
  • 🟨 Benzodiazepine withdrawal can cause seizures
  • 🟨 Opioid withdrawal is unpleasant but not fatal
  • 🟨 Nicotine withdrawal causes irritability & craving

✅ Top 5 MCQs for Practice:

Q1. Which of the following is a serious complication of alcohol withdrawal?

🅰️ Constipation
🅱️ Anxiety
✅ 🅲️ Delirium Tremens
🅳️ Euphoria
Correct Answer: 🅲️ Delirium Tremens
Rationale: DTs are severe, life-threatening reactions to alcohol withdrawal.

Q2. “Cold turkey” symptoms like goosebumps are associated with withdrawal from:

🅰️ Nicotine
🅱️ Alcohol
✅ 🅲️ Opioids
🅳️ Benzodiazepines
Correct Answer: 🅲️ Opioids
Rationale: Goosebumps and flu-like symptoms are classic signs of opioid withdrawal.

Q3. Which medication is used to manage alcohol withdrawal?

🅰️ Fluoxetine
🅱️ Methadone
✅ 🅲️ Lorazepam
🅳️ Nicotine gum
Correct Answer: 🅲️ Lorazepam
Rationale: Benzodiazepines are first-line drugs for alcohol withdrawal.

Q4. Which of the following withdrawal symptoms is potentially fatal?

🅰️ Irritability with nicotine
🅱️ Craving from cocaine
✅ 🅲️ Seizures from benzodiazepine withdrawal
🅳️ Yawning in opioid withdrawal
Correct Answer: 🅲️ Seizures from benzodiazepine withdrawal
Rationale: Abrupt withdrawal from benzos can cause seizures.

Q5. Which of the following is not a typical withdrawal symptom of cocaine?

🅰️ Depression
🅱️ Sleepiness
🅲️ Increased appetite
✅ 🅳️ Hallucinations
Correct Answer: 🅳️ Hallucinations
Rationale: Hallucinations are more common in intoxication, not withdrawal.

🧠🔥 Acute Psychosis

📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Mental Health Nursing Exams

🔰 What is Acute Psychosis?

Acute psychosis is a sudden onset of severe mental disturbance in which a person loses touch with reality, experiences hallucinations, delusions, disorganized thinking, and may pose a risk to self or others.
✅ It is a psychiatric emergency requiring urgent intervention.

🧭 Causes / Etiology of Acute Psychosis:

  • 🔹 Schizophrenia (acute episode)
  • 🔹 Substance-induced psychosis (alcohol, cannabis, cocaine)
  • 🔹 Bipolar disorder (manic phase)
  • 🔹 Severe depression with psychotic features
  • 🔹 Delirium / Organic brain disorder
  • 🔹 Stress-related psychosis (brief psychotic disorder)
  • 🔹 Infections (e.g., encephalitis)
  • 🔹 Brain tumor or epilepsy

🧠 Common Signs and Symptoms:

🟥 1. Perceptual Disturbances

  • Hallucinations (auditory most common)
  • Seeing or hearing things that aren’t there

🟧 2. Thought Disturbances

  • Delusions (false fixed beliefs – e.g., persecution, grandeur)
  • Thought blocking or disorganization

🟨 3. Behavioral Changes

  • Agitation or overactivity
  • Social withdrawal
  • Inappropriate behavior or clothing

🟩 4. Speech Disturbances

  • Incoherent or irrelevant speech
  • Neologisms (made-up words)

🟦 5. Cognitive Impairment

  • Poor attention and concentration
  • Lack of insight and judgment

⚠️ May be associated with:

  • Aggression or violence
  • Suicidal or homicidal thoughts
  • Neglect of hygiene, nutrition, and safety

👩‍⚕️ Nursing Management of Acute Psychosis:

🟩 1. Ensure Safety

🔹 Remove dangerous objects
🔹 Avoid confrontation
🔹 1:1 observation if risk of violence or self-harm

🟨 2. Build Therapeutic Communication

🔹 Speak calmly and clearly
🔹 Avoid arguing with delusions
🔹 Offer reassurance and reorientation
🔹 Maintain a non-threatening attitude

🟧 3. Administer Prescribed Medications

🔹 Antipsychotics:

