Mental Health85-1
Mental Health85-1
Mental Health85-1
NURSING
FILE
SIGNATURE OF PRINCIPAL
MENTAL HEALTH NURSING
4 CASE PRESENTATION
SUBSTANCE ABUSE
BIPOLAR AFFECTIVE DISORDER
5 MENTAL STATUS EXAMINATION
6 MINI MENTAL STATUS EXAMINATION
7 HISTORY TAKING
PARANOID SCHIZOPHERNIA
ANXIETY DISORDER
SUBSTANCE ABUSE
8 PROCESS RECORDING
BIPOLAR DISORDER
MAJOR DEPRESSION
9 ECT REPORT
RECURRENT DEPRESSION
SCHIZOPHRENIA
10 DRUG BOOK
11 HEALTH TALK
STRESS MANAGEMENT
EATING DISORDERS
12 CLASS PRESENTATION
MANIA
CRISIS INTERVENTION
CASE STUDY
ON
OBSESSIVE
COMPULSIVE DISORDER
Patient’s Profile
Identification data
Client name : ABC
Age : 32 Years
Sex : Female
Ward : OPD
Education : 10th standard
Occupation : House wife
Marital status : Married
Religion : Hindu
Date of admission : 07.04.2023
Address : Agroha
Final diagnosis : Obsessive-Compulsive Disorder
Informant : Husband
Information : Reliable
Family tree
Male Male
Female patient
Premorbid personality
Interpersonal relationships : Good relationship with family member.
Use of leisure time : Watching T.V.
Predominant mood : Mood alteration ()
Attitude towards self and other : Self-appraisal of abilities and behaving normally with
others.
Attitude towards work and responsibility : She is interested in doing work and is a
responsible housewife
Religious beliefs and moral attitudes : Having faith on religions and participating in
religious activity.
Speech
Student Nurse : Aapka naam kya hai?
Client : Manjula
Initiation : Patient responded when talk
Reaction time : Normal
Rate : Slow
Productivity : Pressured speech
Volume : Decreased
Tone : Normal variation
Relevance : Relevant
Stream : Normal
Coherence : Coherent
Others : No rhyming, punning, echolalia perseveration or neologism.
Inference:
Speech sample:
Mood
Subjective
Student nurse : Aap kaisa feel kar rhi hai?
Patient : : Thodi stressed hu.
Objective : Anxious mood.
Inference
Thought
Student Nurse : Kya aapke dimag me koi vichar bar bar aata hai?
Client : Jab bhi mai kisi cheez ko chhuti hut oh mujhe aisa lgta hai ki hath gande ho gye aur
jab tak hath na dholu bechaini rahti hai.
Stream : Obsession is present. There is no retarded thinking thought block and flight of
ideas.
Content of thought
Student nurse : kya aapko aisa lagta hai ke koi tumhe nukshan pahuchana chahta hai
Client : nahi
Remarks : No delusion.
Perception
Hallucinations
Student Nurse : Aapko koi aawaje sunai deti hain ya koi jo sirf apko dikhta ho?
Client : Nahi
Remarks : No hallucinations present
Sensorium
Consciousness
Student Nurse : Hello,manjula
Client : Hello, sir
Remarks : Patient has obeyed by calling her name
Orientation
Person
Student Nurse : AApke sath ye kaun baithe hain?
Client : Meri Nanad..
Remarks : Oriented to person
Place
Student Nurse : Abhi aap kaha hain?
Client : RML hospital me.
Remarks : Oriented to place
Time
Student Nurse : Aaj kaun sa din hai?
Client : Mangalwar.
Remarks : Oriented to time
Attention
Student Nurse : in numbers ko ulta boliye 2, 4, 6, 8, 10.
Client : 10, 8…4..6..2.
Remarks : Attention aroused with difficulty
Concentration
Student Nurse : Mahino ke naam bataiye ulte side se?
Client : December, November…September, October, June, July …August, March
….January.
Remarks : Concentration sustained with difficulty
Memory
Immediate
Student Nurse : Aap in sabdo ko boliye Table, Pen, Rose, Bus and Tree.
Client : Table, Pen, Rose, Bus and Tree
Remarks : Immediate memory intact.
Recent
Student Nurse : AApne subah naste me kya khaya hai aaj?
Client : Roti aur sabji aur chai.
Remarks : Recent memory intact.
Remote
Student Nurse : Aapka birthday kab aata hai?
Client : 15 feb.
Remarks : Remote memory intact.
Intelligence
Student Nurse : Abhi desh ke pradhanmantri kaun hain?
Client : Modi ji hain.
Student Nurse : India ka president kon hai?
Client : Dhyan nhi hai.
Student Nurse : India ki rajdhani kya hai?
Client : Delhi.
Student Nurse : Lal kila kha hai?
Client : Delhi mein.
Student Nurse : Delhi ka chief minister kon h?
Client : Kejriwal.
Remarks : Normal intelligence as per educational status.
Abstraction
Student Nurse : kutte aur sher ek jaisi kaun si bate hain aur alag kya hai unme ?
Client : Dono Janwar hai Kutte ko palte hain aur sher ko pal nai sakte.
Judgment:
Student Nurse : Agar yah ape abhi aag lag jaye to aap kya karengi”?
Client : bhag jaungi yaha se or fire bigrade ko phone krungi.
Remarks : Judgment is intact
Vital Signs:
S. No. Vital Sign Normal Value Patient’s Value
1. Temperature 98.60 F 97.40 F
2. Pulse 72-90 Beats/M. 78 Beats/M.
Anxit Alprazola Short 1 Oral BD It act on BDZ Generalized Hypersensitivi Nausea, Check the physician’s
m acting mg receptors I and anxiety ty, acute vomiting, order.
Benzo II which is disorder, Panic narrow angle weakness, Medication given must
diazep linked with disorder, glaucoma, epigestric pain, be charted on the
1.
ines GABA receptor Insomnia, pregnancy, dry mouth, patient’s case sheet.
and enhancing Acute mania. lactation body pain Check the five rights for
GABA drug administration
transmission. Always address the
Fluda Fluoxetin SSRI 20 Oral BD It inhibit the re- Depressive Severe renal Dry mouth, patient by name and
c mg uptake of episode, failure, constipation, make certain
2. serotonin at dysthymia, hypersensitivi sedation. identification
post synaptic enuresis, panic ty Do not leave the patient
space. attack. until the drug is
Halop Haloperid Butyro 10 Oral BD It blocks the Schizophrenia, Closed angle Sedation, swallowed
idol ol pheno mg D2, D3 and D4 drug induced glaucoma, hypotension, Do not allow the patient
nes receptor in psychosis, Coma Extra pyramidal to carry drugs
3. mesolimbic Mania, ADHD, resulting CNS symptoms. Do not force oral
Other therapeutic therapies:
Yoga therapy,
Individual psychotherapy,
Progressive muscle relaxation
Aversion therapy
OBSESSIVE COMPULSIVE DISORDER
Introduction
OCD is psychiatric disorder characterized by subject’s obsessive, distressing,
intrusive thoughts and related compulsions /task/ rituals attempt to neutralize the obsessions.
Obsessions & compulsions are source of distress, time consuming and causes impairment in
individual’s ability socially, occupational and school functioning.
Definition
Recurrent thought or ideas (Obsessions) that an individual is unable to putout of his or her
mind and action that an individual is unable to refrain from performing (compulsions).
Obsessions & compulsions are severe enough to interfere with social and occupational
functioning.
Etiology
Biological theories
Neurotransmitter’s
Serotonin
Noradrenaline
Genetics
Electrophysiological studies
Electroencephalography
Evoked potentials
Brain imaging
Cranial CT & MRI Scans
Behavioral theories
Psychodynamic theories
Neurotransmitter’s
Serotonin – recent clinical and laboratory studies have suggested that changes in brain
serotonin (5-HT) function may be contribute to anxiety types behavior among the anxiety
disorder , perhaps the most compelling evidence implicating 5-HT exists for OCD.
Noradrenaline – OPD patients were found to have higher plasma free 3-methoxy- 4 – hydroxyl,
phenylglycal and plasma nor epinephrine levels. The maximum number of binding sites (Bmax)
triturated clonidine was significant greater in OCD patient than in normal. this pattern of alpha 2
adenorececeptor status is different than the patterns in major depression and panic anxiety there
was a blunted growth hormones, cortisol & ACTH response to clonidine in OCD.
Genetics
Several investigators from the time of griesinger (1868) have found evidence to suggested a
familial origin, in monozygotic twins, 1 st degree relatives of OCD clients the diseases is
common.
C. Electrophysiological studies
Electroencephalography – many of the earlier reports suggested EEG abnormalities in OCD.
Temporal lobe spikes & increased theta wave have been reported in sleep EEG of OCD
subject.
Evoked potentials – obsession patient are characterized by reduced amplitude and decreased
latencies of lobe EP component. The role of the frontal lobes in such cognitive function is
implicit and such a dysfunction.
D. Brain imaging
Cranial CT & MRI Scan – the first reported abnormally in cranial CT in OCD
was an increased in the ventricular brain ratio but this was not replicated subsequent studies
have shown similar results with the care date nuclear. Earlier report found non- specific
abnormalities on MRI of the brain in OCD.
2. Behavioral theories
Interplay b/w classical operant conditioning paradigms. The external aversive
stimuli interact with the organism with privies learning, such stimuli have acquired specific
significant. This result in the stimuli gaining more strength resulting in sensitization. Ritual
acts produce relief and thus through negative reinforcement increase the possibility of
repetition of the phenomena.
Mower’s 2 stages theory – Role of exposure & response prevention.
3. Psychodynamic theories
According to Freud, the anal erotic phase of psychosexual development was
responsible for the evolution of anankastic traits to defend against unacceptable anal
impulses.
Ego psychological theory
The conflict was thought to arise due to inadequate mastery of the oedipal
conflict, resulted in regression to the anal sadistic stag to avoid anxiety to which the subject
was already predisposed due to difficulties in the anal period of development. it stimulates
anal and aggressive impulsive against which defense mechanism are used .e.g. Isolation.
Undoing, reaction formation, orderliness, magical thinking, rigidity, regression.
Autoimmune response to group A streptococcal infection
NURSING PROCESS
S.NO. NEED PROBLEM
1. Reduce anxiety level. Anxiety
2. Participate in self care activities. Self care deficit.
Control obsessional thought, reduce
3. anxiety, social isolation, poor diet, obsessional thought, reduce anxiety,
insomnia, unrestful sleep. ineffective health maintenance.
Fear Decrease avoidance behavior.
4. Improve coping. Ineffective coping.
5.
Book Pictures In Patient
Types 1. Predominantly obsessional Mixed obsessional thought & act.
thought or rumination. Thought, ideas, mental images.
These may be ideas, thought, Washing hand &cleanliness of floor.
mental image, impulses which are
very much distressing to the
individual.eg A woman getting
idea to kill her child whom she
loves.
2.Predominantly compulsive act /
obsessional rituals e.g. washing,
checking, counting etc the
underlying overt behavior is fear,
the ritual act is a symbolic
attempt to overt the danger or
fear. Obsessional thought are ideas images or impulses that enter
3.Mixed obsessional thought & the individual’s mind again and again in stereotyped form.
Obsessional thought are ideas Some OCD suffers even fear that the bath soap.
images or impulses that enter the
NURSING DIAGNOSIS
1. Anxiety as related to earlier life conflicts secondary to obsessive-compulsive disorder (OCD) as evidenced by a decline in social and role
performance, repeated behaviors, and recurrent thoughts.
2. Social Isolation is related to past experiences of difficulty in interaction with others secondary to Obsessive Compulsive Disorder as
evidenced by lack of confidence in public, inability to make eye contact, lack of communication, obsession with one’s own ideas; repetitious
meaningless behavior.
3. Ineffective Coping related to situational crises secondary to obsessive-compulsive disorder as evidenced by obsessive conduct or
ritualistic habits, failing to do something for basic necessities, failure to respond adequately to responsibilities, and poor problem-solving
abilities
4. Self-Care Deficit related to excessive ritualistic habits secondary to Obsessive Compulsive Disorder (OCD) as evideced by the refusal to
practice self-hygiene, unclean clothes, uncombed hair, a bad body odor, lack of enthusiasm for choosing appropriate attire, and incontinence
Deficient Knowledge related to unawareness of potential side effects and unfamiliarity with the drugs being utilized secondary to the new
diagnosis of obsessive-compulsive disorder (OCD) as evidenced by verbally expressing a lack of knowledge or expertise or requesting
information, conveys a false impression of one’s health, performs desired or recommended health behavior incorrectly.
Nursing
Nsg. Diagnosis Goals Intervention Implementation Evaluation
assessment
Subjective Exhaustion related To reduce Identify stressor / root cause for Identified stressor / root cause for Reduce anxiety
data- to anxiety anxiety and anxiety. anxiety. and perform
Hallucinatio And obsessional perform Administer the drugs as per doctor’s Administered the drugs as per productive
n thought. productive prescription. doctor’s prescription. Acts by client
Delusions of Acts by client Observe action ,side of effects of Observed action ,side of effects of responded to
the responded to drugs. drugs. relaxation
persecution relaxation Record and report the observations Recorded and report the techniques with a
Confusion techniques made. observations made. decreased anxiety
Thought with a provide psychotherapy , behavior provided psychotherapy , behavior level
blocking decreased therapy based on symptom therapy based on symptom
Objective anxiety level. Encourage the client’s participation Encouraged the client’s participation
data- in relaxation exercises. in relaxation exercises.
Withdrawal Teach the client to use relaxation Taught the client to use relaxation
behavior techniques techniques
Hostility Help the client see mild anxiety Helped the client see mild anxiety
Inability to
trust others
Inadequate
speech
SUMMARY
Mrs. ABC is a 32 year female patient diagnosed with OCD. She is responding properly and
maintaining eye contact. She is conscious regarding health but over conscious about hygiene
her immediate and remote memory of infect. She is oriented to time, place and person.
Mrs. Manjula is a house wife. She was apparently normal before 8 month. she is over
conscious about cleanliness repeatedly .she is washing house , hand and taking bath 3-4 time
a day. She is feeling anxious when even some come in her house after going the visitor. She
used to wash floor and taking bath. She got contact dermatitis because of repeated hand wash
with soap. She is not accepting that she was washing unnecessary. She was admitted in
hospital with the diagnosis of OCD on 07-04-23 for further evaluation and treatment. I have
taken this case for my case study.
HEALTH EDUCATION
Psychoeducation:
Explain to the patient and family that schizophrenia is a chronic disorder with symptoms that
affect the person’s thought processes, mood, emotions and social functions through-out the
person’s lifetime.
Teach the patient and family about the importance of medication compliance and the
therapeutic/ non- therapeutic effects of antipsychotic medication
Instruct the patient and family to recognize impending symptoms exacerbation and to notify
physician when the patient poses a threat or danger to self or others and requires
hospitalization
Teach the patient and family to identify psychosocial or family stressors that may exacerbate
symptoms of the disorder and methods to prevent them.
BIBLIOGRAPHY
Townsend.M, (2007), “Psychiatric Mental Health Nursing”, Jaypee brothers, New Delhi,
India.
Doenges M.E. et al., (1995), “Psychiatric Care Plans Guidelines for Planning and
Documenting Client Care”, 2nd ed. F. A. Davis Company, Philadelphia, PA.
Ahuja.N, (2006), “A Short Text Book of Psychiatry”, Jaypee brothers, New Delhi, India.
Sreevani.R, (2008), “A Guide to Mental Health and Psychiatric Nursing”, Jaypee Brothers,
New Delhi, India.
CASE STUDY
ON
POST- SCHIZOPHRENIC DEPRESSION
IDENTIFICATION DATA:-
Name of the patient -ABC
Age /Sex -21/F
Father/Spouse –Rishi Ram
C.R No. -71091
Education -12th pass
Occupation -Labour
Income -900
Marital status –Unmarried
Religion -Hindu
Address –Dalamwala-Jind
D.O.A -06/05/23
Ward/Unit No –Psychiatric ward/unit-2
Informant – Sister in law
Information -Reliable
TDI -2Years
Course –Continuous
Intensity -Increasing
Maffi 20years female, unmarried, 10th pass labor residing in Hindu nuclear family of LSES of rural background of Jind.
27July 2019 Patient was asympatomatic but when she get to know that one girl from her village married against wishes of her parents. As per her
cousin brother ye sochti bhut jyada h.. One day when all ladies of her house talked about this, she started behaving abnormally , she started self
muttering and said mai aisi vaisi ladki nahi hu, vo kyo bhaag gyi ghar se galti ki usne, nahi karni chahye thi, kaha jaa rhi h tu mat jaa. She
became irritable and started roaming in her house. When someone try to stop her she do this excessively. This behavior was continued for
10days. She did not engage in household work that time. Her self care was decreased, she took bath with the help of her sister in law. Her sleep
was decreased to only 2hours . her appetite was also decreased . she ate only when someone asked from her.
on 30july 2019After 2days of initiation of symptoms, she developed fever then she was taken to shanti hospital Jind. According to her cousin
brother doctor said her B.P low so IV fluids givn with multivitamin. Patient was admitted for 3days. During her hospital stay, her self muttering
continued and she used abusive language for doctor and nurse. So sedation given to the patient. No documented record of sedation is available.
Then she was discharged from hospital. And patient was sympatomatic till 2years.
28july2022According to her cousin brother, one day shee suddenly stop talking to anyone and not oriented to time, place and person. She took
treatment from PGIMS on OPD basis.
Then She was taken to local baba on 1/8/22 baba did some pooja and rotated cloth over her head. Then She was taken to come. After that She
did not open her eyes and did not ask for food. Her sister in law fed her 2days(tea and biscuits) her sleep got decreased in night. Now she use to
sleep for 10-12hrs/day.
On 3/5/23 she started talking after silent behavior. This time her symptoms of self-muttering increased to next level, become aggressive,
laughing and started shouting. She was taken to PGIMS Rohtak in emergency where tab. Olanzapine 10mg 1HS and tab. Cloze 0.5mg 1HS was
given for 3days. According to her cousin she improved then before. Her self-muttering decreased slightly but improvement in sleep pattern. But
next day she again started self-muttering excessively. Sometimes she started crying without any reason for 1-2hours. According to her cousin her
symptoms aggravated, again her sleep got decreased inspite of taking medication. Now she came in OPD, at MAMC, Agroha.
Treatment History:-
Two years back patient took treatment from PGIMS Rohtak on OPD basis.
50yrs/M 34yrs/F
Father Mother
Cancer
Student
Self
Perinatal history
Antenatal period –Normal
Intranatal period –Normal
Birth –At full term
Birth cry –Immediate
Birth defects –No
Postnatal complications -No
Childhood history
Primary caregiver -Mother
Development milestone- Normal
Behavior and emotional problems- No
Illness during childhood- No
Educational history
Age at beginning of formal education –5years
Marital History
Unmarried
Premorbid personality
Interpersonal relationship –Extrovert and good
Family and social relationships -Good
Attitude to Self – Confident and respect everyone
Attitude towards work and responsibility –Responsible, and do all the work assigned to her
Religious belief-She has faith in god
Habits –Watching T.V and taking to neighbors
Eating pattern -Regular
Elimination -Regular
Sleep -Regular
Use of drugs, tobacco, alcohol –No
MENTAL STATUS EXAMINATION
Date of Examination-3/6/23
A. GENERAL APPEARANCE AND BEHAVIOUR:- Patient was sitting on her bed. Looking one’s age, No physical deformity. When
student went to her she accepted greeting.
Facial expression:-pleasant
Level of grooming:-normal
Level of cleanliness:-adequate
BEHAVIOR:-Abnormal
Cooperativeness:-normal
Psychomotor activity:-Increased
Rapport:-spontaneous
Gesturing:-normal
Posturing:-normal
B. SPEECH:-
Reaction time:-Delayed
Rate:- slow
Volume:- normal
Tone:-monotonous
Stream:- blocking
Pitch:-low
Impression:-poverty of speech
Subjective
Objective
D. THOUGHT:-
Form-
Content(idea)
Student:-Aapke mann me kya khyal aate hai? Kya aapka marne ka dil karta hai?
Client:- Mai kisi layak nahi hu marne ka dil karta hai. Ab kuch ni ho skta, meri shaddi nhi ho rahi hai. Mere ghar vale ish bat se presan hai aur
muje kuch nahi karna hai bss. Kisi se baat krne ka dil nhi krta Muje nhi jinna or muje kisi se koi matlab nhi h.
Student:- Kya aapko lgta hai ki koi aapko maarna ya nuksaan phuchana chahta hai?
Client:- nahi.
Client:-mute
Impression:-thought blocking
Obsession:-
Student:-Kya aapko kabhi kisi kaam ko bar bar karne ka mann karta hai?
Client:-Nahi
Impression:-no obsession
Phobia:-
Student:-aapke padosi kese hai? Kya aap unse baate karti ho?
Client:-thik hai but mera kisi se baat karne ka dil nahi karta akela rahna hi acha lgta hai
IMPRESSION:-
E. PERCEPTION:-
Illusion
Hallucination
Student:-kya aapko aisa kuch sunayi deta hai jo kisi or ko nahi sunta?
Client:- ha, ek aawaj sunai deti hai ki mai tuje nhi chodungi aur mere pass aa ja.
Student:-kya aapko aisa kuch dikhayi deta hai jo kisi or ko nahi dikhta?
Consciousness:-
client:-do
Orientation;-
Time
Place
Person
Attention
Student:- mai aapko kuch digit dungi unko repeat krna hai? 11,13,15.17
Client:- 11,13,15,17
Concentration
Client:-33,31,29,27,22
Immediate
Recall-3/3
Recent
Remote
Client:-24july 1998
Impression:-intact memory
Intelligence
Student:-days in week
Client:-7
Student:-name of PM
Client:-Modi
Client:- 15august
Client:- 14years
Impression:-adequate knowledge
Abstraction
Similarities
Student:-Pen-pencil
Client:-likhte hai
Student:- Apple-mango
Dissimilarities
Proverb
student:-9.2.11?
Client:-bhaag jana
Client:-shaadi karna.
Judgment
Personal
Social
Client:- nahi
Test
Student:-agar hospital me aag lag jaye to kya karogi?
G. INSIGHT:-
Impression:-insight present
DIAGNOSTIC FORMULATION:-
Patient Maalti 21yrs old female, studied till 12 th , unmarried resident belong to hindu nuclear family of LSES of rural background of district jind
has been admitted with continuous illness of 10days with acute onset characterized by self muttering , irrelevant talk, decreased sleep, deceased
self care, wander behavior, visual hallucination with similar episode in past 2years and recovery in 1week of past episode.
Temp. – 98.4 F
B.P.- 120/80 mm of Hg
Pulse- 84/min
No organomegaly present
Definition-
Post-schizophrenia depression describes a depressive episode that arises in the after-month of schizophrenic illness. Some schizophrenic
symptoms may still be present but no longer dominate the clinical picture. These persisting schizophrenic symptoms may be “ positive” or “
negative” though the latter are more common.
How is it diagnosed?
The individual has had a schizophrenia illness meeting the general criteria for schizophrenia within the past 12 months.
Some schizophrenia symptoms are still present
The depressive symptoms are prominent and distressing, fulfilling at least the criteria for a depressive episode, and have been present for at least
2 weeks.
Symptoms-
Psychopathology-
Careful clinical and psychological analyses due to psychopathology are defined four types of depression. From which two types of depression-
agitated and asthenic prevailed in active phase of schizophrenia and remained two hypochondriac and apathy mainly occur during stabilization.
Cognitive symptoms and specified psychopathological and neurodynamical input in alteration of personality structure.
Thought blocking
Poverty of speech
Sleep disturbances
Haloperidol – 5-100mg/day PO
Trifluoperazine- 15-60mg/day PO
Atypical antipsychotic
Clozapine- 25-450mg/day PO
Resperidone – 2-10mg/day PO
Olanzapine -10-20mg/day PO
NURSING MANAGEMENT FOR POST- SCHIZOPHRENIC DEPRESSION-
Nursing assessment-
A nursing assessment includes information regarding any previous incidence of mental illness or psychotic episodes-
Observe behavior pattern, posturing is normal, maintaining eye to eye contact, and accept greetings
Hygiene was also adequate
Thought disturbances is experiencing
Patient reaction time is delayed, volume is high
Patient had auditory hallucination and delusion of persecution
Patient performed self- care activities that is sleep pattern is abnormal
Patient had withdrawal behavior
Nursing Care Plan
Nursing diagnosis-
Disturbed thought process related to inability to trust, panic anxiety, possible hereditary or delusional thinking
Potential for violence, self- directed or at others related to command hallucinations evidenced by physical violence,
destruction of objects in the environment and self -distructive behavior
Self- care deficit related to withdrawal, regression , panic anxiety, cognitive impairment, inability to trust
Social isolation related to inability to trust, panic anxiety, delusional thinking , evidenced by withdrawal, sad, dull affect,
expression of feelings of rejection of aloneness imposed by othe
Nursing Nursing Goal Planning Implementation Evaluation
assessmen diagnosis
t
Subjective Potential for <Not injure others or <To maintain low level < Maintained low level of < Patient able to interact with
data- violence, self- destroy property or of stimulation ( low stimulation others appropriately and
directed or at self lighting, low noise, few anxiety, anger is reduced and
Hallucinati < Observe patient’s
others related to people etc.) in the patient feel comfortable
on <Verbalize feelings behavior frequently
command patient’s environment
of anger or
Delusions hallucinations < Remove all dangerous
frustration < To observe patient’s
of the evidenced by objects from the patient’s
behavior frequently
persecutio physical <Express decrease environment
n violence, feeling of agitation < To remove all
< Alert for signs of
destruction of fear or anxiety dangerous objects from
Confusion increasing fear, anxiety or
objects in the the patient’s
agitation
Thought environment and environment
blocking self -distructive < Apply mechanical
<To be alert for signs of
behavior restraints safely. Check
Objective increasing fear, anxiety
extremities for color, temp.
data- or agitation
and pulse distal to the
Withdrawa <To prevent harm to the restraints for every 15
l behavior patient or others minutes
Psychoeducation:-
For schizophrenia
Explain to the patient and family that schizophrenia is a chronic disorder with symptoms that affect the person’s thought processes, mood,
emotions and social functions through-out the person’s lifetime.
Teach the patient and family about the importance of medication compliance and the therapeutic/ non- therapeutic effects of antipsychotic
medication
Instruct the patient and family to recognize impending symptoms exacerbation and to notify physician when the patient poses a threat or danger
to self or others and requires hospitalization
Teach the patient and family to identify psychosocial or family stressors that may exacerbate symptoms of the disorder and methods to prevent
them.
For depression
Teach the family about the depression. Teach about the beginning symptoms of relapse may assist patients to seek treatment early and avoid a
lengthy recurrence
Discuss the importance of support groups and assist in locating resources
Teach the action, side effects and special instructions regarding medication
Discuss methods to manage side effects of medication
Tell the family to offer the patient some household responsibility within the patient level of capability to promote self esteem
Teach the family to recognize the symptoms of suicidal ideation and how to conduct a suicide assessment
Emphasize that antidepressants can cause constipation which may be prevented with a good bowel regimen adding fiber to the diet and drinking
water
Avoid making life changes while the patient is experiencing recovery from depression
Help the patient and family identify community resources such as suicide hotlines
CASE- PRESENTATION
ON
SUBSTANCE ABUSE
IDENTIFICATION DATA
Name XYZ
Age 60years
Sex Male
Bed no. 5
O.P.D no. 15/467942
Ward Psychiatry ward
Education 8th standard
Occupation labrour
Marrital status Married
Religion Muslim
Language Hindi
Diagnosis Schizophrenia
Identification mark Mole at right hand
Date of identification 4/5/2023
Date of assessment 8/5/2023
Informant Patient
a) Psychological:
According to patient : Afim khana
Nind kam aana
Gussa karna
b) Social: He like to interact with other, he is introvert
c) Interpersonal: He has good interpersonal relationship
d) Occupational: Patient lives in house only no occupation history
e) Biological: Restlessness, insomnia
Duration 1 year
Mode of onset Acute
Course Episodic
Intensity Increasing
Precipitating factor No
Patient was apparently well 30year back now he gives history of consumption of opium husk from the last 30 year. Initially he started taking
opium husk with his friends. Patient works as a farmer and while working in a field patient feel lethargic and weakness sometime patient feel
pain all over the body and then one of his friend offer him opium husk then patient took opium husk with his own will and patient took one
spoon of opium husk and after ate that patient feel better and energetic and with the period of half an hour to one hour patient got relief from
body pain. After that patient starts taking opium husk daily. Patient took one spoon of opium husk per day for the next one year and after one
year patient feels weak again and body ache at afternoon time then patient increased his opium husk intake habits to get the desire effect and
patient starts to take opium husk twice a day morning or afternoon time.
And then after 3month patient start to take opium husk thrice a day. If the patient do not consume opium husk in a day patient had strong desire
or compulsion to take substance when he not consumed opium husk then he complaints of dysphonic mood, nausea, vomiting, muscle ache,
sweating, Insomnia and now Patient is taking treatment in psychiatric ward
Treatment History
Name of the Chemical Action Dosage Route
drug Name
Tab Clox Clonazepam Antipsychotic 0.5mg Oral
Tab tramacon Tramadol Opioid 100mg Oral
SR Analgesic
Family history:-
Family tree
Male Male
Female
Male patient
Name of the family Relation with Age/Sex Education Occupation Marital status Mental Health status
member patient
Prenatal History
Antenatal period No any significant of Prenatal history
Intranatal period
Birth
Birth defect
Postnatal Complication
Childhood history
Primary care giver
Feeding
Age of weaning
Developement Milestones No any significant of Prenatal history
Behaviour and emotional Problems
Illness during childhood
Educational history
Play history
Premorbid personality
Habits
Speech: -
Initiation: - Minimal
Reaction time: - Time taken to answer to question
Rate: - Normal
Productivity: - Normal
Volume: - low
Tone: - low pitch
Relevance: - Fully relevant
Stream - Normal
Coherence: - coherent
Others: - preservation
Subjective
Nurse: - Aapka man kaisa hai?
Patient: - Mere man achha hai.
Objective
Patient affect is appropriate his mood.
Thought: -
Stream: Normal, Autistic thinking, thought block, Poverty of speech, Pressure of thought all are absent.
Form: Normal, Circumstantiality, tangantiality, neologism, verbigeration, flight of idea all are absent.
Content:
1. Delusion:-
Nurse: - Kya apko lgta hai ki aapki wife ka kisis se chakkar hai?
Patient: - Ha mujhe aisa lagta hai.
Inference: - Delusion of infidelity is abesent.
Nurse: - Kya apko lgta hai koi apko wash mei krna chahta hai?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Delusion of control is absent.
Nurse: - kya apko lgta hai aap koi mahan insan hai?
Patient: - nahi mujhe aisa nahi lagta or lgega bhi kyu.
Inference: - Delusion of grandiosity is absent.
Nurse: - kya apko lgta hai jab 2 log baat kar rahe hote hai to wo apke bare mei hi bat krte hai?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Delusion of reference is absent.
2. Hypochondria:-
Nurse: - Kya apko lgta hai apko koi khtarnak bimari hai? Apne kayi hasptalo sei dwai li hai?
Patient: - na, mujhe nahi lgta hai or mane phle bhi dwai nahi li hai.
Inference: - Hypochondria delusion is absent
Ideas: -
Nurse: - kya apke man mei aisa khyal ata hai ki apki zindgi khtm hone wali hai?
Patient: - Nahi mujhe aisa nahi lagta lekin mujhe apni patni pe gussa ata hai to mujhe marne ka khayal ata hai.
Inference: - Suicidal ideas are present.
Nurse: - Kya apko lgta hai ki apke hath gande hai or aap unhe bar bar dhote hai?
Patient: - Nahi aisa nahi hai.
Inference: - No Obsessional/Compulsive phenomena present.
4) Phobia: -
Perception: -
1) Illusions:-
Nurse: - kya apko rassi ko dekh ke aisa to nahi lagta hai ki ye saanp hai?
Patient: - Nahi mujhe aisa nahi lagta.
Inference: - Illusion is not present.
2) Hallucination: -
Auditory Hallucination:-
Nurse: - Kya jab aap akele bathe hote to apko kisi kism ki awaje to nahi suniee deti?
Patient: - Haa, mujhe awaje sunai deti hai aisa lagta hai meri patni or sadu apas me bate karte ho.
Inference: - Auditory Hallucination is present.
b) Visual Hallucination: -
Nurse: - Kya apko aisa kuch dikhayi deta hai jo kisi ko dikhayi nahi deta?
Patient: - Ha mujhe mere sadu dikhaiee dete hai.
Inference: - Visual Hallucination is present.
c) Olfactory hallucination: -
Nurse: - kya apko aisi koi badbu aati hai jaise kuch jal raha hai?
Patient: - Nahi aisa kuch nahi hai.
Inference: - Olfactory hallucination is absent.
d) Gastatory Hallucination: -
Nurse: - Kya apko aisa lgta hai ki kisi cheej ko khane per kdwa swad ata hai?
Patient: - Nahi aisa kuch nahi hota.
Inference: - Gastatory hallucination is absent.
e) Tactile Hallucination: -
Nurse: - Kya apko aisa lgta hai ki apke body pei kuch chalra hai mtlb jaise kuch reing raha hai?
Patient: - Nahi mujhe aisa kuch nahi lgta.
Inference: - Tactile hallucination is absent.
3) Dejavu-Jamaisvu: -
Nurse: - Kya aapko aisa lgta hai kisi jgah aap pehli bar gaye ho lekin apko lge ki aap yha phle bhi aa chuke ho?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Dejavu is absent.
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye ho
Patient:- Nahi mujhe aisa nai lgta
Infrence:-Jamaisvu is absent
4) Depersonalization: -
Nurse: - Kya apko aisa lagta hai ki apme ya apki body mei kch change hua hai?
Patient: - Nahi mujhe aisa nahi lgta.
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye ho
Patient:- Nahi mujhe aisa nai lgta
Infrence:-Jamaisvu is absent
Inference: - Depersonalization is absent.
Consciousness:-
Nurse- aap hospital kyun aye ho?
Patient- mujhe dimagi bimar hu isliye ilaz karane ayi hun.
Inference-Patient is fully conscious.
Attention: -
Concentration: -
Orientation: -
Time: -
Nurse: - Abhi kya time hua hai?
Patient: - 2:50 pm huei hai.
Inference: - Patient is oriented to time.
Place: -
Nurse: - Yei Kaun si jagah hai?
Patient: - hospital
Inference: - Patient is oriented to place.
Person: -
Nurse: - Kya apko pta hai apke sath kaun hai?
Patient: - Haa meri maa h.
Inference: - Patient is oriented to person.
Memory: -
a) Immediate memory:-
Nurse - Mai apko ek no. duga apko wo no. mujhe dobara btana hai 9835664?
Patient: - 9835664
Inference: - Immediate memory is intact
b) Recent memory: -
c) Remote Memory: -
Nurse: - Aapka janam tithi kab hoti hai?
Patient: - august me 5 ko
Inference: - Remote memory is intact.
Intelligent: -
Arithmatic ability
Nurse:- Mai apko 100 rs dekr agar 20rs le lu to btao ki apke pas kitne bachenge
Patient:- Mere paas 80rs bachenge
Infrence :-Intellegence is present
Abstractions: -
a) Proverbs
Nurse: - 9 or 2 11 hona ka kya matlab hai?
Patient: - Bhag jana
Inference: - Patient understanding regarding the proverb is good.
Judgement: -
Nurse:- Aap yaha se jane ke baad kya kroge?
Patient:- Mai ghr walo ki dekhbaal krungi.
Infrence:-Personal judgement is intact.
Nurse: - Agar aapke samne koi accident ho jaye to aap kya kroge?
Patient: - Logo ko mdad kei liye bulaugi.
Inference: - Social Judgement is intact.
Nurse: Agar apke ghr me aag lag jaye aap kya kroge?
Patient: sab milke aag nhujaynge.
Infrence: Test judgement is Present.
Insight: -
Nurse: - Aap yha kiske sath aye ho?
Patient: - Apni maa k sath
Nurse:- aapke yaha ane ka kya karan hai?
Patient:- mai yaha doctr banne aayi hu.
Nurse: - Kya aapko lgta hai aapko koi bimari hai?
01. ……..
4.5.2023 9am Clonazepam tab Assessment was done
02.
…….. History taking was done
10am Tramadol
5.5.2023
9am Clonazepam ………. Patient was asking about fresh complaints
01
………. Health education was given to the patient and her family members
02.
10am Tramadol regarding medication and importence of follow up.
………
03.
12am B-complex
Day-3
Myself Jyoti Batra, student of M.Sc. Nursing 1st year. I am posted in Psychiatry ward. My patient Mr abdul with diagnosis Schizophrenia
assigned to me. I learned about this disorder and various psychiatric illnesses and their management and how to deal with mentally ill patient. I
learnt all these things under the supervision of Miss Renuka mam . I learnt about pharmacology of substance abuse patient and also about
psychotherapies like , behaviour therapy etc. It was a great learning experience for me and I will apply this knowledge in my future
Health education
Educate the patient relative do not force the patient about any activity
Educate the Family member to provide psychological support.
Encorage the patient to ventilate the feeling to a close one
Encorage the family members that do not judge the patient for any activity
Educate the family members to provide balance diet to the patient
Advise the family member about the importance of treatment
Advise the Patient to consult the doctor if any side effect occur
Educate the patient and family members about the side effect of medicine
Educate the family members to follow up the treatment
BIBLIOGRAPHY
Neerja KP: Essentials of mental health and psychiatric nursing vol. 1 Jaypee publisher
Sreevani R. A Guide To Mental Health And Psychiatric Nursing.2nd Edition. Jaypee Publisher
CASE PRESENTATION
ON
BIPOLAR AFFECTIVE DISORDER
IDENTIFICATION DATA:-
Name of the patient -abc
Age /Sex -20/M
Father/Spouse –Malkha
C.R No. -76302
Education -10th pass
Occupation -Labour
Income -9000/
Marital status –Unmarried
Religion -Hindu
D.O.A -20//06/23 at 13:35pm
Ward/Unit No –Psychiatric ward/unit-2
Informant –Self and his mother
Relation with patient-mother
Information -Relevant
Presenting Chief Complaints:-
As per patient:-
Mai thik hu mujhe kuch nhi hua
As per informant:-
Sota nahi hai
Ladai jhagda karta hai x15days
Gussa karta hai]
TDI -1Years
Duration -1 Years
Course –Episodic
Intensity -Increasing
5/6/23 patient went out of the house without telling anyone. On being called on his phone he told that he went to Mandi and would return later
no need to call him. Next day he returned in the morning, slept for 2-3hrs. but after waking up he started to shout at his father or other family
member. For last few days patient broke items like utensils, cycle, and chair. Patient also stopped taking his ATT medication 15days back.
Family members also noticed that patient has decreased need of sleep and remained energetic whole day. Patient went several times out of the
house and came back. Next day on being asked where he went patient would not reply and instead shout on them. He would also say that people
in the neighborhood are talking ill about him. His level of self-care declined. Patient appetite also decreased. Family member also noticed that
patient had started change the place of god photographs kept in the house without any reason.one day neighbor reported to his family member
that he started shouting loudly in public in front of everyone that ‘mai bhole baba hu dhup batti karo’.when patient was asked to come along with
family members to the hospital he threatened than he would harm himself by keeping his hand in the fan. He slapped his family members several
times, and abused the driver and was forcefully brought to the psychiatry OPD on 20/6/23 and got admitted in 13/II.
Treatment History:-
Patient got admitted in Hindu Rao Hospital for one day with diagnoses of Abdominal Koch’s
26/7/21
Tab. Sertraline 50mg 1HS
Tab. Sodium valproate 500mg 1-x-1 x20days
Tab. Diazepam 5mg 2HS
10/5/23
Tab. Sertraline 50mg 1HS
Tab. Sodium valproate 500mg 1-x-1 x20days
Tab. Diazepam 5mg 2HS
As there was no relief of symptoms,
Patient again took treatment
ECT -No
Psychotherapy -No
Past Psychiatric and Medical History
Psychiatric:- No history of psychiatric illness in past
Medical:-No history of seizure
No history of head injury, consciousness or chronic fever
History of any cannabis abused in last 2 years.
No history of DM/HTN/CAD/HIV positivity
Family History
Client belongs to Hindu nuclear family of lower socio economic status
No family history of psychiatric illness.
50yrs/M 40yrs/F
Illiterate Illiterate
Father Mother
Alcholic
Perinatal history
Antenatal period –Normal
Intranatal period –Normal
Birth –At full term
Birth cry –Immediate
Birth defects –No
Postnatal complications -No
Childhood history
Primary caregiver -Mother
Development milestone- Normal
Behavior and emotional problems- No
Illness during childhood- No
Educational history
Age at beginning of formal education –5years
Puberty
Age at appearance of secondary sexual characteristics -14Years
Anxiety related to puberty changes-Not Significant
Occupational History- Labor in paper making factory x2years
Marital History
Unmarried
Premorbid personality
Interpersonal relationship –Extrovert and good
Family and social relationships -Good
Attitude to Self – Confident and respect everyone
Attitude towards work and responsibility –Responsible, and do all the work assigned to her
Religious belief-She has faith in god
Habits –Watching T.V
Eating pattern -Regular
Elimination -Regular
Sleep –Regular
Use of drugs, tobacco, alcohol –Yes(Cannabis)
MENTAL STATUS EXAMINATION
Date of Examination-10/6/23
A. GENERAL APPEARANCE AND BEHAVIOR:- Patient was sitting on her bed. Looking one’s age, No physical deformity. When student
went to her she accepted greeting.
Facial expression:-Anxious
Level of cleanliness:-inadequate
BEHAVIOR:-
Cooperativeness:-less than so
Psychomotor activity:-Increased
Rapport:-Not established
Gesturing:-normal
Posturing:-normal
B. SPEECH:-
Initiation:- Spontaneous
Reaction time:-Delayed
Rate:- Rapid
Volume:- increased
Tone:-High pitch
Stream:-normal
Impression- Patients speaks in Hindi. She has normal volume, tone, and rate of speech.