  • Haloperidol, Risperidone, Olanzapine
    🔹 Use IM injections in violent or non-cooperative patients
    🔹 Monitor for side effects (e.g., EPS, sedation)

🟥 4. Create a Low-Stimulus Environment

🔹 Reduce noise and visitors
🔹 Provide a calm, structured routine
🔹 Avoid sudden changes or overstimulation

🟦 5. Supportive Measures

🔹 Maintain hydration, nutrition, hygiene
🔹 Monitor sleep and rest patterns

🟪 6. Family Education and Support

🔹 Explain the condition and treatment
🔹 Encourage follow-up and medication adherence
🔹 Reduce stigma and increase awareness

⚖️ 7. Legal and Ethical Care

🔹 If involuntary admission is required → Follow MHCA 2017, Sec 89–90
🔹 Ensure patient rights and documentation

📚 Golden One-Liners for Quick Revision:

  • 🟨 Acute psychosis = sudden loss of contact with reality
  • 🟨 Common features: hallucinations, delusions, disorganized speech
  • 🟨 Antipsychotics like haloperidol and risperidone are first-line treatment
  • 🟨 1:1 monitoring and calm communication are key nursing actions
  • 🟨 Use non-confrontational approach; never argue with hallucinations or delusions

✅ Top 5 MCQs for Practice:

Q1. Which of the following is a core symptom of acute psychosis?

🅰️ Memory loss
✅ 🅱️ Hallucinations
🅲️ Itching
🅳️ Constipation
Correct Answer: 🅱️ Hallucinations
Rationale: Hallucinations are a key perceptual disturbance in psychosis.

Q2. The best nursing response to a patient having delusions is:

🅰️ Agree with the patient
🅱️ Laugh at the belief
✅ 🅲️ Do not argue and redirect to reality
🅳️ Ignore the patient
Correct Answer: 🅲️ Do not argue and redirect to reality
Rationale: Arguing worsens the delusion; gentle redirection is therapeutic.

Q3. Which antipsychotic is commonly used in acute psychosis?

🅰️ Paracetamol
✅ 🅱️ Haloperidol
🅲️ Amoxicillin
🅳️ Diazepam
Correct Answer: 🅱️ Haloperidol
Rationale: Haloperidol is a fast-acting typical antipsychotic.

Q4. What is the priority nursing intervention for an acutely psychotic patient?

🅰️ Provide group therapy
🅱️ Encourage TV watching
✅ 🅲️ Ensure safety and reduce stimulation
🅳️ Start discharge planning
Correct Answer: 🅲️ Ensure safety and reduce stimulation
Rationale: Safety and environmental control are the first steps.

Q5. Which of the following is a thought disturbance seen in psychosis?

🅰️ Hallucination
🅱️ Delirium
✅ 🅲️ Delusion
🅳️ Coma
Correct Answer: 🅲️ Delusion
Rationale: Delusions are false fixed beliefs—key features of psychosis.

🧠🆘 Crisis and Its Intervention: AIDS (HIV/AIDS)

📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Mental Health Nursing Exams

🔰 What is a Crisis?

A crisis is a sudden, overwhelming emotional disturbance in response to a stressful or traumatic event, where usual coping mechanisms fail, leading to psychological imbalance.

💉 What is AIDS-related Crisis?

When a person is diagnosed with HIV/AIDS, they may experience multiple crises — emotional, psychological, social, economic, and physical — that disrupt their ability to function normally.
✅ AIDS-related crisis often involves shock, fear, stigma, and depression, requiring immediate psychosocial intervention.

🧭 Types of Crises in HIV/AIDS Patients:

🟥 1. Developmental Crisis

  • Facing chronic illness during youth or parenthood
  • Disruption of life roles and future plans

🟧 2. Situational Crisis

  • Diagnosis of HIV
  • Disclosure to family or employer
  • Facing death of a partner or child due to HIV/AIDS

🟨 3. Social Crisis

  • Stigma and discrimination
  • Isolation, rejection from family or society

🟩 4. Economic Crisis

  • Loss of job or income
  • Increased cost of treatment and medications

🟦 5. Health Crisis

  • Opportunistic infections
  • Progression to AIDS
  • Facing terminal illness or death