Subjective
Client-abhi thik hu
Impression-labile
Objective
irritable
D. THOUGHT:-
Stream(flow of thought)
Normal
Impression-Normal
Content(idea)
Student:-aapke mann me kya khyal aate hai? Kya aapka marne ka dil karta hai?
Client:-nahi, lekin kaam chhut gya hai. Mahine se kaam pe nahi gya. Kaam to karna pdega dikkat par kmaane khane k liye chahye
Student:-kya aapko lgta hai ki koi aapko maarna ya nuksaan phuchana chahta hai?
Client:-mute
Impression:-thought blocking
Student:-kya aapko kabhi kisi kaam ko bar bar karne ka mann karta hai?
Client:-nahi
Impression:-no obsession
Client:-darta hu apne se andhere se. raat ko ghr aane me dar lgta hai. Andhera hota hai to mandi bhaag jata hu.
Student:-aapke padosi kese hai? Kya aap unse baate karte ho?
Client:-Nahi
E. PERCEPTION:-
Illusion
Impression:-no illusion
Hallucination
Student:-kya aapko aisa kuch sunayi deta hai jo kisi or ko nahi sunta?
Client:-nahi
Student:-kya aapko aisa kuch dikhayi deta hai jo kisi or ko nahi dikhta?
Client:-nahi
Consciousness:-
client:-char
Orientation;-
a)Time
b)Place
c)Person
Attention
Student:- mai aapko kuch digit dungi unko repeat krna hai?
Student:- 11,15,17,19
Client:-11,15,17,19
Student:-22,24,26,28
Client:-28,26,24,22
Concentration
Student:-40-3
Client:-37
Student:- 100-7
Client:-93
Impression:-concentration sustained
Memory
a)Immediate
Recall-3/3
b)Recent
c)Remote
Client:-Global school
Impression:-intact memory
Intelligence
Student:-days in week
Client:-7
Student:-name of PM
Client:-Modi
Client:- 15august
Client:- 14years
Impression:-adequate knowledge
Abstraction
Similarities
Student:-Pen-pencil
Client:-likhte hai
Student:- Apple-mango
Dissimilarities
Proverb
student:-9.2.11?
Client:-bhaag jana
Client:-shaadi karna.
Judgment
Personal
Social
Client:-haa
Test
Student:-agar hospital me aag lag jaye to kya karogi?
G. INSIGHT:-
Client:-Nahi
Impression:-insight 1/5
DIAGNOSTIC FORMULATION:-Patient Deepak 20Y/M, unmarried labor by occupation, residing in Hindu nuclear family of LSES of rural
background of Delhi has been admitted with episodic illness of 1year with current episode characterized by decreased need of sleep, over
activity, over talkativeness, abusive and aggressive behavior, poor self-care, decreased appetite for last 15days with past history suggestive of
Manic episode1year back which required admission. History of Koch Abdomen in March 2019. Family history of alcohol abuse in father
dependence pattern with substance history suggestive of Cannabis used for last 2years with amount or pattern not known, with well adjust PMP.
On MSE general appearance shabbily dresses, argumentative, aggressiveness. Rapport not established, psychomotor activity increased, reaction
time decreased, affect irritable, social judgment impaired, insight 1/5
B.P -110/70mmHg
Temperature -98.6 F
Pulse -70/min
No organanomegaly present
It is also known as manic depression. This is characterized by recurrent episode of mania and depression in the same patient at different times.
Typically the patient experiences extreme highs mania or depression alternating with extreme lows, interspersed between the highs and lows are
periods of normal mood.
Onset-onset usually occur between ages of 20 and 30. Symptoms sometimes appear in the late childhood or early adolescence.
Rapid speech with frequent topic changes Difficulty concentrating or thinking clearly
without disorientation or intellectual
impairment
Decreased need for sleep and food
Psychomotor agitation
Impulsivity
Anhendonia
Impaired judgment
Suicidal ideation
DIAGNOSIS:-
Based on sign and symptoms
ICD 10 criteria
PSYCHOPATHOLOGY
Depressive or hypersomnia
Insomnia or hypersomnia
Feeling of inadequacy
Social withdrawal
Loss of libido or interest in pleasurable activity
Lethargy
Suicidal ideation
Manic phase
Hypomanic phase
Insomnia
Depressive phase
Insomnia or hypersomnia
Feelings of inadequacy
Decreased productivity
X
Social withdrawal
Lethargy
Suicidal ideation
x
INVESTIGATION AND DIGNOSIS
MSE
Psychiatric history
Clinical observation
Investigation
KFT
S.Creatinine- 1.0mg/dl
LFT
SGOT -39U/L
SGPT-22U/L
S. Alkaline phosphate- 39 to 117U/L
S. protein- 7.2g/dl
B. sugar- 123mg/dl
NURSING ASSESSMENT-
-Amenorrhea
Subjective Data High risk for <Control < To demonstrate a stable <Demonstrate a stable Risk of inury is
related to thought mood and practice self-care mood and practice self- reduced
In mania-
extreme processes activites care activites
< Feeling of joy hyperactivity
< During manic phase- < Decrease
<Rapid mood Demonstrate environmental stimui, to
< To decrease environmental
swings a stable promote relaxation and
stimui, to promote relaxation
mood and enable to sleep
< Sleep and enable to sleep
practice self-
disturbance < Monitor drug level,
care < To monitor drug level,
especially lithium
In depression- activities especially lithium
< Change the client’s
>Suicidal idea <To change the client’s
energy in one direction
energy in one direction
> Worthlessness,
< Change the client’s
hopelessness < To prevent overstimulation
energy in one direction
< Impairment of During depression
<Ensure the client spend
cognition
Phase- with him and focus on
Objective Data strengths and
< To ensure a safe
accomplishments and
In mania environment to client
minimize failure
Nursing Nursing Goal Planning Implementati Evaluation
assessment diagnosis on
Subjective Data Risk suicidal Short term < To ask about <Patient is Risk for suicide is
behavior ”Have any thought asked about decease to some
< Anhedonia Patient will
related to about harming have any extent
not harm self
<Worthlessness, depression yourself” in any thought about
hopelessness way harming
yourself in
<Suicidal ideas Long term < Make a short
any way.
term verbal or
<Impairment of Patient well
written contract < Created a
cognition recognize
that the patient will safe
self, worth,
< Somatic not harm. environment
dignity,
symptoms that is free
power and <To create a safe
from sharp
self-esteem environment
objects, belts,
Objective data <To avoid the glass, items,
patient to leave alcohol,
<Alterations of
alone. supervise
activity
closely during
To observe any
<Poor personal meal and
sudden change in
hygiene medication
mood
<Altered social
HEALTH EDUCATION
For depression
Teach the family about the depression. Teach about the beginning symptoms of relapse may assist patients to seek treatment early and avoid a
lengthy recurrence
Discuss the importance of support groups and assist in locating resources
Teach the action, side effects and special instructions regarding medication
Discuss methods to manage side effects of medication
Tell the family to offer the patient some household responsibility within the patient level of capability to promote self esteem
Teach the family to recognize the symptoms of suicidal ideation and how to conduct a suicide assessment
Emphasize that antidepressants can cause constipation which may be prevented with a good bowel regimen adding fiber to the diet and drinking
water
Avoid making life changes while the patient is experiencing recovery from depression
Help the patient and family identify community resources such as suicide hotlines.
For mania
Teach about the bipolar illness and ways to manage the disorder
Teach about medication management
For patient who is taking lithium, teach about the need for adequate salt and fluid intake
Teach the patient and family about signs of toxicity and the need to seek medical attention immediately
Teach about the behavioral signs of relapse and how to seek treatment in early stages
Educate the patient and family about risk taking behavior and how to avoid
CLASS PRESENTATION
ON
MANIA
SUBMITTED TO: SUBMITTED BY:
MRS. DEEKSHA MS. JYOTI BATRA
ASSISTANT PROFESSOR M.SC. NURSING 1ST YEAR
MENTAL HEALTH NURSING MENTAL HEALTH NURSING
On completion of teaching the student will acquire depth knowledge regarding mania disorder.
Specific object:-
At the end of the teaching activity the student will be able to define mania.
At the end of the teaching the student will be able to enlist the etiological factor.
At the end of the teaching will be explained about symptom of mania.
Duration Specific Concepts Teaching Learning Av- Evaluation
Objective Activity Activity Aids
2 min Introduc Introduction:- Explain by Listening Green What
e Topic Mania is a flight of ideas, Increase pressure of speech, Lecture cum Board do
2 min and elevated mood, energy and increase activity. Discussion you
Define Mean
Note:- according ICD it include F30-F39 (in mood disorder)
mania. of mania ?
Definition:- MANIA
Mania can be described by ‘hyperactive’ ‘over-excited’
Sudden generate thought And Ideas. It is psychosis disorder.
Aetiology:-
types ⮚ Heredity.
At the end of the class the students will acquire in-depth knowledge on crisis intervention and to develop a positive attitude towards
handling the crisis in day to day clinical practice and also develops a competent skill in applying this knowledge in taking care of clients both in
wellness and sick.
Specific Objectives:
7. Follow-Up
They are:
1. Stabilize
2. Acknowledge
3. Facilitate understanding
4. Encourage adaptive coping
5. Restore functioning or,
6. Refer
Summary:
Conclusion:
Teacher reference
● Mary C. Townsend’s, “Psychiatric Mental Health Nursing”, sixth edition, F. A. Davis publication
Student reference:
● R. Sreevani’s, “A Guide To Mental Health and Psychiatric Nursing”, 3rd edition Jaypee Brothers Publication
NURSING CARE PLAN
ON
SCHIZOPHRENIA
IDENTIFICATION DATA
Name Mr xyz
Age 65years
Sex Male
Bed no. 5
O.P.D no. 15/467942
Ward Psychiatry ward
Education 5th standard
Occupation labrour
Marrital status Married
Religion Muslim
Language Hindi
Diagnosis Mental and Behaviour disorder due to the use of opioids
Identification mark Mole at right hand
Date of identification 1/7/2023
Date of assessment 4/7/2023
Informant Patient
a) Psychological:
According to patient: Afim khana
Nind kam aana
Gussa karna
Duration 1 year
Mode of onset Acute
Course Episodic
Intensity Increasing
Precipitating factor No
Patient was apparently well 35year back now he gives history of consumption of opium husk from the last 35 year. Initially he started taking
opium husk with his friends. Patient works as a farmer and while working in a field patient feel lethargic and weakness sometime patient feel
pain all over the body and then one of his friend offer him opium husk then patient took opium husk with his own will and patient took one
spoon of opium husk and after ate that patient feel better and energetic and with the period of half an hour to one hour patient got relief from
body pain. After that patient starts taking opium husk daily. Patient took one spoon of opium husk per day for the next one year and after one
year patient feels weak again and body ache at afternoon time then patient increased his opium husk intake habits to get the desire effect and
patient starts to take opium husk twice a day morning or afternoon time.
And then after 3month patient start to take opium husk thrice a day. If the patient do not consume opium husk in a day patient had strong desire
or compulsion to take substance when he not consumed opium husk then he complaints of dysphonic mood, nausea, vomiting, muscle ache,
sweating, Insomnia and now Patient is taking treatment in psychiatric ward
Treatment History
Name of the Chemical Action Dosage Route
drug Name
Tab Clox Clonazepam Antipsychotic 0.5mg Oral
Tab tramacon Tramadol Opioid 100mg Oral
SR Analgesic
Family history:-
Family tree
Male Male Male patient
Female
Personal History
Prenatal History
Antenatal period No any significant of Prenatal history
Intranatal period
Birth
Birth defect
Postnatal Complication
Childhood history
Educational history
Habits
Eating pattern patient takes 3Meals in a day
Elimination Bowel and bladder habits are normal
Sleeping pattern Patient takes 5-6 hours during night and 1 hour of sleep during a da
MENTAL STATUS EXAMINATION
General Appearance and Behaviour
Speech: -
Initiation: - Minimal
Reaction time: - Time taken to answer to question
Rate: - Normal
Productivity: - Normal
Volume: - low
Tone: - low pitch
Relevance: - Fully relevant
Stream - Normal
Coherence: - coherent
Others: - preservation
Subjective
Nurse: - Aapka man kaisa hai?
Patient: - Mere man achha hai.
Objective
Patient affect is appropriate his mood.
Thought: -
Stream: Normal, Autistic thinking, thought block, Poverty of speech, Pressure of thought all are absent.
Form: Normal, Circumstantiality, tangantiality, neologism, verbigeration, flight of idea all are absent.
Content:
1. Delusion:-
Nurse: - Kya apko lgta hai ki aapki wife ka kisis se chakkar hai?
Patient: - Ha mujhe aisa lagta hai.
Inference: - Delusion of infidelity is abesent.
Nurse: - Kya apko lgta hai koi apko wash mei krna chahta hai?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Delusion of control is absent.
Nurse: - kya apko lgta hai aap koi mahan insan hai?
Patient: - nahi mujhe aisa nahi lagta or lgega bhi kyu.
Inference: - Delusion of grandiosity is absent.
Nurse: - kya apko lgta hai jab 2 log baat kar rahe hote hai to wo apke bare mei hi bat krte hai?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Delusion of reference is absent.
2. Hypochondria:-
Nurse: - Kya apko lgta hai apko koi khtarnak bimari hai? Apne kayi hasptalo sei dwai li hai?
Patient: - na, mujhe nahi lgta hai or mane phle bhi dwai nahi li hai.
Inference: - Hypochondria delusion is absent.
Ideas: -
Nurse: - kya apke man mei aisa khyal ata hai ki apki zindgi khtm hone wali hai?
Patient: - Nahi mujhe aisa nahi lagta lekin mujhe apni patni pe gussa ata hai to mujhe marne ka khayal ata hai.
Inference: - Suicidal ideas are present.
3) Obsessional Compulsive Phenomena: -
Nurse: - Kya apko lgta hai ki apke hath gande hai or aap unhe bar bar dhote hai?
Patient: - Nahi aisa nahi hai.
Inference: - No Obsessional/Compulsive phenomena present.
4) Phobia: -
Perception: -
1) Illusions:-
Nurse: - kya apko rassi ko dekh ke aisa to nahi lagta hai ki ye saanp hai?
Patient: - Nahi mujhe aisa nahi lagta.
Inference: - Illusion is not present.
2) Hallucination: -
Auditory Hallucination:-
Nurse: - Kya jab aap akele bathe hote to apko kisi kism ki awaje to nahi suniee deti?
Patient: - Haa, mujhe awaje sunai deti hai aisa lagta hai meri patni or sadu apas me bate karte ho.
Inference: - Auditory Hallucination is present.
b) Visual Hallucination: -
Nurse: - Kya apko aisa kuch dikhayi deta hai jo kisi ko dikhayi nahi deta?
Patient: - Ha mujhe mere sadu dikhaiee dete hai.
Inference: - Visual Hallucination is present.
c) Olfactory hallucination: -
Nurse: - kya apko aisi koi badbu aati hai jaise kuch jal raha hai?
Patient: - Nahi aisa kuch nahi hai.
Inference: - Olfactory hallucination is absent.
d) Gastatory Hallucination: -
Nurse: - Kya apko aisa lgta hai ki kisi cheej ko khane per kdwa swad ata hai?
Patient: - Nahi aisa kuch nahi hota.
Inference: - Gastatory hallucination is absent.
e) Tactile Hallucination: -
Nurse: - Kya apko aisa lgta hai ki apke body pei kuch chalra hai mtlb jaise kuch reing raha hai?
Patient: - Nahi mujhe aisa kuch nahi lgta.
Inference: - Tactile hallucination is absent.
3) Dejavu-Jamaisvu: -
Nurse: - Kya aapko aisa lgta hai kisi jgah aap pehli bar gaye ho lekin apko lge ki aap yha phle bhi aa chuke ho?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Dejavu is absent.
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye ho
Patient:- Nahi mujhe aisa nai lgta
Infrence:-Jamaisvu is absent
4) Depersonalization: -
Nurse: - Kya apko aisa lagta hai ki apme ya apki body mei kch change hua hai?
Patient: - Nahi mujhe aisa nahi lgta.
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye ho
Patient:- Nahi mujhe aisa nai lgta
Infrence:-Jamaisvu is absent
Inference: - Depersonalization is absent.
Consciousness:-
Nurse- aap hospital kyun aye ho?
Patient- mujhe dimagi bimar hu isliye ilaz karane ayi hun.
Inference-Patient is fully conscious.
Attention: -
Concentration: -
Nurse: -100 me se 7 panch bar ghtaoo
Patient: - 93,86,79…. hote hai
Orientation: -
Time: -
Nurse: - Abhi kya time hua hai?
Patient: - 2:50 pm huei hai.
Inference: - Patient is oriented to time.
Place: -
Nurse: - Yei Kaun si jagah hai?
Patient: - hospital
Inference: - Patient is oriented to place.
Person: -
Nurse: - Kya apko pta hai apke sath kaun hai?
Patient: - Haa meri maa h.
Inference: - Patient is oriented to person.
Memory: -
a) Immediate memory:-
Nurse - Mai apko ek no. duga apko wo no. mujhe dobara btana hai 9835664?
Patient: - 9835664
Inference: - Immediate memory is intact
b) Recent memory: -
c) Remote Memory: -
Intelligent: -
General fund of information
Nurse: - Diwali kab aati hai?
Patient: - November main.
Inference: - Patient intelligence is adequate.
Arithmatic ability
Nurse:- Mai apko 100 rs dekr agar 20rs le lu to btao ki apke pas kitne bachenge
Patient:- Mere paas 80rs bachenge
Infrence :-Intellegence is present
Abstractions: -
a) Proverbs
Nurse: - 9 or 2 11 hona ka kya matlab hai?
Patient: - Bhag jana
Inference: - Patient understanding regarding the proverb is good.
Judgement: -
Nurse: - Agar aapke samne koi accident ho jaye to aap kya kroge?
Patient: - Logo ko mdad kei liye bulaugi.
Inference: - Social Judgement is intact.
Nurse: Agar apke ghr me aag lag jaye aap kya kroge?
Patient: sab milke aag nhujaynge.
Infrence: Test judgement is Present.
Insight: -
Educate the patient relative do not force the patient about any activity
Educate the Family member to provide psychological support.
Encourage the patient to ventilate the feeling to a close one
Encourage the family members that do not judge the patient for any activity
Educate the family members to provide balance diet to the patient
Advise the family member about the importance of treatment
Advise the Patient to consult the doctor if any side effect occur
Educate the patient and family members about the side effect of medicine
Educate the family members to follow up the treatment
BIBLIOGRAPHY
Neerja KP: Essentials of mental health and psychiatric nursing vol. 1 Jaypee publisher
Sreevani R. A Guide To Mental Health And Psychiatric Nursing.2nd Edition. Jaypee Publisher
HISTORY COLLECTION:
IDENTIFICATION DATA-
Name : Mrs. abc
Age : 48 years
Sex : Female
Marital Status : Married
IP No. : 352617
Date of Admission : 15/07/2023
Religion : Hindu
Occupation : Housewife
Education : 5th
Socio-economic status : Middle class
Address : Agroha
Informant : Husband
CHIEF COMPLAINTS-
According to the patient:
Nind nhi aati
Dimag ghum rha hai
Sir bhari ho rkha hai
According to Informant:
Gali galoch krti hai
Soti nhi hai
Nachna gaana krti hai
Akele me badbdati hai
Dwaiya nhi khati
PRESENT PSYCHIATRIC HISTORY-
The onset is chronic within year. The duration is about 37 year. It is periodical type. There is ↑sing and ↓sing intensity. There are no
precipitating factors. But she is having irritability, sleep disturbance, suspeciousness, muttering to self, overalertness, aggressiveness, increased
activity. Her hygiene is maintained by the family
PAST PSYCHIATRIC HISTORY-
Mrs Kamla was suffering from schizoaffective Manic type disease since last 37 years.
The first episode was in 2001 when she was 21 years old. there was decreased need for sleep, irritability, increased psychomotor activity, over
religiosity, muttering to self and even to third person, delusion of persecution was there.
The second episode was in 2015 when she got similar symptoms and admitted in RML hospital.
The third episode was in July 2017.
4th episode was in August 2018.
5th episode was in December 2019.
Sixth episode was in February 2022.
FAMILY HISTORY-
DEATH -
In Mrs kavita’s family her younger brother and her older sister was suffering from depression. so there was psychiatric history present in the family. Mrs kamla’s
husband was suffering from congenital heart disease that's why he had undergone pacemaker implantation in 2016. there was no other significant history in the
family.
PERSONAL HISTORY-
Prenatal History:
During prenatal period, there is no any evidence of radiation exposure but the child had history of pneumonia. The mother was carried out all the
antenatal checkups. There was no complication to mother and child during the period.
Natal History:
The mother had normal vaginal delivery no complication during delivery. Breathe and cried at birth milestones were normal.
Behaviour during childhood:
The mother was provided breast milk to the child up to 3 years and weaning was also practiced. There was no neurotic symptoms and habit and
excretory disorders.