😔 Emotional Responses in AIDS Crisis:

  • Denial
  • Shock
  • Fear of death
  • Depression
  • Anger
  • Hopelessness
  • Suicidal ideation

👩‍⚕️ Nursing Interventions for AIDS-related Crisis:

🟩 1. Psychological First Aid / Crisis Counseling

🔹 Offer empathetic, non-judgmental listening
🔹 Allow ventilation of feelings
🔹 Acknowledge and normalize emotions
🔹 Maintain confidentiality

🟨 2. Patient and Family Education

🔹 Explain the nature of HIV/AIDS, treatment options
🔹 Correct myths and misconceptions
🔹 Inform about ART (antiretroviral therapy) and prognosis

🟧 3. Supportive Counseling

🔹 Strengthen coping strategies
🔹 Encourage participation in support groups
🔹 Provide hope and motivation

🟥 4. Suicide Prevention & Mental Health Referral

🔹 Screen for depression, anxiety, suicidal thoughts
🔹 Refer to psychiatric or clinical psychologist if needed

🟦 5. Social and Legal Support

🔹 Help access free ART centers (ICTC/NACO)
🔹 Assist in obtaining legal protections (HIV/AIDS Act 2017)
🔹 Link with NGOs, government support schemes

🟪 6. Long-Term Follow-Up and Rehabilitation

🔹 Monitor for adherence to ART
🔹 Encourage nutritional care and hygiene
🔹 Promote positive living with HIV

📚 Golden One-Liners for Quick Revision:

  • 🟨 AIDS diagnosis = common trigger for situational crisis
  • 🟨 Major emotions: shock, fear, guilt, stigma, hopelessness
  • 🟨 Psychological First Aid is first-line support
  • 🟨 Suicide risk is high in newly diagnosed HIV patients
  • 🟨 Nurses must educate, support, and empower HIV-positive clients

✅ Top 5 MCQs for Practice:

Q1. A person newly diagnosed with HIV shows denial and panic. This is an example of:

🅰️ Developmental crisis
✅ 🅱️ Situational crisis
🅲️ Existential crisis
🅳️ Sociocultural crisis
Correct Answer: 🅱️ Situational crisis
Rationale: The crisis arises due to sudden diagnosis and fear.

Q2. What is the nurse’s priority in managing AIDS-related psychological crisis?

🅰️ Administer medication
✅ 🅱️ Provide emotional support and counseling
🅲️ Report to authorities
🅳️ Isolate the patient
Correct Answer: 🅱️ Provide emotional support and counseling
Rationale: Emotional support is critical to managing crisis and coping.

Q3. The HIV/AIDS Act 2017 ensures:

🅰️ Compulsory isolation
🅱️ Right to marry is denied
✅ 🅲️ Protection against discrimination
🅳️ No free ART
Correct Answer: 🅲️ Protection against discrimination
Rationale: The act legally protects HIV+ individuals’ rights.

Q4. Which is a sign of emotional crisis in HIV-positive patients?

🅰️ Increased appetite
✅ 🅱️ Suicidal ideation
🅲️ Fever
🅳️ Nausea
Correct Answer: 🅱️ Suicidal ideation
Rationale: Common due to despair and social rejection.

Q5. What is the first step in crisis intervention?

🅰️ Starting ART
✅ 🅱️ Listening and assessing emotional needs
🅲️ Reporting to the doctor
🅳️ Isolating the patient
Correct Answer: 🅱️ Listening and assessing emotional needs
Rationale: Establishing trust and understanding is the foundation.

🧠💥 Adolescent Crisis

📘 Important for Mental Health Nursing, Pediatric Nursing, Psychology & School Health Programs

🔰 What is an Adolescent Crisis?

An adolescent crisis refers to a developmental and emotional turmoil experienced during adolescence due to physical, psychological, and social changes.
✅ It often involves identity confusion, risk-taking behavior, and inability to cope with peer, family, and academic pressures.