Premorbid personality
DEMOGRAPHIC DATA:
Name : Aniket
Age : 21 years
Sex : Male
Ward : Male Ward
Education : 12th class
Occupation : Student
Religion : Hindu
Community : Urban
Socio Economic Status : Low-middle class
Marital status : Unmarried
Language : Hindi
Nationality : Indian
Address : Fatehabad (Haryana)
Diagnosis : Biplar affective disorder (BAPD)
Informant:
Primary Source: Patient
Secondary Source: Informant and Medical Record
Information: Appropriate
Reliable
Adequate
Informant:
Reliability of Information: Reliable
Relationship with Patient: Brother
Duration of relationship: From Birth
CHIEF COMPLAINTS:
According to Patient: patient is not able to explain the exact problem
According to informant:
• Not doing work properly
• Not maintaining hygiene
According to Medical Record:
Spontaneous verbalizing
Feeling of sedation
Altered consciousness
Loss interest in maintaining hygiene
Circumstentiality
Irrelevant talk
Suspicious
Escape from nearest ones From 3 years
Insomnia
Big talks
History of current episode: patient was apparently well 2 and half year back, his interpersonal
relationship and biological functions were fixed at that time. Then his family members got to know from
the school that patient leaves the house in the working for school but does not go to school and roams here
and there with bad elements of village. In following few days they noticed that past (new expensive
mobile, phones, scooty, car, television) and he also started saying bizarre things like SDM and other
proves him and he wants to be a superstar and a famous actor. Sleep got decreased. He went to Mumbai
several times without his family members. He was very irritable and 3-4 persons are not able to control at
that place. He didn’t ready to take medicine because he think that he is absolutely fine.
PAST HISTORY:
Psychiatric History: patient was apparently well 2 and half year back, his interpersonal relationship and
biological functions were fixed at that time. Then his family members got to know from the school that
patient leaves the house in the working for school but does not go to school and roams here and there with
bad elements of village. In following few days they noticed that past (new expensive mobile, phones,
scooty, car, television) and he also started saying bizarre things like SDM and other proves him and he
wants to be a superstar and a famous actor. Sleep got decreased. He went to Mumbai several times without
his family members. He was very irritable and 3-4 persons are not able to control at that place. He didn’t
ready to take medicine because he think that he is absolutely fine.
Medical History:
Patient has no history of Jaundice, Pneumonia, Asthma, TB, Head injuries, Seizures.
Surgical History:
The patient has no past surgical history.
FAMILY HISTORY:
Family Genogram:
Family Genogram:
2. Birth History:
Order : Fourth child
Term : Full term normal delivery
Place : Home
Type : Normal
Labour : Normal
First cry : Normal
Cyanosis or jaundice : Absent
Immediate breast feeding : Yes
Neonatal infections : Absent
3. Milestones: Delayed
Social activity:
Has friends/withdrawn/socializing well : Not Withdrawn
Social mixing/participation : good
Relationship with people of same and opposite sex: Average relationship
13. Personality:
Attitude to others in social, family and sexual relationship: Patient has inability to
trust other, make and sustain relationship but anxious and emotionally cold, etc. patient has
negative attitude towards others.
Attitudes to self: Patient has a feeling of big.
Moral and religious attitudes and standards: Patient is religious priorly before 2 and
half year but after this he feeling a boundation of religion and he want to escape from
religious boundation.
Mood: mood (affect) is not defined because patient is sedative condition.
Leisure activities and hobbies: Patient was not interested in doing any leisure able
activity.
Fantasy life: Patient have fantasy life.
Reaction pattern to stress: Patient does not have ability to tolerate frustrations, losses,
disappointments, and this leads to arousing anger, anxiety or depression.
Habits:
• Eating : Normal
• Sleeping : Disturbed
• Excretory functions : Normal
PHYSICAL EXAMINATION
VITAL SIGNS:
• Temperature : 98.8 oF
• Pulse : 92 beats/min
• Respiration : 26 breath/min
• Blood Pressure : 130/80 mmHg
GENERAL APPEARANCE:
• Nourishment : Normal
• Body Build : Ectomorphic
• Healthy : Unhealthy
• Activity : Dull
POSTURE:
•Body Curves : Normal body curves.
HEIGHT : 5’8”
WEIGHT : 65kg
SKIN CONDITION:
• Colour : Whitish in clear.
• Texture : Dry texture
• Temperature : Warm in touch.
• Lesions : No lesion present
SPEECH/ THOUGHT
Evaluation of Speech:
1. Intensity: The voice of patient was not normally audible, patient was speaking very
slowly, and repetition was needed to hear the patient.
2. Pitch: The voice was changing according to the subject matter.
3. Speed: The patient spoke at a usual rate of speech but very slowly.
4. Spontaneity:Patient responded when questions were put to him and sometimes
remains mute.
5. Manner:Manner of speaking was normal.
6. Reaction time: It was abnormally slow.
DISORDERS IN CONTENT OF THOUGHT:
.
1. Persecutory delusion: Present, as patient has belief that someone is going to harm
him.
DISORDERS OF PERCEPTION
HALLUCINATION:
May be defined as a sensory experience in the absence of a stimulus or object.
Auditory Hallucination: Present, as patient hears multiple voices of males and females.
Visual Hallucinations: Present, as patient see faces of his friends.
VARIATIONS OF PERCEPTION:
Heightened perception: present in patient
DISORDERS OF MEMORY
ORIENTATION: Patient was oriented to time, place ,person.
INSIGHT:
Patient’s assessment of his illness.
LEVELS OF INSIGHT: Grade-I insight is present.
CONCENTRATION: Concentration is poor.
ABSTRACT THINKING: Abstract thinking is not present.
JUDGEMENT: Judgment is poor.
INTELLIGENCE: Present.
SLEEP: The patient has persistent insomnia.
Investigations:
NAME RESULT REFERRAL VALUE REMARKS
Random Blood Sugar 102 mg/dL 70-110 mg/dL Normal
KFT:
Urea 20 mg/dL 15-45 mg/dL Normal
S. Creatinine 0.86 mg/dL 0.7-1.3 mg/dL Normal
Uric Acid 4.6 mg/dL 3.5- 7.2 mg/dL Normal
Electrolytes:
Sodium 144 mmol/L 135-158 mmol/L Normal
Potassium 4.6 mmol/L 3.8-5.6 mmol/L Normal
Calcium 1.2 mmol/L 1.1-1.3 mmol/L Normal
Phosphorus 2.8 mg/dL 2.5-5.0 mg/dL Normal
LFT:
S. Bilirubin
Total 0.39 mg/dL 0.2-1.2 mg/dL Normal
Direct 0.10 mg/dL 0.0-0.2 mg/dL Normal
SGOT/AST 21 U/L <40 U/L Normal
SGPT/ALT 18 U/L <38 U/L Normal
Total Protein 6.3 g/dL 6.2-8.5 g/dL Normal
S. Albumin 4.3 g/dL 3.5-5.3 g/dL Normal
GGT 14 U/L 8-78 U/L Normal
Medication:
GENERIC NAME DOSAGE ROUTE FREQUENCY ACTION
Tab. Quantiapine 200 mg P/O BD Antipsychotic
Tab. Trihexiphenyldine 2 mg P/O BD Antiparkinsonian
Tab. Lopez 1 mg P/O HS Anticonvulsant
NURSING CARE PLAN
NURSING DIAGNOSIS
1. Impaired Social Interaction: The state in which an individual participates in an insufficient or excessive quantity or ineffective quality of
social exchange.
2. Disturbed Sensory Perception: Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated,
distorted or impaired response to such stimuli.
3. Disturbed Thought Process: Disruption in cognitive operations and activities.
4. Interrupted Family Process: Change in family relationships and/or functioning.
5. Impaired Verbal Communication: decreased, reduced, delayed, or absent ability to receive, process, transmit or use a system of symbols.
Assessment Diagnosis Goals Intervention Implementation Evaluation
Subjective Impaired Verbal Expected outcomes Identify the duration of the Therapeutic levels of an Patient trying
data Communication: or patient goals for psychotic medication of the antipsychotic aids clear to start verbal
Am not want decreased, reduced, impaired verbal client. thinking and diminishes communication
to talk with delayed, or absent communication derailment or looseness with the family
Keep voice in a low manner and
anyone. ability to receive, nursing diagnosIS ofassociation. or medical
speak slowly as much as
process, transmit or team.
possible. A high-pitched/loud tone of
Objective use a system of
voice can elevate anxiety levels
data symbols. Keep environment calm, quiet
while slow speaking aids
Nurse and as free of stimuli as
understanding.
observe the possible.
client not Keep anxiety from escalating
Use clear or simple words, and
communicate and increasing confusion and
keep directions simple as well.
with anyone. hallucinations/delusi
Focus on and direct client’s
Client might have difficulty
attention to concrete things in
processing even simple
the environment
sentences.
Assess if the medication has
Helps draw focus away from
reached therapeutic levels.
delusions and focus on reality-
Expected outcomes identify with client symptoms he based things.
NURSING CARE PLAN
ON
PERSONALITY DISORDER
Informant Patient
a) Psychological:
According to patient:
Nind kam aana
Gussa karna
Akele bethe bolna
Treatment History
Family history:-
Family tree
Male
Female
Personal History
Prenatal History
Antenatal period No any significant of prenatal history
Intranatal period
Birth
Birth defect
Postnatal Complication
Childhood history
Educational history
Play history
Premorbid personality
Habits
Speech: -
Initiation: - Minimal
Reaction time: - Time taken to answer to question
Rate: - Normal
Productivity: - Normal
Volume: - low
Tone: - low pitch
Relevance: - Fully relevant
Stream - Normal
Coherence: - coherent
Others: - preservation
Nurse: - Aap apne bare me kuch btaye.
Patient:- Mera naam deepa hai, mai bimar hu
Inference- Patients speaks in Hindi. She have normal volume, tone, and rate of speech.
Subjective
Nurse: - Aapka man kaisa hai?
Patient: - Mere man achha hai.
Objective
Patient affect is appropriate his mood.
Thought: -
Stream: Normal, Autistic thinking, Thought block, Poverty of speech, Pressure of thought
all are absent.
Form: Normal, Circumstantiality, tangantiality, neologism, verbigeration, flight of idea all
are absent.
Content:
1. Delusion:-
Nurse: - Kya apko lgta hai ki aapki wife ka kisis se chakkar hai?
Patient: - Ha mujhe aisa lagta hai.
Inference: - Delusion of infidelity is abesent.
Nurse: - Kya apko lgta hai koi apko wash mei krna chahta hai?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Delusion of control is absent.
Nurse: - kya apko lgta hai aap koi mahan insan hai?
Patient: - nahi mujhe aisa nahi lagta or lgega bhi kyu.
Inference: - Delusion of grandiosity is absent.
Nurse: - kya apko lgta hai jab 2 log baat kar rahe hote hai to wo apke bare mei hi bat krte
hai?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Delusion of reference is absent.
2. Hypochondria:-
Nurse: - Kya apko lgta hai apko koi khtarnak bimari hai? Apne kayi hasptalo sei dwai li hai?
Patient: - na, mujhe nahi lgta hai or mane phle bhi dwai nahi li hai.
Inference: - Hypochondria delusion is absent.
Ideas: -
Nurse: - kya apke man mei aisa khyal ata hai ki apki zindgi khtm hone wali hai?
Patient: - Nahi mujhe aisa nahi lagta lekin mujhe apni patni pe gussa ata hai to mujhe marne
ka khayal ata hai.
Inference: - Suicidal ideas are present.
Nurse: - Kya apko lgta hai ki apke hath gande hai or aap unhe bar bar dhote hai?
Patient: - Nahi aisa nahi hai.
Inference: - No Obsessional/Compulsive phenomena present.
4) Phobia: -
Perception: -
1) Illusions:-
Nurse: - kya apko rassi ko dekh ke aisa to nahi lagta hai ki ye saanp hai?
Patient: - Nahi mujhe aisa nahi lagta.
Inference: - Illusion is not present.
2) Hallucination: -
Auditory Hallucination:-
Nurse: - Kya jab aap akele bathe hote to apko kisi kism ki awaje to nahi suniee deti?
Patient: - Haa, mujhe awaje sunai deti hai aisa lagta hai meri patni or sadu apas me bate karte
ho.
Inference: - Auditory Hallucination is present.
b) Visual Hallucination: -
Nurse: - Kya apko aisa kuch dikhayi deta hai jo kisi ko dikhayi nahi deta?
Patient: - Ha mujhe mere sadu dikhaiee dete hai.
Inference: - Visual Hallucination is present.
c) Olfactory hallucination: -
Nurse: - kya apko aisi koi badbu aati hai jaise kuch jal raha hai?
Patient: - Nahi aisa kuch nahi hai.
Inference: - Olfactory hallucination is absent.
d) Gastatory Hallucination: -
Nurse: - Kya apko aisa lgta hai ki kisi cheej ko khane per kdwa swad ata hai?
Patient: - Nahi aisa kuch nahi hota.
Inference: - Gastatory hallucination is absent.
e) Tactile Hallucination: -
Nurse: - Kya apko aisa lgta hai ki apke body pei kuch chalra hai mtlb jaise kuch reing raha
hai?
Patient: - Nahi mujhe aisa kuch nahi lgta.
Inference: - Tactile hallucination is absent.
3) Dejavu-Jamaisvu: -
Nurse: - Kya aapko aisa lgta hai kisi jgah aap pehli bar gaye ho lekin apko lge ki aap yha
phle bhi aa chuke ho?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Dejavu is absent.
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye
ho
Patient:- Nahi mujhe aisa nai lgta
Infrence:-Jamaisvu is absent
4) Depersonalization: -
Nurse: - Kya apko aisa lagta hai ki apme ya apki body mei kch change hua hai?
Patient: - Nahi mujhe aisa nahi lgta.
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye
ho
Patient:- Nahi mujhe aisa nai lgta
Infrence:-Jamaisvu is absent
Inference: - Depersonalization is absent.
Consciousness:-
Nurse- aap hospital kyun aye ho?
Patient- mujhe dimagi bimar hu isliye ilaz karane ayi hun.
Inference-Patient is fully conscious.
Attention: -
Concentration: -
Orientation: -
Time: -
Nurse: - Abhi kya time hua hai?
Patient: - 2:50 pm huei hai.
Inference: - Patient is oriented to time.
Place: -
Nurse: - Yei Kaun si jagah hai?
Patient: - hospital
Inference: - Patient is oriented to place.
Person: -
Nurse: - Kya apko pta hai apke sath kaun hai?
Patient: - Haa meri maa h.
Inference: - Patient is oriented to person.
Memory: -
a) Immediate memory:-
Nurse - Mai apko ek no. duga apko wo no. mujhe dobara btana hai 9835664?
Patient: - 9835664
Inference: - Immediate memory is intact
b) Recent memory: -
c) Remote Memory: -
Intelligent: -
Nurse:- Mai apko 100 rs dekr agar 20rs le lu to btao ki apke pas kitne bachenge
Patient:- Mere paas 80rs bachenge
Infrence :-Intellegence is present
Abstractions: -
a) Proverbs
Nurse: - 9 or 2 11 hona ka kya matlab hai?
Patient: - Bhag jana
Inference: - Patient understanding regarding the proverb is good.
Judgement: -
Nurse: Agar apke ghr me aag lag jaye aap kya kroge?
Patient: sab milke aag nhujaynge.
Infrence: Test judgement is Present.
Insight: -
Nurse: - Aap yha kiske sath aye ho?
Patient: - Apni maa k sath
Nurse:- aapke yaha ane ka kya karan hai?
Patient:- mai yaha doctr banne aayi hu.
Nurse: - Kya aapko lgta hai aapko koi bimari hai?
Pt frequently checked;
was accompanied
throughout meals.
During the crisis “Tunnel Pt was talked to;
period vision“ may emphasized that the
employ therapeutic be crisis is temporary;
use of present; unbearable pain can
self and statements be
suggest give survived; help is
perspective & help available; they’re not
offer hope
Subjective Cues: Risk for self- At the end of the
Reported scars mutilation related 8
were from to impulsive hours
cutting during behavior and nursing
her teenage ineffective coping intervention the Assess for A pattern of Pt was interviewed At the end of the
years. strategies & client will presence of self- injurious behavior and she verbalized 8
physically self- be able to: harm urges & will likely engage to have cutting hours
damaging acts as Demonstrate no history of self- in similar self- urges whenever nursing
Objective Cues: evidenced by signs of self-injury injury harm behaviors she’s distressed, intervention the
Visible scars on history of non- / be when stressed. angry or anxious. client was free
arms and legs suicidal self-injury. free from of self- Render close from self-
Impulsivity injury as evidenced supervision where The client is easier Pt was placed in a injury as there was
Medical record by absence of cuts they can be to observe with room near the no signs
states pt as history or observed easily less chance to nurse station for of
of any forms leave the area easy monitoring,
cutting her arms of self- inflicted Closely supervise undetected away from exits any self-
and legs when she injuries use of sharp / other and stairwells. inflicted injury
was a teenager. (e.g., burns, potentially They may use in
scratches, cuts) dangerous objects. these items for The pt was closely
self-destructive monitored and any form
acts. strictly kept out
from sharp /
Have a no-harm potentially (cuts,
contract with the dangerous objects; burns, scratches)
client. Pt is encouraged stayed with her
to take during use of and agreed
responsibility for cutlery during
healthier behavior. meals. upon
keeping a no- harm
Written no-harm contract.
contract was
secured; stating not
to act on impulse
to do self-harm
Use a matter-of- The pt was talked GOAL WAS MET.
fact approach A neutral approach to objectively
when self- prevents blaming, discuss her
mutilation occurs. which increases thoughts &
anxiety, giving feelings before
special self-mutilating
attention that without
encourages acting criticizing / giving
out. sympathy;
withdrawing
attention while she
acts out by
diverting it through
other activities
(e.g.,
asking her to
meditate).
At the end of the
8-
hour nursing
At the
intervention the
client will be Encourage They may Pt was asked to
able to: identification of be feelings directly express
Demonstrate feelings / that feelings directly by end of hours
related to verbalizing it and
self- listening as she
unaware of
trigger self-
self-control as mutilating / self- destructive discusses this feelings and urges.
evidenced by destructive behavior and needs
performing behaviors. to develop more
alternative effective skills to Pt was assisted to make a written list of
activities to avoid self- her strengths and successful *coping
self-mutilating Help the client destructive behavior from the past.
behaviors. identify strengths behavior in the
and successful future.
coping behaviors Self-perception Pt was assisted in making a plan through
that used in the may be one of identifying and list actions that might
past. hopelessness/ modify the intensity of such situations
helplessness, and people whom they can contact to
Work out a plan needing assistance discuss and examine intense feelings
identifying to recognize (rage, self-hate) arises.
alternative to self- strengths.
mutilating The client was taught and encouraged to
behaviors. Plan is periodically engage in other coping behaviors like
reviewed and increasing physical exercise, expressing
evaluated. Offers a feelings verbally or in a journal
chance to deal with /meditation technique.
Encourage the feelings and nursing intervention, the client
client to try to use struggles that arise. demonstrated self-control
new coping as there were no acting out (self-
behaviors/strategie harming) and she
s and stress They may have openly discussed
management skills limited, or no what precipitates for her to
in present and knowledge of have urges
future situations. stress and
management feelings related to her cutting. The client
techniques / may also started writing on a
not have used journal to express frustration and
positive techniques anger sources and ways
Health education
● Educate the patient relative do not force the patient about any activity
● Encorage the family members that do not judge the patient for any activity
● Advise the Patient to consult the doctor if any side effect occur
● Educate the patient and family members about the side effect of medicine
Reference/s:
Doegenes, M., Moorhouse, M. F., & Murr, A. (2019). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales (Fifteenth ed.).
F.A. Davis Company. Martin, P. B. (2019, April 11). 3 Suicide Behaviors Nursing Care Plans. Nurseslabs. https://nurseslabs.com/suicide-
behaviors-nursing-care-plans/ Videback, S. (2020). Psychiatric-Mental Health Nursing (8th ed.) [E-book]. Wolters Kluwer.
NCP #2 Reference/s:
Doegenes, M., Moorhouse, M. F., & Murr, A. (2019). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales (Fifteenth ed.).
F.A. Davis Company. Martin, P. B. (2019, October 15). 4 Personality Disorders Nursing Care Plans. Nurseslabs.
https://nurseslabs.com/personality-disorders-nursing-care-plans/ Videback, S. (2020). Psychiatric-Mental Health Nursing (8th ed.) [E-book].
Wolters Kluwer.
IDENTIFICATION DATA
Name Mr ABC
Age 60years
Sex Male
Bed no. 5
O.P.D no. 15/467942
Ward Psychiatry ward
Education 8th standard
Occupation labrour
Marrital status Married
Religion Muslim
Language Hindi
Diagnosis Schizophrenia
Identification mark Mole at right hand
Date of identification 4/5/2023
Date of assessment 8/5/2023
Informant Patient
a) Psychological:
According to patient : Afim khana
Nind kam aana
Gussa karna
b) Social: He like to interact with other, he is introvert
c) Interpersonal: He has good interpersonal relationship
d) Occupational: Patient lives in house only no occupation history
e) Biological: Restlessness, insomnia
Duration 1 year
Mode of onset Acute
Course Episodic
Intensity Increasing
Precipitating factor No
Patient was apparently well 30year back now he gives history of consumption of opium husk from the last 30 year. Initially he started taking
opium husk with his friends. Patient works as a farmer and while working in a field patient feel lethargic and weakness sometime patient feel
pain all over the body and then one of his friend offer him opium husk then patient took opium husk with his own will and patient took one
spoon of opium husk and after ate that patient feel better and energetic and with the period of half an hour to one hour patient got relief from
body pain. After that patient starts taking opium husk daily. Patient took one spoon of opium husk per day for the next one year and after one
year patient feels weak again and body ache at afternoon time then patient increased his opium husk intake habits to get the desire effect and
patient starts to take opium husk twice a day morning or afternoon time.
And then after 3month patient start to take opium husk thrice a day. If the patient do not consume opium husk in a day patient had strong desire
or compulsion to take substance when he not consumed opium husk then he complaints of dysphonic mood, nausea, vomiting, muscle ache,
sweating, Insomnia and now Patient is taking treatment in psychiatric ward
Treatment History
Family history:-
Family tree
Male Male
Female
Male patient
Personal History
Prenatal History
Antenatal period No any significant of Prenatal history
Intranatal period
Birth
Birth defect
Postnatal Complication
Childhood history
Premorbid personality
Habits
Speech: -
Initiation: - Minimal
Reaction time: - Time taken to answer to question
Rate: - Normal
Productivity: - Normal
Volume: - low
Tone: - low pitch
Relevance: - Fully relevant
Stream - Normal
Coherence: - coherent
Others: - preservation
Subjective
Nurse: - Aapka man kaisa hai?
Patient: - Mere man achha hai.
Objective
Patient affect is appropriate his mood.
Thought: -
Stream: Normal, Autistic thinking, thought block, Poverty of speech, Pressure of thought all are absent.
Form: Normal, Circumstantiality, tangantiality, neologism, verbigeration, flight of idea all are absent.
Content:
1. Delusion:-
Nurse: - Kya apko lgta hai ki aapki wife ka kisis se chakkar hai?
Patient: - Ha mujhe aisa lagta hai.
Inference: - Delusion of infidelity is abesent.
Nurse: - Kya apko lgta hai koi apko wash mei krna chahta hai?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Delusion of control is absent.
Nurse: - kya apko lgta hai aap koi mahan insan hai?
Patient: - nahi mujhe aisa nahi lagta or lgega bhi kyu.
Inference: - Delusion of grandiosity is absent.
Nurse: - kya apko lgta hai jab 2 log baat kar rahe hote hai to wo apke bare mei hi bat krte hai?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Delusion of reference is absent.
2. Hypochondria:-
Nurse: - Kya apko lgta hai apko koi khtarnak bimari hai? Apne kayi hasptalo sei dwai li hai?
Patient: - na, mujhe nahi lgta hai or mane phle bhi dwai nahi li hai.
Inference: - Hypochondria delusion is absent
Ideas: -
Nurse: - kya apke man mei aisa khyal ata hai ki apki zindgi khtm hone wali hai?
Patient: - Nahi mujhe aisa nahi lagta lekin mujhe apni patni pe gussa ata hai to mujhe marne ka khayal ata hai.
Inference: - Suicidal ideas are present.
4) Phobia: -
Perception: -
1) Illusions:-
Nurse: - kya apko rassi ko dekh ke aisa to nahi lagta hai ki ye saanp hai?
Patient: - Nahi mujhe aisa nahi lagta.
Inference: - Illusion is not present.
2) Hallucination: -
Auditory Hallucination:-
Nurse: - Kya jab aap akele bathe hote to apko kisi kism ki awaje to nahi suniee deti?
Patient: - Haa, mujhe awaje sunai deti hai aisa lagta hai meri patni or sadu apas me bate karte ho.
Inference: - Auditory Hallucination is present.
b) Visual Hallucination: -
Nurse: - Kya apko aisa kuch dikhayi deta hai jo kisi ko dikhayi nahi deta?
Patient: - Ha mujhe mere sadu dikhaiee dete hai.
Inference: - Visual Hallucination is present.
c) Olfactory hallucination: -
Nurse: - kya apko aisi koi badbu aati hai jaise kuch jal raha hai?
Patient: - Nahi aisa kuch nahi hai.
Inference: - Olfactory hallucination is absent.
d) Gastatory Hallucination: -
Nurse: - Kya apko aisa lgta hai ki kisi cheej ko khane per kdwa swad ata hai?
Patient: - Nahi aisa kuch nahi hota.
Inference: - Gastatory hallucination is absent.
e) Tactile Hallucination: -
Nurse: - Kya apko aisa lgta hai ki apke body pei kuch chalra hai mtlb jaise kuch reing raha hai?
Patient: - Nahi mujhe aisa kuch nahi lgta.
Inference: - Tactile hallucination is absent.
3) Dejavu-Jamaisvu: -
Nurse: - Kya aapko aisa lgta hai kisi jgah aap pehli bar gaye ho lekin apko lge ki aap yha phle bhi aa chuke ho?
Patient: - Nahi mujhe aisa nahi lgta.
Inference: - Dejavu is absent.
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye ho
Patient:- Nahi mujhe aisa nai lgta
Infrence:-Jamaisvu is absent
4) Depersonalization: -
Nurse: - Kya apko aisa lagta hai ki apme ya apki body mei kch change hua hai?
Patient: - Nahi mujhe aisa nahi lgta.
Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha nai aaye ho
Patient:- Nahi mujhe aisa nai lgta
Infrence:-Jamaisvu is absent
Inference: - Depersonalization is absent.
Consciousness:-
Nurse- aap hospital kyun aye ho?
Patient- mujhe dimagi bimar hu isliye ilaz karane ayi hun.
Inference-Patient is fully conscious.
Attention: -
Orientation: -
Time: -
Nurse: - Abhi kya time hua hai?
Patient: - 2:50 pm huei hai.
Inference: - Patient is oriented to time.
Place: -
Nurse: - Yei Kaun si jagah hai?
Patient: - hospital
Inference: - Patient is oriented to place.
Person: -
Nurse: - Kya apko pta hai apke sath kaun hai?
Patient: - Haa meri maa h.
Inference: - Patient is oriented to person.
Memory: -
a) Immediate memory:-
Nurse - Mai apko ek no. duga apko wo no. mujhe dobara btana hai 9835664?
Patient: - 9835664
Inference: - Immediate memory is intact
b) Recent memory: -
c) Remote Memory: -
Arithmatic ability
Nurse:- Mai apko 100 rs dekr agar 20rs le lu to btao ki apke pas kitne bachenge
Patient:- Mere paas 80rs bachenge
Infrence :-Intellegence is present
Abstractions: -
a) Proverbs
Nurse: - 9 or 2 11 hona ka kya matlab hai?
Patient: - Bhag jana
Inference: - Patient understanding regarding the proverb is good.
Judgement: -
Nurse:- Aap yaha se jane ke baad kya kroge?
Patient:- Mai ghr walo ki dekhbaal krungi.
Infrence:-Personal judgement is intact.
Nurse: - Agar aapke samne koi accident ho jaye to aap kya kroge?
Patient: - Logo ko mdad kei liye bulaugi.
Inference: - Social Judgement is intact.
Nurse: Agar apke ghr me aag lag jaye aap kya kroge?
Patient: sab milke aag nhujaynge.
Infrence: Test judgement is Present.
Insight: -
Nursing Diagnosis
Nurse Communication Client Nurse’s Analysis of the (Effectiveness, Technique, Name &
(Verbal & Non Communication Thoughts & Rationale)
Verbal) (Verbal & Non Feelings
Verbal) Related to the
Interaction
1. Hello… Hello… I had the Greeting the patient:
feeling that he It is necessary in order to have an appropriate start for the
(Establishing eye (Looking me directly wanted to talk conversation.
contact while with a facial with someone.
aproaching in a friendly expression that
manner) denotes interest.)
2. My name is Susan, I'm Yes, not problem I felt well Introducing oneself and
Nursing student at……, when he establishing a contract:
and I would like to talk (The client has a flat answered and It should be done when meeting the client for the first time
with you for a moment. emotional but approved in order to have an appropriate start for a therapeutic
Would you like to accepting expression talking with communication.
speak with me? in his face. He is me.
calm and has a
(Leaning forward the soft speech)
patient, with open
posture)
3. Ok, thank you. My name is J.K Thinking Identifying the patient / Giving
and your name is…? about how to recognition:
(He shows relax start the Shows to the client that the nurse wants to recognizes him
( I took a sit next to him posture and open conversation as an individual, as a person.
at his right side) attitude, well and taking him
groomed straight to the
appearance) point without
being too
invasive.
4. How are you today? I’m ok… Trying to Broad opening question:
active initiate the Gives the client the lead in the interaction , and it may
(Leaning forward, (He seems not very conversation. stimulate him to take the initiative.
making eye contact) convinced of that)
5. Would you like to tell The reason why I'm Satisfied that Broad opening question:
me a little about here is because… he understood Gives the client the lead in the interaction , and it may
yourself, what brought you know… I had my question stimulate him to take the initiative.
you here? or what is have several and he was
happening to you if you suicidal attempts in willing to
want to share it with my life, and last open himself
me? week I knew I was to the
going to try it again. conversation.
(Using SOLER I wanted to kill
technique of active myself, but I
listening) recognize the
symptoms and I
came here before I
actually did it.
I came voluntary
here.
6. Tell me little bit Yes, it is what I I wished not Restating:
more… wanted having to The restatement encourages the
You said you wanted to to do. I feel really ask that
sad, is question, it is
kill yourself? something in my really sad. client to continue, and let the client know that he or she
mind, is depression, I knew exactly communicated the idea effectively.
(Active listening ) something that I what he was
cannot control or get talking about,
rid of it, and I cannot because I was
handle it anymore. very closed to
I'm really tired. It a person in my
hurts my mind, is life with the
pain, is an same problem.
uncontrollable pain
that I feel, and I
don't know why I
feel this way.
(Very cooperative
and providing
detailed information
about himself)
9. I imagine how hard Yes it is, and I I’m feeling Emphaty:
should be for you to cannot explain sad, and When empathetic, the
have this two diseases. myself why I have thinking how nurse is nonjudgmental, sensitive capable of imagining
this depression and can I help him another person’s experience.
(Active listening ) this pain. to alleviate his
I can not tolerate it pain. I believe
any more. I live with it is too much
my partner and I suffering for
cannot talk with him an individual
about this. having this
two diseases.
(Confused,
frustrated, sad)
10. Can you explain it little He is very I’m realizing Seeking clarification:
it bit more. supportive with me, his support It helps the nurse to avoid making assumptions that
What it’s the reason and I don’t want to system is understanding has occurred when it has not.
why you cannot speak talk with him failing. Is hard
with him? (Active because I don’t want to understand
listening ) to hurt him. It is the refusing of
enough with my seeking help
pain. I in his close
don’t want to pass family and
him my problems. keeping all to
himself.
(Confused and
depressed)
11. But what do you think But the thing is. His depressive Presenting reality:
he What you disease Clarifying misconceptions that
would prefer? Help you would do if you have makes him
if to disoriented
kill yourself? something in my mind, is depression, really sad. client to continue, and let the client
something that I cannot control or get rid I knew exactly what know that he or she communicated
(Active of it, and I cannot handle it anymore. I'm he was talking about, the idea effectively.
listening ) really tired. It hurts my mind, is pain, is because I was very
an uncontrollable pain that I feel, and I closed to a person in
don't know why I feel this way. my life with the same
problem.
( His sadness and powerless is evident in
his face)
7. How were you Taking my bottle of meds at one time. Trying to know more Exploring:
planning to kill about the situation. Allows the nurse to gather more
yourself. (The sadness continue) information regarding important
topics mentioned by the client.
(Active
listening )
8. You say you In November, 2 months ago. I took 90 I was feeling very Placing event in time or
tried it before pills. sorry for him. He had sequence:
to kill yourself? It happen to me because I have Bipolar so much going on in Putting events in proper sequence
When was the Disorder. I'm also HIV(+). I had being his life. helps both the nurse and client to see
previous time suffering from Bipolar since 1982 and I them in perspective.
that you had was diagnosed with HIV 8 years ago. The nurse may gain information
also tried it? about recurrent patterns or themes in
(Very cooperative and providing the client’s behaviors.
(Active detailed information about himself)
listening )
9. I imagine how Yes it is, and I cannot explain myself I’m feeling sad, and Emphaty:
hard should be why I have this depression and this pain. thinking how can I When empathetic, the
for you to have I can not tolerate it any more. I live with help him to alleviate nurse is nonjudgmental, sensitive
this two my partner and I cannot talk with him his pain. I believe it is capable of imagining another
diseases. about this. too much suffering for person’s experience.
an individual having
(Active (Confused, frustrated, sad) this two diseases.
listening )
10. Can you He is very supportive with me, and I I’m realizing his Seeking clarification:
explain it little don’t want to talk with him because I support system is It helps the nurse to avoid making
it bit more. don’t want to hurt him. It is enough with failing. Is hard to assumptions that understanding has
What it’s the my pain. I understand the occurred when it has not.
reason why you don’t want to pass him my problems. refusing of seeking
cannot speak help in his close
with him? (Confused and depressed) family and keeping all
(Active to himself.
listening )
11. But what do But the thing is. What you His depressive disease Presenting reality:
you think he would do if you have to makes him disoriented Clarifying misconceptions that
would prefer?
Help you if
you open to him, or decide between hurt yourself and hurt about the potential client may be expressing. Intents to
see you that you took the person you love? consequences of self- indicate an alternate line of thought
your injury could for the client to consider.
life. (Poor judgement) produce to his
(Active listening significant others.
techniques )
1 It is a difficult answer Yes I know but is something very He is having poor Non therapeutic:
2 but … Don’t you think difficult to explain, the pain inside my judgment about the It could be non therapeutic because
. that hurting yourself brain, the depression, the loneliness has significance of hurting I’m Rejecting and refusing to
and taking your life, is such dimension that is very difficult to other person or consider or showing contempt for
a way of hurt him too? think clear. himself. the client’s ideas or behaviors.
I’m also Probing or
(Small frown) (Frustrated, sad) persistent questioning the client.
1 Do your partner has Yes, he has. We both contracted it but Feeling sorry for both Non therapeutic:
3 HIV too? we never knew how we got it. now. I’m Introducing an unrelated topic
. or changing the subject.
(Non judgmental (The depression seems to be bothering
expression) him much more than the HIV disease) The topic could be a little related
but I’m loosing the focus about my
patient. The fact of knowing if his
partner has or not HIV it doesn’t
contribute to identify the patient’s
feelings or problems.
1 Are you taking Yes, I'm taking 22 pills twice at day. I think 44 pills at day Exploring:
4 medicines to control But other problem is that the pills are is something that even Allows the nurse to gather more
. the HIV and the good for certain time and after a period myself I wouldn’t information regarding important
Bipolar Disorder? they are not effective anymore. even tolerate. topics mentioned by the client.
Thinking about what
( Light surprised (Continues willing to give information are the positives
expression after the about him) things in his life and
client’s answer) ways to help him to
find the support he
needs.
1 I know. It happens Yes he does. I believed he has Giving information:
5 because your body and I would like also here at the hospital let loneliness and I am Increases the client’s knowledge
. metabolism get use to us talk in groups, to have a way to share maybe helping him in about a topic, let the client know
them and the meds each other our problems. It is necessary some way to escape what to expect, and builds trust
turn not being as much to have therapy groups, that can help for from it. with the client.
effective than they our situation.
were before.
It is something that ( Showing hopeful interest on being
your doctor needs to accomplished his desire)
address periodically to
ensure you get the best
option available.
(Trying to be
explicative)
1 Have you ever Yes, I was member of a I realize that that the Encouraging comparison:
6 participated therapy group for many patient is willing to The client benefits from
. in therapy groups in talk
the
past and that has years, but now here we need and he trusts me. making this comparisons because he
helped you with your someone that listen to us. It is why might recall past coping strategies
depression? we are here. If nobody talk or listen that were effective
to us is the same that being at home. or remember that he has survived a
(Active listening ) similar situation.
(Increased interest in talking about it)
1 I understand what you Ok thanks. Trying to explain that Accepting:
7 mean. We do have people in this hospital An accepting response indicates the
. meetings groups here, (Showing doubt of the possibility of is willing to help him nurse has heard and follow the train
and you will have the being helped in the hospital) when he needs it. of thought. It does not indicate
opportunity to talk I believe that he really agreement but is nonjudgmental.
and express your feels lonely and Giving information:
feelings. But always desperate for Increases the client’s knowledge
remember you have communi- cating with about a topic, let the client know
the right to call the someone willing to what to expect, and builds trust with
nurse anytime you listen him. the client.
need it and ask help or
something else you
need.
(Trying to be
explicative)
1 Do you believe that I don’t know if it would relieves Thinking in orienting Encouraging expression:
8 maybe participating in 100% from my depression but it may the client to find a Asking the client to consider people
therapy groups can help something. support system that and events in light of his own
help you to deal with help him to resolve values , the nurse encourages the
your problems, (Slightly hopeful, but not convinced) his emotional client to make his own appraisal of
as it was in the past? problem. the situation.
(Active listening )
1 Tell me what No I don’t work, I have disability. Thinking also that Exploring:
9 activities you having a passive life Allows the nurse to gather more
. normally do? Do you (Flat expression) style doesn’t help to information regarding important
work? his disease. topics mentioned by the client.
(Active listening )
2 I see… and the fact Well, life is very difficult today but Trying to find more Non therapeutic:
0 that you don’t work, that is not affecting me so much with reasons that may This question could be done instead a
. can that situation also my depression. influence in his like: Does this situation contribute to
be contributing with depression. your distress? , because some people
economic problems (Sadness and flat expression) don’t like to speak about their
you may have? economic problems, and they
Since life is very actually can deny a fact that is real,
difficult today for without giving more information.
everybody. It is that
situation also
affecting you in your
depression? (Trying
not being too
invasive)
2 And, what about Yes, it could help for moments but Feeling that he Encouraging expression:
1 doing activities to the depression always come back. wanted to find help in Asking the client to consider people
. help you distract a therapeutic group as and events in light of his own
yourself from your (The sadness expression continues) he did in the past. values , the nurse encourages the
depression? client to make his own appraisal of
the situation.
(Active listening )
2 I believe that the fact Yes, I know. I wanted to remark Making observation:
2 that the positives aspects It verbalizes what the nurse
. you recognized your
suicidal thinking and (Hopeless) about himself, and his perceives when the client cannot
decide to come to the accomplishments to
hospital seeking help increase his self- verbalize or make themselves
it is a good point, and esteem. understood.
a positive alternative
you chose instead of Formulating a plan of action:
harming yourself. It is It may be helpful for the client
something that you to plan in advance what he or she do
would have to in future similar situations.
implement in the
future if it ever
happen again.
( Showing a positive
attitude)
2 You are doing a big Thank you for have listened to me. I think that it is Summarizing: Brings out the
3 progress seeking help, (Grateful expression) necessary help him to important points of the discussion,
. and coming here visualize the positive increase awareness and provides a
voluntary to the I think I have to take my medicines side of his situation in sense of closure at the completion of
hospital. I wish you a now… order to give him each discussion for both client and
soon relief of your some hope and nurse.
medical problems, ( He sudden remembers encouragement.
and the ability to something…)
continue increasing
strength dealing with
them.
(Trying to give some
hope)
2 Thanks to you for I’m going to get my medicines. It was a good Closing of the interview
4 share with me your conversa- tion. I feel
. concerns. (Standing up) he wanted to talk and
it may helped
(Smiling, standing up) him.
PROCESS RECORDING
ON
MAJOR DEPRESSION
Client: Okay
SN: Tell me what SN: Took a seat Open Anxious “I hope she T 2) Self-improvement- I should have
brought you here? in a private area. Question/ Relived opens up.” asked her more about her medication
Legs cross arms General Lead and compliance. I should have used
Client: I was on a CR at my side. clarification and asked What did you
for a petty mean by you didn’t know day from
misdemeanor, when Client: looking night? Or How did the medication make
my doctor changed my down, scribbling you feel?
medicine to Latuda I on paper. No eye 3) I started off feeling very anxious so I
didn’t know night contact didn’t know what to say to start off the
Dialogue Non Verbal Technique Student Student T/ Analysis
Communication Feelings Thoughts N
SN: You don’t show SN: leans Open question Curious, Why isn’t she T 3) I am confused as to why she has no
any emotion when you forward, Concerne angry? emotion about a man who I feel has
talk about your maintains eye d Maybe she’s ruined her life. PTSD can cause
husband, how do you contact completely detachment so I do not feel like I will be
feel about him now? detached. able to elicit any emotion from her at
Client: Maintains Maybe she’s this point. My thoughts contributed
Client: Were divorced eye contact, no following the negatively to my interview because she
now. He took half of expression steps, made wasn’t able to express her feelings
my money and tried to amends and toward this man who abused her for 20
get my children’s half forgave? years.
as well. I don’t know
he’s in the mainland
now.
SN: I see you’ve been SN: Sitting Open question Hopeful “She has T 4) Patient finally smiles when speaking
through a lot, how do upright slightly plans for the of her future plans. Her feelings of
you feel now? leaning forward, future! I optimism are congruent with her
maintains eye wonder what expression.