📊 WHO Defines Adolescents As:

  • Age group: 10 to 19 years
  • Period of rapid physical and mental growth, sexual maturity, and identity formation

🧭 Types of Adolescent Crises:

🟥 1. Developmental Crisis

  • Conflict in identity vs. role confusion (Erikson’s stage)
  • Struggling with self-image, sexuality, independence

🟧 2. Situational Crisis

  • Events like:
    • Failure in exams
    • Breakups
    • Family conflict/divorce
    • Rejection by peers

🟨 3. Social Crisis

  • Peer pressure
  • Bullying or cyberbullying
  • Stigma around body image or gender identity

🟩 4. Psychological Crisis

  • Depression
  • Anxiety
  • Self-harm or suicidal ideation
  • Eating disorders (anorexia, bulimia)

⚠️ Warning Signs of Adolescent Crisis:

  • Sudden withdrawal or isolation
  • Drop in academic performance
  • Risky behavior: drugs, unsafe sex
  • Aggression or defiance
  • Mood swings, irritability
  • Talk of hopelessness or suicide
  • Change in appearance or sleeping habits

👩‍⚕️ Nursing Interventions for Adolescent Crisis:

🟩 1. Establish Therapeutic Relationship

🔹 Use trust, confidentiality, and empathy
🔹 Listen actively, be non-judgmental
🔹 Create safe space for expression

🟨 2. Crisis Counseling & Emotional Support

🔹 Help adolescent identify feelings and triggers
🔹 Use supportive communication
🔹 Encourage positive coping mechanisms

🟧 3. Risk Assessment

🔹 Screen for depression, self-harm, suicide risk
🔹 Use tools like HEADSS assessment (Home, Education, Activities, Drugs, Sexuality, Suicide)

🟥 4. Involve Family & Educate Caregivers

🔹 Guide parents on adolescent psychology
🔹 Promote open communication
🔹 Address family stressors (e.g., violence, neglect)

🟦 5. Refer to Mental Health Services When Needed

🔹 Psychologists, school counselors
🔹 Psychiatric support if severe (e.g., suicidal)
🔹 Link with adolescent helplines or NGOs

🟪 6. Promote Healthy Lifestyle and Peer Support

🔹 Encourage physical activity, hobbies
🔹 Support group counseling or peer-led discussions
🔹 Educate on sexual health and substance abuse prevention

📚 Golden One-Liners for Quick Revision:

  • 🟨 Adolescence = crisis of identity vs. role confusion
  • 🟨 Common triggers = exam failure, peer rejection, parental conflict
  • 🟨 Suicidal thoughts, risk-taking, substance abuse are red flags
  • 🟨 HEADSS tool helps in adolescent psychosocial assessment
  • 🟨 Nurses must act as supportive listeners and guides

✅ Top 5 MCQs for Practice:

Q1. What is the major psychological conflict in adolescence according to Erikson?

🅰️ Trust vs. mistrust
✅ 🅱️ Identity vs. role confusion
🅲️ Intimacy vs. isolation
🅳️ Industry vs. inferiority
Correct Answer: 🅱️ Identity vs. role confusion
Rationale: This is the central developmental task during adolescence.

Q2. HEADSS assessment tool is used for:

🅰️ Nutritional status
✅ 🅱️ Adolescent psychosocial screening
🅲️ Sleep patterns
🅳️ Vision screening
Correct Answer: 🅱️ Adolescent psychosocial screening
Rationale: HEADSS explores risk areas like home, school, drugs, and suicide.

Q3. Which of the following is NOT a typical sign of adolescent crisis?

🅰️ Self-harm
🅱️ Drug use
✅ 🅲️ Strong social engagement
🅳️ Risky sexual behavior
Correct Answer: 🅲️ Strong social engagement
Rationale: Withdrawal or isolation is more common during crisis.

Q4. What is the nurse’s first step when an adolescent shares suicidal thoughts?

🅰️ Ignore
🅱️ Scold the teen
✅ 🅲️ Stay with them and inform mental health professional
🅳️ Tell them to sleep it off
Correct Answer: 🅲️ Stay with them and inform mental health professional
Rationale: Immediate intervention is vital to prevent suicide.

Q5. Which intervention best helps adolescents build positive identity?

🅰️ Social isolation
🅱️ Strict rules
✅ 🅲️ Encouraging hobbies, peer support
🅳️ Forced counseling
Correct Answer: 🅲️ Encouraging hobbies, peer support
Rationale: Positive outlets enhance self-esteem and identity formation.

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