Client: Well… I feel contact they are?
optimistic. I finally
contacted my children Client: Makes eye
and I even have a contact, slight
HISTORY
TAKING
HISTORY TAKING
PARANOID SCHIZOPHERNIA
FAMILY TREE:-
INDEX
Male Client
Female
CHILDHOOD HISTORY:-
Primary care giver:- Mother
Feeding:- 2 yr (Breast milk)
Age at weaning:- 6-7 yr. Month onwards
Developmental mile stone:- Normal
Behavioural & emotional problem:- No
Illness during childhood:- No illness
EDUCATIONAL HISTORY:-
Age at beginning of formal education:- 3 yr
Academic performance:- Good in studies
Extracurricular achievement:- No achievements
Relationship with peers and teachers:- good
School phobia:- No
Reason for termination of studies:- failed in 12th
PLAY HISTORY:-
Game played:- Carrom & Cricket
Relationship with play mates:- Good
OCCUPATIONAL HISTORY:-
Age at starting work:- 20 yr
Current job satisfaction:- Satisfied with his job
Whether job is appropriate to patients background:- Yes
PUBERTY
Age at appearance of secondary sexual characters:- 15 yrs
Anxiety related to puberty changes:- -
Age at menarche:- -
OBSTETRICAL HISTORY
LMP:- -
No. of children:- -
Any abnormalities associated with pregnancy:- -
Termination of pregnancy:- -
PREMORBID PERSONALITY:-
Interpersonal relationship:- Extrovert
Family and social relationship:- Good
Use of leisure time:- By watching news and playing cricket
Predominant mood:- Fluctuating mood
Usual reaction to stressful situation:- He shows aggression behaviour
in small matter
Attitude to work and responsibility:- Satisfied
HABITS:-
Eating pattern:- Non-vegeterian (3-4 times/day)
Elimination :- Normal (urine output :4-5 times/day)
Sleep:- Insomnia
Use of drugs, tobacco, alcohol:- Patient Is Alcoholic
Dislike :- Bitter gord
Like:- Like all kind of food
GENERAL EXAMINATION
TEMPERATURE:- 98.6OF
PULSE:- 88beats/min
RESPIRATION:- 22 breaths/min
BLOOD PRESSURE:- 120/80mm / Hg
SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM
S1 and S2 sound is present
No cardiac abnormality is present
RESPIRATORY SYSTEM
No dyspnea
Lungs are bilaterally symmetrical
INTEGUMENTARY SYSTEM
No rashes
No wrinkles
No bed sore
GASTROINTESTINAL SYSTEM
Inspection- No tenderness present
Palpation – No distension
Auscultation – Normal bowel sound
GENITOURINARY SYTEM
Elimination is normal
Urine output is normal
MUSCULOSKELETAL SYSTEM
Edema is absent
Range of motion – Present
HISTORY TAKING
ANXIETY DISORDER
IDENTIFICATION DATA
Name Mrs ABC
Age 55years
Sex Female
Bed no. 5
O.P.D no. 16/480626
Ward Psychiatry ward
Education 12th standard
Occupation Homemaker
Marrital status Married
Religion Hindu
Language Hindi
Diagnosis Anxiety Disorder
Identification mark Mole at left feet
Date of identification 5/7/2023
Date of historytaking 5/7/2023
Informant Patient
a) Psychological:
According to patient:
Nind kam aana
Gussa karna
Akele bethe bolna
Treatment History
Family history:-
Family tree
Female
Personal History
Prenatal History
Antenatal period No any significant of prenatal history
Intranatal period
Birth
Birth defect
Postnatal Complication
Childhood history
Primary care giver
Feeding
Age of weaning
Development Milestones No any significant of prenatal history
Behaviour and emotional Problems
Illness during childhood
Educational history
Play history
Premorbid personality
Age 60years
Sex Male
Bed no. 5
O.P.D no. 15/467942
Ward Psychiatry ward
Education 8th standard
Occupation labrour
Marrital status Married
Religion Muslim
Language Hindi
Diagnosis Schizophrenia
Identification mark Mole at right hand
Date of identification 4/5/2023
Date of assessment 8/5/2023
Informant Patient
a) Psychological:
According to patient : Afim khana
Nind kam aana
Gussa karna
Patient was apparently well 30year back now he gives history of consumption of opium husk
from the last 30 year. Initially he started taking opium husk with his friends. Patient works as
a farmer and while working in a field patient feel lethargic and weakness sometime patient
feel pain all over the body and then one of his friend offer him opium husk then patient took
opium husk with his own will and patient took one spoon of opium husk and after ate that
patient feel better and energetic and with the period of half an hour to one hour patient got
relief from body pain. After that patient starts taking opium husk daily. Patient took one
spoon of opium husk per day for the next one year and after one year patient feels weak again
and body ache at afternoon time then patient increased his opium husk intake habits to get the
desire effect and patient starts to take opium husk twice a day morning or afternoon time.
And then after 3month patient start to take opium husk thrice a day. If the patient do not
consume opium husk in a day patient had strong desire or compulsion to take substance when
he not consumed opium husk then he complaints of dysphonic mood, nausea, vomiting,
muscle ache, sweating, Insomnia and now Patient is taking treatment in psychiatric ward
Treatment History
Family history:-
Family tree
Male Male
Female
Male patient
Personal History
Prenatal History
Antenatal period No any significant of Prenatal history
Intranatal period
Birth
Birth defect
Postnatal Complication
Childhood history
Play history
Premorbid personality
Habits
MANIA
Patient’s Profile
Identification data
Client name : Mr. XYZ
Age : 15 Years
Sex : Male
Ward : Male ward
Education : 9th class
Occupation : Student
Marital status : Unmarried
Religion : Hindu
Date of admission : 06.07.2023
Address : Patna, Bihar
Informant : Father (Reliable)
According to Patient
Steroid dwa khai thi aankh ke operation ki wajah se isliye mjboori me aana pda
3 months
Sar ghumta hai
Nind nhi aati
According to Informant
Pahle se jyada bat krta tha
Kai bar same words ko repeat krta tha
3 months
Kahta tha ki main Bajrangbali hu or kele khata tha
Khta hai ki mujhe swarg dikhta hai
3) Speech-
Coherence: coherent.
Relevance: relevant
Volume: Normal
Tone: low pitched.
Murmur: absent
Reaction Time: Normal.
4) Thought-
6) Disorders of perception-
Hallucination:
Q. aapko kuch ajib sa dikhayi ya sunai deti hai, jo dusro ko sunai ya dikhayi nahi
deta hai ?
A. Nahi Aisa kuch nai hai.
Inference: Normal, no hallucination present.
7) Cognitive Functions-
b) Memory:
Told patient three words ghoda, gadi, train
1) Immediate memory
Nurse: “abhi maine 3 shabd khe the unko repeat krengi?”.
Patient:”,gadi”.
Remark: Patient has poor immediate memory.
2) Recent Memory
Nurse:”aapne kal dinner me kya khaya tha?”.
Patient:”sabji, roti”.
Remark: My patient is having good recent memory.
3) Remote Memory
Nurse:”aapki date of birth kya hai ?”.
Patient: “04/02/2004”.
Remark: My patient is having good remote memory.
c) Orientation:
Time:
Nurse: “abhi kya time hoga ?”.
Patient: “11:00 a.m.”.
Place:
Nurse: “abhi aap kha ho?”
Patient: “hospital”.
Person:
Nurse: “aapke sath kon hai?”
Patient: “papa hai”.
Remark: My patient is oriented to time, person, and place.
d) Abstraction:
Nurse: “bulb or tubelight me kya difference hai?
Patient: “dono ki shape alg ahi”.
Nurse: “aam or seb me kya difference hai?
Patient: “dono ki shape or color alg hai”.
Remark: My patient’s abstraction is normal.
e) Intelligence and General Observation:
Q. India ka prime minister kaun h?
Answer: Moji Ji hain.
Q. Apne Desh Ki RAJDHANI kya h?
Answer. Delhi Hai.
Q. Bihar ki rajdhani kya hai?
A. patna.
Q. India ka president kon hai?
A. No answer.
INFERENCE: intelligence is average based on his formal education.
f) Judgment:
Q: agar ekdum se yhan aag lag jaaye to aap kya karoge?
A: fire bigrade ko phone krunga.
Remark: he has good judgment power.
g) Insight:
Nurse: “aap yehape kyoun aaye hain”?
Patient: Steroid dwa khai thi aankh ke operation ki wajah se isliye mjboori me aana pda
Remark: he has no insight.
h) General Observation:
Sleep
1) Insomnia: present.
2) Hypersomnia: Absent.
3) Non –organic sleep: Absent.
4) Early morning awakening: present.
5) Episodic Disturbances: Absent.
MENTAL STATUS
EXAMINATION
ON
PARANOID SCHIZOPHRENIA
Patient’s Profile
● Identification data
According to Patient
● Mujhe log dikhai dete Hain woh log mujhe kehte hain ki tu sunn Raha hai Na
● Mujhe lagta hai ki mere charo aur camera lage hue hey aur koi mere photo
● Khta hai ki mere charo aur camera lage hue hey aur koi mere photo
OBJECTIVES;
Question : kya apme aisi koi baat hai jo apko dusro se alag karti hai ?
Ans : Nai aisa kuch nai hai.
Remarks : no delusion of grandiosity present
QUESTION : kya aapko lgta hai ki koi aapko hani phuchana chahta hai ?
Ans : mujhe lgta hai ki koi mere photo kheech kar net par dal rha hai
aur mere charo or camera lge hue hai
b) Obsession : absent
c) Phobia: Absent.
d) Preoccupation: Absent.
AGE : 30 yrs
SEX : Male
ADDRESS : Behal
OCCUPATION : farmer
INCOME : 15,000Rs
RELIGION : Hindu
INFORMANT : Father
6. FAMILY TREE:-
INDEX
Male Client
Female
7. PAST FAMILY HISTORY:-
No significant history of any psychiatric illness
No history of suicidal attempt and drug dependence
8. CONCURRENT SOCIAL SITUATION:-
Social economic status of client is very good as my patient is having job and he is
earning enough to run the family and to bear the expense of treatment
9. ATTITUDE OF FAMILY MEMBERS TOWARDS PATIENT:-
The attitude of family members is very supportive and caring
10. PREMORBID HISTORY:-
a) PERINATAL HISTORY:-
My client has full term normal delivery. No complications like convulsion,
cyanosis were present.
b) CHILDHOOD HISTORY:-
Primary care giver:- Mother
Feeding:- 2 yr (Breast milk)
Age at weaning:- 6-7 yr. Month onwards
Developmental mile stone:- Normal
Behavioural & emotional problem:- No
Illness during childhood:- No illness
c) EDUCATIONAL HISTORY:-
Age at beginning of formal education:- 3 yr
Academic performance:- Good in studies
Extracurricular achievement:- No achievements
Relationship with peers and teachers:- good
School phobia:- No
Reason for termination of studies:- failed in 12th
d) PLAY HISTORY:-
Game played:- Carrom & Cricket
Relationship with play mates:- Good
g) PUBERTY
Age at appearance of secondary sexual characters:- 15 yrs
Anxiety related to puberty changes:- -
Age at menarche:- -
h) SEXUAL AND MARITAL HISTORY:-
Type of marriage:- Arrange
marriage
Duration of marriage:- 8 yrs
Interpersonal and sexual relations:- satisfactory
i) PREMORBID PERSONALITY:-
Interpersonal relationship:- Extrovert
Family and social relationship:- Good
Use of leisure time:- By watching news and
playing cricket
Predominant mood:- Fluctuating mood
Usual reaction to stressful situation:- He shows
aggression behaviour
in small
matter Attitude to work and responsibility:-
Satisfied
j) HABITS:-
Eating pattern:- Non-vegeterian
(3-4 times/day)
Elimination :- Normal (urine
output :4-5 times/day)
Sleep:- Insomnia
Use of drugs, tobacco, alcohol:- Patient Is
Alcoholic
Dislike :- Bitter gord
Like:- Like all kind
of food
MINI MENTAL STATUS EXAMINATION
GENERAL APPEARANCE:-
LEVEL OF GROOMING:- Adequate dressed with proper personal hygiene. Kempt and tidy
CO-OPERATIVENESS:- Co-operative
RAPPORT:- Spontaneous
GESTURE:- Normal
POSTURING :- Normal
MOTOR BEHAVIOUR:-
LEVEL OF ACTIVITY:- Non- goal directed , but easily distracted by minimal external
stimulus
SPEECH:-
INITIATION :- Spontaneous
RATE:- Rapid
STREAM:- Circumstantiality
PATIENT:- My name is Gopal. She is my wife Reena. And I have taken medicines
PATIENT:- I am in hospital
THOUGHT:-
PATIENT:- You don’t know who I am ? I am the owner of big Company and I am planning
for making apartment for my daughters
MOOD / AFFECT:-
MOOD: Happy
AFFECT : Congruent
HALLUCINATION:- Absent
ILLUSION:- Absent
COGNITIVE FUNCTION:-
PATIENT:- Yes
PATIENT:- 10, 9, 8, 7, 6, 5, 4, 3, 2, 1
2. ORIENTATION
ORIENTATION TO TIME: Oriented
3. MEMORY
IMMEDIATE MEMORY: Impaired
NURSE:- Repeat the words – rice, dal, fish, vegetables?
PATIENT:- Fish, vegetables…….don’t remember.
4. ABSTRACT THINKING
NURSE:- Tell the similarity between orange and banana
PATIENT:- Both are fruits
5. INTELLIGENCE
COMPREHENSION:-Able to follow simple command
GENERAL KNOWLEDGE:- Adequate
NURSE:- Who is the Prime Minister of India
PATIENT:- Narendra Modi
6. JUDGEMENT
SOCIAL JUDGEMENT:- Intact
NURSE:- What you will do if house catches fire
PATIENT:- I will call fire brigade
INSIGHT:-
GRADE 4: Complete awareness of being ill
NURSE:- Where are you? What happen to you?
PATIENT:- I am in hospital. I used to think excessively so I had admitted here.
SUMMARY:-
MOTOR BEHAVIOUR : Increased And non Goal Directed
SPEECH CONTENT : Fully relevant
THOUGHT: Flight of ideas
MOOD: Mood happy
PERCEPTION: Auditory Hallucination Absent
JUDGEMENT: Both social and personal judgement intact
MEMORY: Immediate memory is impaired
MINI MENTAL STATUS
EXAMINATION
Informant Patient
a) Psychological:
According to patient: Shak karna
Nind kam aana
Gussa karna
Akele bethe bolna
b) Social: She like to interact with other, she is introvert
c) Interpersonal: She has good interpersonal relationship
d) Occupational: Patient lives in house only no occupation history
e) Biological: Restlessness, insomnia
History of present illness
Duration 1 year
Mode of onset Acute
Course Episodic
Intensity Increasing
Precipitating factor No
Family history:-
Family tree
Female
Personal History
Prenatal History
Antenatal period No any significant of Prenatal history
Intranatal period
Birth
Birth defect
Postnatal Complication
Childhood history
Educational history
Play history
Premorbid personality
Habits
❖ Speech: -
Initiation: - Minimal
Reaction time: - Time taken to answer to question
Rate: - Normal
Productivity: - Normal
Volume: - low
Tone: - low pitch
Relevance: - Fully relevant
Stream - Normal
Coherence: - coherent
Others: - preservation
● Nurse :- Aap apne bare me kuch btaye.
● Inference- Patients speaks in Hindi. She have normal volume, tone, and rate of
speech.
Subjective
Objective
● Mood: - Normal
● Affect: - Normal
❖ Thought: -
Stream: Normal, Autistic thinking, Thought block, Poverty of speech,Pressure of thought all
are absent.
Form: Normal, Circumstantiality, tangantiality, neologism, verbigeration, flight of idea all
are absent.
Content:
1. Delusion:-
● Nurse: - Kya apko lgta hai ki aapki wife ka kisis se chakkar hai?
● Nurse: - Kya apko lgta hai koi apko wash mei krna chahta hai?
● Nurse: - kya apko lgta hai aap koi mahan insan hai?
● Nurse: - kya apko lgta hai jab 2 log baat kar rahe hote hai to wo apke bare mei hi bat
krte hai?
● Nurse: - Kya apko lgta hai apko koi khtarnak bimari hai? Apne kayi hasptalo sei dwai
li hai?
● Patient: - na, mujhe nahi lgta hai or mane phle bhi dwai nahi li hai.
⮚ Ideas: -
● Nurse: - kya apke man mei aisa khyal ata hai ki apki zindgi khtm hone wali hai?
● Patient: - Nahi mujhe aisa nahi lagta lekin mujhe apni patni pe gussa ata hai to mujhe
● Nurse: - Kya apko lgta hai ki apke hath gande hai or aap unhe bar bar dhote hai?
4) Phobia: -
❖ Perception: -
1) Illusions:-
● Nurse: - kya apko rassi ko dekh ke aisa to nahi lagta hai ki ye saanp hai?
2) Hallucination: -
a) Auditory Hallucination:-
● Nurse: - Kya jab aap akele bathe hote to apko kisi kism ki awaje to nahi suniee deti?
● Patient: - Haa, mujhe awaje sunai deti hai aisa lagta hai meri patni or sadu apas me
b) Visual Hallucination: -
● Nurse: - Kya apko aisa kuch dikhayi deta hai jo kisi ko dikhayi nahi deta?
● Nurse: - kya apko aisi koi badbu aati hai jaise kuch jal raha hai?
d) Gastatory Hallucination: -
● Nurse: - Kya apko aisa lgta hai ki kisi cheej ko khane per kdwa swad ata hai?
e) Tactile Hallucination: -
● Nurse: - Kya apko aisa lgta hai ki apke body pei kuch chalra hai mtlb jaise kuch reing
raha hai?
3) Dejavu-Jamaisvu: -
● Nurse: - Kya aapko aisa lgta hai kisi jgah aap pehli bar gaye ho lekin apko lge ki aap
● Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha
nai aaye ho
● Infrence:-Jamaisvu is absent
4) Depersonalization: -
● Nurse: - Kya apko aisa lagta hai ki apme ya apki body mei kch change hua hai?
● Nurse:-Kya aapko ais lgta hai kisi jagah aap phle gye ho lekin apko lge ki aap yaha
nai aaye ho
● Infrence:-Jamaisvu is absent
I. Consciousness:-
Nurse- aap hospital kyun aye ho?
Patient- mujhe dimagi bimar hu isliye ilaz karane ayi hun.
Inference-Patient is fully conscious.
II. Attention: -
III. Concentration: -
IV. Orientation: -
a) Time: -
b) Place: -
● Nurse: - Yei Kaun si jagah hai?
● Patient: - hospital
c) Person: -
V. Memory: -
a) Immediate memory:-
● Nurse - Mai apko ek no. duga apko wo no. mujhe dobara btana hai 9835664?
● Patient: - 9835664
b) Recent memory: -
c) Remote Memory: -
● Nurse: - Aapka janam tithi kab hoti hai?
● Patient: - august me 5 ko
VI. Intelligent: -
Arithmatic ability
● Nurse:- Mai apko 100 rs dekr agar 20rs le lu to btao ki apke pas kitne bachenge
VII. Abstractions: -
a) Proverbs
VIII. Judgement: -
● Nurse: - Agar aapke samne koi accident ho jaye to aap kya kroge?
● Nurse: Agar apke ghr me aag lag jaye aap kya kroge?
❖ Insight: -
● Patient:-kabi kabi
ON
STRESS MANAGEMENT
DATE : 18-4-2023
TIME : 9.30 am
PREVIOUS KNOWLEDGE OF THE GROUP: THE GROUP HAS SOME KNOWLEDGE ABOUT THE MANAGEMENT OF
STRESS
General Objective
At the end of the class, the students will gain knowledge regarding Management of Stress
Specific Objectives
3 Explain the 15 min STRATEGIES OF COPING WITH STRESS Teacher ppt Teacher What are the
strategies of a)Awareness explains writes the strategies of
coping with The initial step in managing stress in awareness- to strategies of strategies of coping with
stress become aware of the factors that create stress and coping with coping with stress ?
the feeling associated with a stressful response. As stress the stress the
one can become aware of stressors, he or she can
omit, avoid, or accept them.
b) Got organized
Coping with stress is all about planning. You can
plan to fall or plan to successes. Organized time for
work, family, hobbies, spiritual time, time with
friends and time alone, time for exercise and time
for relaxation.
MEDITATION
Meditation is a holistic discipline during which
time the practitioner trains his or her mind in order
to realize some benefit. Meditation is generally a
subjective, personal experience and most often
done without any external involvement, except
perhaps prayer beads to count prayers.
S Specific Duratio Content Teacher AV aids B/B activity Evaluation
No Objectives n /learning
UNHEALTHY WAYS OF COPING WITH
4. Explain 3 min STRESS Teacher ppt Teacher What are the
unhealthy explaines writes unhealthy
ways of Smoking unhealthy unhealthy ways of
coping with Drinking too much ways of ways of coping with
stress Over eating or under eating coping with coping with stress?
Using pills or drugs to relax stress stress
-Sleeping to much
Withdrawing from friends, family, and activities -
Zoning out for hours in front of the T.V or
computer.
Taking your stress out on others (lashing out, angry
outbursts, physical violence)
SUMMARY
5 Summarize 1 min
the topic Teacher
Today we have learned about stress management, summarize
its meaning, coping strategies and relaxation the topic
technique and nurses role in the management of
stress.
CONCLUSION
Managing stress can help reduce the stress and
6 Conclude 1 min make you feel healthier. We have to remember that
the topic we cannot change the view of others but prepare Teacher
ourselves to prove our point. No one is perfect so concludes
do not underestimate yourself. Always practice out the topic
for different relaxation techniques. Always think
positively and keep a positive attitude.
S Specific Duratio Content Teacher AV aids B/B activity Evaluation
No Objectives n /learning
7 ASSIGNMENT
BIBLIOGRAPHY:
Principles And Practices Of Nursing Management
8 And Administration For B.Sc. And M.Sc. Nursing,
Jogindar Vati, JAYPEE Publication, Pg No: 532-
535
A Guide To Mental Health And Psychiatric
Nursing, R.Shreevani, 3 rd Edition, Pg No:259
Mental Health For Nursing, Lalit Batra, PEEPEE
Publishers, Pg No:31
Leadership And Nursing Care Management, Diane
L. Huber, Fourth Edition, Pg No: 131)
Text Book Of Psychiatric Nursing, Anbu.T,
EMMESS Publication, Pg No: 198, 200
Voice of Research, Vol. 2, Issue 3, December
2013.http://www.voiceofresearch.org/doc/Dec-
2013/Dec2013_20.
HEALTH TALK
ON
EATING DISORDERS
Eating disorders
Defination
Eating disorders are mental health problems that involve disordered eating behaviour - this
can include eating too little or too much or becoming fixated with one’s weight or shape. 1
▪ Anorexia nervosa - where someone tries to keep their body weight as low as possible
(by for example, not eating enough and / or exercising excessively) and has a
distorted view of their body, thinking they are larger than they are.
▪ Binge eating – where someone eats excessively in a short period of time in an out of-
control way and feels compelled to do so on a regular basis
Symptoms
Symptoms of eating disorders will vary between individuals and type of eating disorder. Not
matching the symptoms exactly does not mean that someone does not have an eating
disorder, however, some common symptoms include:
▪ Eating very little food or eating large amounts of food in a short time in an
uncontrolled way
▪ Spending a lot of time worrying about your body weight and shape
▪ Changes in mood
▪ Withdrawing from social groups, hobbies you used to enjoy or from family life
▪ Physical signs such as digestive problems or weight being very high or very low for
someone of your age and height
● 10% in male
Physical symptoms
● Fatigue
● Insomnia
● Dizziness or fainting
● Absence of menstruation
● Intolerance of cold
● Dehydration
● Exercising excessively
● Bingeing and self-induced vomiting to get rid of food, which may include the use of
laxatives, enemas, diet aids or herbal products
● Eating only a few certain "safe" foods, usually those low in fat and calories
● Complaining about being fat or having parts of the body that are fat
● Social withdrawal
● Irritability
● Insomnia
Treatment modality
Psychological therapies
Family therapy
Psychological therapies involve working through your thoughts, feelings and behaviours with
a mental health professional in regular sessions over a set period of time.1
Common psychological therapies for treatment and management of eating disorders include
cognitive behavioural therapy (CBT), family therapy or psychotherapy and what is right for
you may depend on your age. During your therapy sessions, you may work with the mental
health practitioner to agree on an eating plan to ensure you are getting the appropriate
vitamins and minerals from your diet.11 Your GP may also conduct an X-ray to check the
health of your bones as being underweight for a prolonged period of time can lead to low
bone strength.11
People with bulimia may be able to participate in a guided self-help programme, which
involves completing exercises in a workbook alongside having short sessions with a
practitioner. While this approach can be helpful to some, it is not a suitable treatment
approach for everyone.11
Individual Therapy
A form of therapy called cognitive behavioral therapy is often used to treat anorexia nervosa.
CBT helps change unhealthy thoughts and behaviors. Its goal is to help you learn to cope
with strong emotions and build healthy self-esteem.
Family Therapy
Family therapy gets family members involved in keeping you on track with your healthy
eating and lifestyle. Family therapy also helps resolve conflicts within the family. It can help
create support for the family member learning to cope with anorexia nervosa.
Group Therapy
Group therapy allows people with anorexia nervosa to interact with others who have the same
disorder. But it can sometimes lead to competition to be the thinnest. To avoid that, it’s
important that you attend group therapy that is led by a qualified medical professional.
Medication
While there is no medication at this time that is proven to treat anorexia nervosa,
antidepressants may be prescribed to deal with the anxiety and depression common in those
with anorexia. These may make you feel better. But antidepressants do not diminish the
desire to lose weight.
Hospitalization
Depending on the severity of your weight loss, your primary care provider may want to keep
you in the hospital for a few days to treat the effects of your anorexia nervosa. You may be
put on a feeding tube and intravenous fluids if your weight is too low or if you’re dehydrated.
If you continue to refuse to eat or exhibit psychiatric issues, your primary care provider may
have you admitted into the hospital for intensive treatment.
Psychopharmacology
Various medication prescribed for anxiety and depression fluoxetine ,clomiperamine with
anorexia nervosa
Bulimia nervosa
fluoxetine
SSRI
Imiperamine
Phenalzine
Bulimia nervosa
Onset late adolescent or early adulthood
A serious eating disorder marked by bingeing, followed by methods to avoid weight gain.
Bulimia is a potentially life-threatening eating disorder.
People with this condition binge eat. They then take steps to avoid weight gain. Most
commonly, this means vomiting (purging). But it can also mean excessive exercising or
fasting.
Treatments include counselling, medication and nutrition education.
Usually self-diagnosable
People with this condition binge eat. They then take steps to avoid weight gain. Most
commonly, this means vomiting (purging). But it can also mean excessive exercising or
fasting.
Therapies
Support group
Cognitive behavioral therapy
Cognitive therapy
Behavior therapy
Counseling psychology
Psychoeducation
Family therapy
Behaviour therapy and Psychotherapy
Medications
SSRIs
Self-care
Physical exercise
-
ECT REPORT
ON
RECURRENT DEPRESSION
SUBMITTED TO: SUBMITTED BY:
MRS. DEEKSHA MS. JYOTI BATRA
ASSISTANT PROFESSOR M.SC. NURSING 1ST YEAR
MENTAL HEALTH NURSING MENTAL HEALTH NURSING
ECT REPORT
I. IDENTIFICATION DATA:-
Religion- Hindu
Education-Illiterate
Income- 9000/Month
As per patient:-
As per informant:-
Onset-Acute
Course-Episodic
TDI-14years
Episode-2 episode
XYZ 42y male married and illiterate wage worker by occupation belong to rural
area of MSES. Patient was known case of depressive disorder and discharge from
ward.Patient was maintaining well on treatment but after 1month of discharge he
start consuming Buphi daily 1tolla. After that he developed difficulty in inititation
and maintenance of sleep, patient remains awake all night, remain sitting on bed.
Patient feels sad all the time; don’t want to talk with anyone. He lost interest in
daily routine activity. He got irritated when family member try to talk with him
and sometime he shout on grandson who play in front of him. And after this he
has stopped to going on work.His appetite also reduced to once in a day.
According to patient he wants to commit suicide as there is nothing left in his life.
Once he went to river side and sit there with intention to jump into river. His
family member reaches there and brings back to home.
IV. Treatment History:-Patient was known case of depressive disorder and discharge
from ward. She took treatment from PGIMS and treatment was
ECT History:- 1month back patient admitted in PGIMS Rohtak with same chief
complaint and diagnosed with recurrent Depressive Disorder. 4MECT had been
given during this.
VI. Family History:- Client belongs to Hindu nuclear family of middle socio economic
status
No family history of psychiatric illness.
44yrs/Female 50yrs/Male
Illiterate Illitrate
Wife Self
✔
a. Informed consent
✔
b. Assess vital sign
✔
c. Nil per oral
✔
d. Withhold night dose drug
✔
e. Head shampooing
✔
f. Remove jewelry
✔
g. Empty bladder
✔
h. Pre ECT medication
j. Oxygen administration
✔
ECT REPORT
No of ECT Received
Date Time Frequency Duration Temperature Pulse Respiration B.P Level of consciousness
▪ Conscious after
10min
▪ Conscious after
15min
▪ Conscious after
10min
ON
SCHIZOPHRENIA
I. IDENTIFICATION DATA:-
Religion- Hindu
Education-M.A, BEd
Occupation- Unemployed
Income- 10000/month
D.O.A-29/8/2023 at 14:00pm
Informant- Sonu
As per patient:-
As per informant:-
Onset-Insidious
Course-Continuous
TDI-10years
Episode-2 episode
In 2012 she was admitted in 13/II PGIMS, Rohtak for 2month and 14MECT was
given and tab. Haloperidol was given for 30 days. She shows improvement in her
condition then discharged from hospital. After going home, 2month later she perform
unusual behavior. She would say that his family member want to kill her by giving
poison with food. She was seen muttering to self. She starts to speak in two different
voices. Sometime she speaks abusing language. One day she finds naked in her room
and when asked she replied in 4 different voices ‘hat jao yha se mere sath raat bhar
gande kaam karta hai’ she shows suspicious behavior all time. One day she went to
the police station and complains that they are not her real siblings and they want to
kill her. Her sleep status also decreased.
Diagnosis – F20
IV. Treatment History:-Patient was known case of Schizophrenia and discharge from
ward. She took treatment from PGIMS and treatment was
Tab. Clonazepam
50yrs/Female 55yrs/Male
Housewife Clerk
Mother Father
c) Educational history
Age at beginning of formal education –5year
d) Emotional problems during adolescence -No
e) Puberty
Age at appearance of secondary sexual characteristics -12Years
f) Occupational History-Unemployed
g) Premorbid personality
● Habits –Watching T.V and talking with family member and friends
e. Head shampooing
✔
f. Remove jewelry
✔
g. Empty bladder
✔
j. Oxygen administration
✔
▪ Semi-conscious
▪ Conscious after
10min
▪ Semi-conscious
▪ Conscious after
15min
▪ Unconscious
▪ Conscious after
10min
ASSIGNMENT
ON
PHOBIA
PHOBIA
INTRODUCTION
The word is derived from the Greek phobos meaning extreme fear and flight. The
ancient Greek god, Phobos, was believed to be able to reduce the enemies of the Greeks to a
state of abject terror, making victory in battle more likely.
Fear, aversion, or the strong aversion tested by people of any age or any gender is generally
named like phobia. It is an intensive, most of the time an unexplainable concern and a fear in
certain specific situations or compared to certain specific objects which at the end carries out
to the action to avoid with this situation or object.
Definition
Phobia is persistent avoidance behaviour secondary to irrational fear of a specific object,
activity or situation.
Marks has defined phobia on the following four criteria:
1 The fear is out of proportion to the demands of the situation
2 It cannot be explained or reasoned away
3 It is beyond voluntary control
4 The fear leads to an avoidance of the feared situation.
Epidemiology
Phobias affect people of all the ages, all the long walks of the life, and in each place in world.
The national institute of the mental health has disclosed that 5.1%-12.5% of Americans have
phobias. Phobias form the psychiatric disease commonest between the women of all the ages
and are the second common disease between the men oldest of 25, according to NIMH
statistic.
Aetiology
A Behavioural Factor
1Stimulus Response Model
Involves the traditional Pavlovian stimulus response model of the conditioned response to
account for the creation of phobia. That is, anxiety is aroused by a naturally frightening
stimulus that occurs in contiguity with a second inherently neutral stimulus .As a result of the
contiguity, especially when the two stimuli are paired on several occasions, the originally
neutral stimulus takes on the capacity to arouse anxiety by itself. The neutral stimulus,
therefore, becomes a conditioned stimulus for anxiety production.
2 Operant Conditioning Theories
In the classic stimulus response theory, the conditioned stimulus gradually loses its
potency to arouse a response, if it is not reinforced by a periodic repetition of the
unconditioned stimulus. In the phobic symptoms the attenuation of the response to the phobic
stimulus (that is reconditioning of stimulus) does not occur. The symptom may last for years
without any apparent external reinforcement. The operant conditioning theory provides a
model to explain that phenomenon .According to it, anxiety is a drive that motivates the
organism to do what it can, to obviate the painful affect. In the course of its random
behaviour, the organism learns that certain actions enable it to avoid the anxiety-provoking
stimulus.Those avoidance patterns remains stable for long periods of time; as a result of the
reinforcement they receive from their capacity to diminish activity.
B Psychoanalytic Theories
According to the psychoanalytic theory, the major function of anxiety is a signal to the ego,
that a forbidden unconscious drive is pushing for conscious expression, thus altering the ego
to strengthen and marshal its defences against the threatening instinctual force.
In social and specific phobia, the conflict is regarding sexual arousal, leading to castration
anxiety. When repression fails to be entirely successful, the ego must call on auxiliary
defences. These defences in social and specific phobia are of displacement, symbolization
and avoidance .In agoraphobia, it is the separation anxiety playing a central role.
Neurobiology
Phobias are generally caused by an event recorded by the amygdala and hippocampus and
labelled as deadly or dangerous; thus whenever a specific situation is approached again the
body reacts as if the event were happening repeatedly afterward. Treatment comes in some
way or another as a replacing of the memory and reaction to the previous event perceived as
deadly with something more realistic and based more rationally. In reality most phobias are
irrational, in that the subconscious association causes far more fear than is warranted based
on the actual danger of the stimulus; a person with a phobia of water may admit that their
physiological arousal is irrational and over-reactive, but this alone does not cure the phobia
Phobias are more often than not linked to the amygdala, an area of the brain located
behind the pituitary gland in the limbic system. The amygdala may trigger secretion
of hormones that affect fear and aggression. When the fear or aggression response is initiated,
the amygdala may trigger the release of hormones into the body to put the human body into
an "alert" state, in which they are ready to move, run, fight, etc. This defensive "alert" state
and response is generally referred to in psychology as the fight-or-flight response.
Classification
According to ICD-10
F40-48 Neurotic, Stress-Related and Somatoform Disorders
F40 Phobic Anxiety Disorders
F40.0 Agoraphobia
.00 Without panic disorder
.01 With panic disorder
F40.1Social phobias
F40.2 Specific (isolated) phobias
F40.8 Other Phobic anxiety disorders
F40.9 Phobic anxiety disorder, Unspecified
Signs &Symptoms
● Hyperventilation
● Blushing
● Palpitations
● Confusion
● Gastrointestinal symptoms
● Urinary urgency
● Muscle tension
● Anticipatory anxiety
Agoraphobia
It is characterised by an irrational fear of being in places away from the familiar setting of
home, in crowds, or in situations that the patient cannot leave easily.
Usually begins between ages 15 and 35 and affects three times as many women as men or
approximately 3 percent of the population.
As the agoraphobia increases in severity, there is a gradual restriction in normal day-to-day
activities. The activity may become severely restricted that the person becomes self
imprisoned at home.
Signs &Symptoms
● When accompanied by panic disorder, fear that having panic attack in public will lead to
embarrassment or inability to escape (for symptoms of a panic attack).
Differential features of common phobias
Agoraphobi Anxiety about or avoidance of being trapped in situations or places with no way to
a escape easily if panic develops. Agoraphobia is more common than panic disorder. It
affects 3.8% of women and 1.8% of men during any 6-mo period. Peak age of onset is
the early 20s; first appearance after age 40 is unusual.
1. Phobic Disorders is common form of anxiety disorder, having unreasonable fear of certain
situations, conditions, or substance.
2. Phobic Disorders is further divided into three types such as agoraphobia, social phobia (social
anxiety disorder) and specific phobias.
3. Agoraphobia includes fear of that places from where escape is difficult. Social phobia is fear
of certain social or presentation situations and specific phobias includes fear about specific
situation or object.
4. Patient is aware during this situation but cannot control it.
5. Distress, anxiety and avoidance of situation that causes fear, decreased attention and memory,
travelling on buses, trains or planes are some symptoms of phobic disorders.
6. Treatment for phobic disorders includes exposure therapy, cognitive-behavior therapy,
antidepressant drugs therapy, facing situation systematically and social skills training.
KINDS OF PHOBIA AND THEIR MEANING
Phobia Feared Object or Situation
Acrophobia - Heights
Aerophobia - Flying
Agoraphobia - Open spaces, public places
Aichmophobia - Sharp pointed objects
Ailurophobia - Cats
Amax phobia - Vehicles, driving
Anthropophobia - People
Aqua phobia - Water
Arachnophobia - Spiders
Astraphobia - Lightning
Batrachophobia - Frogs, amphibians
Blennophobia - Slime
Brontophobia - Thunder
Carcinophobia - Cancer
Claustrophobia - Closed spaces, confinement
Clinophobia - Going to bed
Cynophobia - Dogs
Dementophobia - Insanity
Dromophobia -Crossing streets
Emetophobia - Vomiting
Entomophobia - Insects
Genophobia - Sex
Gephyrophobia - Crossing bridges
Hematophobia - Blood
Herpetophobia - Reptiles
Homilophobia -Sermons
Linonophobia - String
Monophobia -Being alone
Musophobia - Mice
Mysophobia -Dirt and germs
Nudophobia - Nudity
Numerophobia -Numbers
Nyctophobia - Darkness, night
Ochlophobia - Crowds
Ophidiophobia -Snakes
Ornithophobia - Birds
Phasmophobia - Ghosts
Pnigophobia - Choking
Pogonophobia - Beards
Siderodromophobia - Trains
Taphephobia - Being buried alive
Thanatophobia - Death
Trichophobia - Hair
Triskaidekaphobia - The number 13
Trypanophobia - Injections
Zoophobia - Animals
Treatment
● Psychotherapy
● Behavior therapy
● Pharmacotherapy
● Supportive therapy
Insight-oriented Psychotherapy
Ii is superior to psychoanalytic psychotherapy. Insight-oriented psychotherapy enables the
patient to understand the origin of the phobia, phenomena of secondary gain and the role of
resistance, and enables the patient to seek healthy ways of dealing with anxiety provoking
stimuli.
Behaviour therapy
Cognitive behaviour therapy and various techniques of behaviour therapy like
desensitization; flooding and social skill training are used.
Desensitization is carried out entirely in imagination and geared around the hierarchy of
anxiety provoking situations whereas in flooding most therapeutic effect is concentrated at
the top of hierarchy. The therapist teaches the patient various techniques to deal with the
anxiety , including relaxation, breathing control and cognitive approaches to situation.
One cognitive-behavioral therapy is desensitization (also known as exposure therapy), in
which people are gradually exposed to the frightening object or event until they become used
to it and their physical symptoms decrease For example, someone who is afraid of snakes
might first be shown a photo of a snake. Once the person can look at a photo without anxiety,
he might then be shown a video of a snake. Each step is repeated until the symptoms of fear
(such as pounding heart and sweating palms) disappear. Eventually, the person might reach
the point where he can actually touch a live snake. Three-fourths of affected people are
significantly improved with this type of treatment
Another, more dramatic, cognitive-behavioral approach is called flooding. It exposes the
person immediately to the feared object or situation. The person remains in the situation until
the anxiety lessens.
Social skill training includes such methods as modelling and role-playing. All the three types
of behaviour therapies are useful in the treatment. The key aspects of successful behaviour
therapy
The patient’s commitment to treatment
Clearly identified problems and objectives
Available alternative strategies for coping with the patient’s feelings.Cognitive-behavioural
treatment of social phobia includes imaginal exposure, in which patients visualize their own
participation in phobic events, performance based exposure in which patients enacted
simulated phobic situations during sessions, cognitive restricting, in which patient’s
cognitions experienced during exposure situation and home work assignments involving
confrontation of environmental events. Most patient gain significantly and improvement is
maintained at 3 and 6 months.
Pharmacotherapy
For generalized type or social phobia
Antidepressant -Phenelzine, imipramine, sertraline.
Benzodiazipines- clonazepam, alprazolam, lorazepam, diazepam and SSRI have been found
useful.
Supportive therapy
The support afforded to patients by a positive relationship with their physicians has a
beneficial effect.
Eye Movement Desensitization and Reprocessing (EMDR) has been demonstrated in peer-
reviewed clinical trials to be effective in treating some phobias. Mainly used to treat Post-
traumatic stress disorder, EMDR has been demonstrated as effective in easing phobia
symptoms following a specific trauma, such as a fear of dogs following a dog
bite. Hypnotherapy coupled with Neuro-linguistic programming can also be used to help
remove the associations that trigger a phobic reaction. However, lack of research and
scientific testing compromises its status as an effective treatment. These treatment options are
not mutually exclusive. Often a therapist will suggest multiple treatments.
Prognosis
Phobias are among the most treatable mental health problems; depending on the severity of
the condition and the type of phobia, most properly treated people can go on to lead normal
lives. Research suggests that once a person overcomes the phobia, the problem may not
return for many years, if it returns at all. Children most often outgrow their specific phobias,
with or without treatment.
Untreated phobias are another matter. In adults, only about 20 percent of specific phobias go
away without treatment, and agoraphobia gets worse with time if untreated. Social phobias
tend to be chronic and are not likely go away without treatment. Moreover, untreated phobias
can lead to other problems, including depression, alcoholism, and feelings of shame and low
self-esteem. Therefore, specific phobias that persist into adolescence should receive
professional treatment.
A group of researchers in Boston reported in 2003 that phobic anxiety appears to be a risk
factor for Parkinson's disease (PD) in males, although as of 2004 it is not known whether
phobias cause PD or simply share an underlying biological cause .While most specific
phobias appear in childhood and subsequently fade away, those that remain
in adulthood often need to be treated. Unfortunately, most people never get the help they
need; only about 25 percent of people with phobias ever seek help for their condition.
Nursing management
Assessment
Focus on physical symptoms, precipitating factors, avoidance behavior associated with
phobia, impact of anxiety on physical functioning, normal coping ability,thought content and
social support systems.
Nursing diagnosis 1
Fear related to a specific stimulus or causing embarrassment to self in front of others,
evidenced by behaviour directed towards avoidance of the feared object/situation.
Objective:
Patient will be able to function in the presence of a phobic object or situation without
experiencing panic anxiety.
Nursing interventions
Reassure the patient that he is safe
Explore patient’s perception of the threat to physical integrity or threat to self concept.
Include patient in making decisions related to selection of alternative coping strategies.
If the patient elects to work on eliminating the fear, techniques of desensitization or
implosion therapy may be employed.
Encourage patient to explore underlying feelings that may be contributing to irrational fears.
Nursing Diagnosis 2
Social isolation related to fear of being in a place from which one is unable to escape,
evidenced by staying alone, refusing to leave the room/home.
Objective:
Patient will voluntarily participate in group activities with peers.
Interventions
Convey an accepting attitude and unconditional positive regard.
Make brief, frequent contacts.
Be honest and keep all promises.
Attend group activities with the patient that may be frightening for him.
Administer anti-anxiety medications as ordered by physician, monitor for effectiveness and
adverse effects.
Discuss with the patient signs and symptoms of increasing anxiety and techniques to
interrupt the response.
Give recognition and positive reinforcement for voluntary interactions with others.
Nursing diagnosis-3
Ineffective coping related to the fear attacks associated with disease condition
Nursing diagnosis -4
Ineffective communication pattern related to the fear associated with social gatherings
Evaluation
Effectiveness of planned interventions will be demonstrated in the patient’s ability to
recognize and deal with the anxiety producing factors .Relaxed participation in unit activities
and reports longer periods of restful sleep indicates reduced anxiety.
Conclusion
Phobias vary in severity among individuals. Some individuals can simply avoid the subject of
their fear and suffer relatively mild anxiety over that fear. Others suffer full-fledged panic
attacks with all the associated disabling symptoms. Most individuals understand that they are
suffering from an irrational fear, but they are powerless to override their initial panic reaction.
ASSIGNMENT
ON
MENTAL HEALTH ACT
2017
It states that mental illness be determined "in accordance with nationally and
internationally accepted medical standards (including the latest edition of the International
Classification of Disease of the World Health Organization) as may be notified by the Central
Government." Additionally, the Act asserts that no person or authority shall classify an
individual as a person with mental illness unless in directly in relation with treatment of the
illness.
► The Convention on Rights of Persons with Disabilities and its Optional Protocol was
adopted on the 13th December, 2006 at United Nations Headquarters in New York and came
into force on the 3rd May, 2008 (UNCRPD)
► India signed and approved the Convention on 1st October, 2007
► The MHCA 2017 on 7th april got assent of president of India and eventually come
into force from May 29, 2018
Need For Mental Health Legislation
RELEVANCE
• Legislation to empower persons with physical and mental disabilities has great implications
for the mental health professionals.
• Many services listed under the MHA Act fall within our scope. Therefore, It is essential for
mental health professionals to familiarize themselves with mental health related legislation as
it presents both opportunities and challenges to their practice.
CHAPTER -I
PRELIMINARY
It contains basic definitions
Informed consent - consent given for a specific intervention, without any force, undue
influence, fraud, threat, mistake or misrepresentation, and obtained after disclosing adequate
information including risks and benefits and alternatives to the specific intervention in a
language and manner understood by the person
Mental healthcare - analysis and diagnosis and treatment as well as care and rehabilitation
of a person for his mental illness or suspected mental illness
Mental health establishment - means any health establishment, including Ayurveda, Yoga
and Naturopathy, Unani, Siddha and Homeopathy establishment and includes any general
hospital or general nursing home, either wholly or partly meant for care of persons with
Mental illness.
Prisoner with mental illness - a person with mental illness under-trial or convicted of an
offence and detained in a jail or prison
►obtained after completion of a full time course of two years which includes supervised
clinical training or doctorate in clinical psychology which includes supervised clinical
training, from any university recognised by the University Grants Commission established
under the University Grants Commission Act, 1956
CHAPTER II
No person or authority shall classify a person as a person with mental illness, except for
purposes directly relating to the treatment or in other matters as covered under this Act
Mental illness of a person shall not be determined on the basis of political, economic or
social status or membership of a cultural, racial or religious group, or for any other reason not
directly relevant to mental health status of the person
Every person, including a person with mental illness shall be deemed to have capacity to
make decisions regarding his mental health care or treatment, if such person has ability to,––
a) Understand the information relevant to the mental health care or treatment decision;
c) Use or weigh that information as part of the process of making the mental health care or
treatment decision
CHAPTER III
Advance directive
Every person, who is not a minor, shall have a right to make an advance directive in writing
specifying any or all of the following:
May be made by a person irrespective of his past mental illness or treatment for the same
Invoked only when the person ceases to have capacity to make decisions
An advance directive made may be revoked, amended or cancelled by the person who
made it at any time.
• It shall be the duty of every mental health establishment to propose or give treatment to a
person with mental illness, in accordance with his valid advance directive.
• The legal guardian shall have right to make an advance directive in writing in respect of a
minor, till such time he attains majority
• Review of advance directives -central authority can make regulations and modifications to
protect patient’s rights
CHAPTER IV
Nominated representative
• Every person, who is not a minor, shall have a right to appoint a nominated representative.
• The nomination shall be made in writing on plain paper with the person’s signature or
thumb impression of the person referred to.
• The person appointed as the nominated representative shall not be a minor, be competent to
discharge the duties or perform the functions assigned to him under this Act, and give his
consent in writing to the mental health professional.
CHAPTER V
b) half-way homes,
c) sheltered accommodation
d) supported accommodation
► Right to protection from cruel, inhuman and degrading treatment (Clause 20)
Right to equality and non – discrimination. (Section 21)
Right to information - The PMI and nominated representative will have the RTI for the
clause under which patient is admitted, nature of illness and treatment options available.
(Section 22)
Right to personal contacts and information - Right to receive and refuse visitors, Right to
receive and make phone calls, send and receive mail through electronic mode including
through email (section 26)
► Creating awareness about mental health and illness and reducing stigma associated with
mental illness.
INDEPENDENT ADMISSION
► Any person who considers himself to have mental illness and desire admission, who is not
minor.
D) Informed consent
► Nominated representative to be with the minor for the entire duration of admission
► Any admission of a minor which continues for a period of thirty days shall be immediately
informed to the concerned Board.
► On Request (DOR)
► Minor becoming Major under-in patient care, can decide as independent patient.
a) SUCH Person is unable to understand the nature and purpose of his decisions and requires
substantial or very high support from his nominated representative; or
d) Showing an inability to care for himself to a degree that places the individual at risk of
harm to himself.
Leave of absence
►A PMI admitted maybe granted leave from the MHE by the psychiatrist After securing
consent of Nominated Representative.
►If the PMI does not return, to contact the person on leave, or Nominated Representative
► If any person absents himself without leave or without discharge from the mental health
establishment:
Leave of absence
►The medical officer or mental health professional in charge of the mental health
establishment may grant:
► To be absent from the establishment subject to such conditions, if any, and for such
duration as such medical officer or psychiatrist may consider necessary.
EMERGENCY TREATMENT
► WHO CAN TREAT- By any Registered Medical Practitioner, subject to informed consent
from the Nominated Representative.
PSYCHOSURGERY
► Psychosurgery as treatment only with patient’s informed Consent and Mental health
Review Board or concerned.
CHAPTER XV
► Unauthorized institutions will be punished 5000-50000 for 1st time, upto 2 lakhs for 2nd
time.
► Any person who do the work against the Act, are liable to give upto ten thousand rupees
or six months of jail or both.
CHAPTER XVI
►Decriminalization of Suicide
► Any person who attempts to commit suicide shall be presumed to be suffering from
mental illness at the time of attempting suicide and shall not be liable to punishment under
this section. (ie dissolution of IPC 309)
► Any person who attempts to commit suicide shall be presumed, unless proved otherwise,
to have severe stress and shall not be tried and punished under the said code.
► The act states that every citizen has right to access mental health care and treatment from
facilities run or funded by the appropriate government
► It assures free treatment to those who are homeless or below poverty line.
► A person with mental illness will also have the right to confidentiality with respect to his
mental health, mental health care and treatment.
►The bill mentions that every insurer shall make provisions for medical insurance for
treatment of mental illness on the same basis is available for treatment on physical illness.
► It bans electroconvulsive therapy (ECT) without anesthesia and any type of ECT to
children and restricts psychosurgery
► It also empowers the mentally ill person to choose the treatment and appoint individual as
nominated representatives who can take decisions on behalf of them.
(Math et al. 2019)
LIMITATIONS:
► The act mentions that a six member mental review board formed by the states will take
decisions on what treatments to offer at government facilities. “While the idea of board is
good, to have only one psychiatrist to take decision is not sufficient.”
► Some psychiatrists are also concerned that giving all patients to choose forms of treatment
could hamper the process.
► As this act provides advance directives it increases the work of psychiatrist whose number
is very less in our country.
► This act mentioned establishing new improvised institutions without concerning about
reforming already established institutions
► The definition of mental health is too restrictive. Going entirely by this definition,
disorders like conversion disorder, phobia, panic disorders and personality disorders which
are mental illnesses as per international classification of diseases (ICD 10), get excluded.
► Further adding to the confusion is the section 2 of MHCA 2017 which states that the
determination of mental illness is as per national or international guidelines like ICD or
Diagnostic and statistical manual (DSM).So there is a dilemma whether to follow the
definition of MHCA 2017 or ICD 10 (Math et al. 2019)
The Mental Healthcare Act 2017 aims at decriminalizing the attempt to die by suicide by
seeking to ensure that the individuals who have attempted suicide are offered opportunities
for rehabilitation from the government as opposed to being tried or punished for the attempt.
The Act seeks to fulfill India's international obligation pursuant to the Convention on Rights
of Persons with Disabilities and its Optional Protocol.
It looks to empower persons suffering from mental illness, thus marking a departure from the
Mental Health Act 1987. The 2017 Act recognizes the agency of people with mental illness,
allowing them to make decisions regarding their health, given that they have the appropriate
knowledge to do so.
The Act aims to safeguard the rights of the people with mental illness, along with access to
healthcare and treatment without discrimination from the government. Additionally, insurers
are now bound to make provisions for medical insurance for the treatment of mental illness
on the same basis as is available for the treatment of physical ailments.
The Mental Health Care Act 2017 includes provisions for the registration of mental health
related institutions and for the regulation of the sector. These measures include the necessity
of setting up mental health establishments across the country to ensure that no person with
mental illness will have to travel far for treatment, as well as the creation of a mental health
review board which will act as a regulatory body.
The Act has restricted the usage of Electroconvulsive therapy (ECT) to be used only in cases
of emergency, and along with muscle relaxants and anaesthesia. Further, ECT has
additionally been prohibited to be used as viable therapy for minors.
The responsibilities of other agencies such as the police with respect to people with mental
illness has been outlined in the 2017 Act.
The Mental Health Care Act 2017 has additionally vouched to tackle stigma of mental illness,
and has outlined some measures on how to achieve the same.
Conclusion
► The mental health care act has some unprecedented measures aimed towards a sea of
change for better, regarding access to treatment for the mentally ill across the country and
particularly so for unprivileged. The mental health care act has brought a lot of promises for
the patients with mental illness.
REFRENCES
"Mental health bill decriminalising suicide passed by Parliament". The Indian Express. 27
March 2017. Archived from the original on 27 March 2017. Retrieved 27 March 2017.
"The Mental Health Care Act, 2017" (PDF). Government of India. Archived from the
original (PDF) on 12 October 2019. Retrieved 12 October 2017.
"Mental Health Act, 1987" (PDF). Archived from the original (PDF) on 5 January 2018.
Retrieved 5 January 2018.
ASSIGNMENT
ON
NATIONAL MENTAL
HEALTH PROGRAM
Attitudes and views toward psychopathology in the medical and larger social community
have undergone drastic transformation throughout history, at times progressing through a
rather tortuous course, to eventually receive validation and scientific attention. Departing
from a simplistic view centred on supernatural causes, modern theories in the early 20th
century began to recognize mental disorders as unique disease entities, and two main theories
of psychodynamics and behaviorism emerged as potential explanations for their causes. With
the increasing acceptance of mental illness as a unique form of pathology, official diagnostic
classification systems were adopted, new avenues of research spawned, and modern
approaches to treatment incorporating pharmaacotherapy and psychotherapy were
established. Although much scientific progress has been made in the fields of diagnosing and
treating mental illness, at a societal level the recent psychiatric deinstitutionalization
movement has been met with mixed success, calling into question how to most effectively
implement into clinical practice the knowledge that has been gained over the previous
centuries.
The prevailing views of early recorded history posited that mental illness was the product of
supernatural forces and demonic possession, and this often led to primitive treatment
practices such as trepanning in an effort to release the offending spirit. Relatively little in the
way of improvements were achieved throughout the European Middle Ages, and the
oppressive sociopolitical climate saw many sufferers of mental illness being submitted to
physical restraint and solitary confinement in the asylums of the time. It was not until the late
19th and early 20th centuries that modern theories of psychopathology began to emerge.
Around this time, two main theoretical approaches began to inform our understanding of
mental illness: the psychodynamic theory proposed by Austrian neurologist Sigmund Freud
(1856–1939), and the theory of behaviorism advanced by American psychologist John B.
Watson (1878–1958). Freud’s theory of psychodynamics centred on the notion that mental
illness was the product of the interplay of unresolved unconscious motives, and should be
treated through various methods of open dialogue with the patient.[2] Behaviorism, on the
other hand, suggested that psychopathology was more closely related to the effects of
behavioral conditioning, and that treatment should focus on methods of adaptive
reconditioning, using the same principles of classical conditioning elucidated by the Russian
physiologist Ivan Pavlov (1849–1936).
Against the backdrop of these broad theoretical frameworks, modern approaches to the
diagnosis and treatment of psychopathology began to emerge and, along with these, the need
to systematically categorize mental illness became apparent. In post–Second World War
North America a need for a formal classification system was recognized in order to provide
more efficient and targeted mental health services for veterans. This led to the creation of the
first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952,
which was largely drawn from the World Health Organization’s sixth edition of the
International Classification of Diseases (ICD-6).Early editions of the DSM described mental
disorders in terms of “reactions,” postulating that such illnesses should be classified with
reference to antecedent socio-environmental and biological causative factors. However, in
1980 with the publication of the third edition, the DSM shifted its focus and intentionally
remained neutral on the potential etiological causes of the various forms of mental illness.
This position was maintained in subsequent editions, including the current DSM-5, published
in 2013.
With theoretical frameworks and a classification system in place, the study and treatment of
mental illness began to expand significantly in the mid-20th century. Important developments
in this period laid the foundation for modern pharmacologic and psychotherapeutic
approaches aimed at addressing mental illness. From a pharmacological perspective, the
catecholamine hypothesis, published in the 1950s, was an influential milestone although
perhaps overly simplistic. Following research into the actions of drugs like reserpine and
monoamine oxidase inhibitors, the catecholamine hypothesis proposed that depression and
other affective disorders were likely caused by decreased levels of catecholamines such as
norepinephrine.
The field of psychotherapy, with its early roots in Freud’s psychodynamic theory, also saw
new developments in this period. In particular, individuals such as American psychologist
Albert Ellis (1913–2007) and American psychiatrist Aaron T. Beck (b. 1921) began adopting
treatment approaches aimed at addressing the maladaptive cognitions and emotions
underlying mental disorders.When combined with principles of behaviorism, this approach
led to the eventual development of cognitive-behavioral therapy (CBT), the current gold
standard psychotherapeutic approach in the treatment of anxiety disorders. Taken together,
the catecholamine hypothesis and the development of CBT have had a substantial impact on
the modern treatment of depression and anxiety, the two disorders accounting for the highest
proportion of disability-adjusted life years among mental illnesses across the globe.
● The promotion of optimal health and well-being and the prevention of mental illness
● Behaviors and mental states that indicate potential danger to self or others.
● Barriers to treatment efficacy and recovery posed by alcohol and substance abuse and
dependence.
● Self-concept and body image changes, developmental issues, life process changes,
and events that affect the mental and emotional well-being of the individual, family,
or community.
social support that help individuals re-engage in the seeking of meaningful lives.
Contemporary practices
Based on the biopsychosocial model of psychiatric nursing, this text provides thorough
coverage of mental health promotion, assessment, and interventions in adults, families,
children, adolescents, and older adults. On the forefront of the shift towards today's emphasis
on evidence-based psychiatric nursing, this text continues to highlight current research
evidence and describe evidence-based care. Included in the book's many useful and engaging
features are psychoeducation checklists, therapeutic dialogues, NCLEX[registered] notes,
vignettes of famous people with mental disorders, research for best practice boxes, and
illustrations showing the interrelationship of the biologic, psychological, and social domains
of mental health and illness. The Fifth Edition has been updated with an emphasis on
recovery throughout the chapters, plus a new chapter on sexual disorders.
Know thyself is a basic now thyself is a basic principle of psychiatric ciple of psychiatric
nursine. Possessing ing. Possessing self-awareness indicates that the nurse has arrived at a
philosophical belief about life, death, and the overall human condition. Introspection is
critical to the development of selfunderstanding. It involves objectively examining one's
personal beliefs, attitudes, motivations, strengths, and limitations. This process is believed to
be important because nurses' psychological state influences the way patient information is
analyzed. Additionally, nurses' social biases can influence the way they interact with clients
(Boyd, 1998). This process of personal introspection adds dimension to the nurse-client
relationship and is pertinent to understanding client responses, thus enabling nurses to
explore these issues with their clients.
According to Arnold and Boggs (1999), in addition to being essential for successful
implementation of the therapeutic relationship, self-knowledge is a necessary precursor to
professionalism. Professional development, according to Schon (1983), is evident in the
reflection of expert practitioners using a critical process that involves discovery of previously
implicit assumptions. Reflective practice and the development of self-awareness are
important concepts to the advancement of nursing as a profession. However, many
practitioners find reflective practice mysterious and confusing (Wilson, 1996), as well as
anxiety provoking. Because self-awareness is a necessary characteristic of professional
nurses, its essence should be well understood. Becoming acquainted with the work of the
primary contributors to the construct of self-awareness is one way to appreciate more fully
the way self-awareness evolves and its meaning.
Socrates, Plato, and Aristotle distinguished themselves as the earliest scholars of the mind,
speculating about and debating the existence and location of the mind (Eckroth-Bucher,
2001). Examining their philosophical tenets and applying their philosophical principles helps
nurses understand the contemporary relevance of the concept and practice of self-awareness
in psychiatric nursing as a tool to facilitate mental health in patients (Eckroth-Bucher, 2001).
In ancient Greece, philosophers, poets, and tragedians, as well as physicians, influenced the
population. Therefore, individuals often turned to philosophers to find relief for their various
psychological problems or to improve their relationships with others. This article discusses
the influence of ancient Greek philosophers, poets, and tragedians on contemporary
psychiatric nursing.
Good mental health involves a sense of wellbeing, confidence and self-worth. It enables us to
fully enjoy and appreciate other people, day-to-day life, and our environment. However,
sometimes people can lose their sense of wellbeing and become mentally unwell. On
occasions when their welfare is at risk (or if others welfare is at risk) they may need to be
treated without their consent in hospital or in the community. They become what are known
as an involuntary patient. The law that enables that to happen is called Mental Health Act
(2014) (Act).
● The rights of persons with mental illness and their personal support persons.
The Mental Health Commission (MHC) is responsible for the ongoing monitoring and
evaluation of the Act and the Mental Health Regulations. Mental Health Act 2014
resources are available to help key groups understand and apply the Act:
● Transport officers.
Consumer handbook to the Mental Health Act 2014 (Handbook) is an invaluable resource for
the community regarding understanding the Act. The Handbook has been prepared to help
people experiencing mental illness and their family members, to navigate the mental health
system and uphold their rights. This handbook has been written by people with lived
experience of mental illness it is user friendly, relevant and informative. The Handbook
outlines:
● consumer and carer rights
● further opinions
● the roles of the Mental Health Advocacy Service, the Mental Health Tribunal and the
Chief Psychiatrist
The legislation is built around 15 principles described in a Charter of Mental Health Care
Principles. Mental health services and private psychiatric hostels must always consider these
principles when they are providing treatment, care and support to a person experiencing
mental illness. The Charter applies to voluntary and involuntary patients.
It is estimated that 6-7 % of population suffers from mental disorders. The World Bank report
(1993) revealed that the Disability Adjusted Life Year (DALY) loss due to neuropsychiatric
disorder is much higher than diarrhea, malaria, worm infestations and tuberculosis if taken
individually. Together these disorders account for 12% of the global burden of disease (GBD)
and an analysis of trends indicates this will increase to 15% by 2020 (World Health Report,
2001). One in four families is likely to have at least one member with a behavioral or mental
disorder (WHO 2001). These families not only provide physical and emotional support, but
also bear the negative impact of stigma and discrimination. Most of them (>90%) remain un-
treated. Poor awareness about symptoms of mental illness, myths & stigma related to it, lack
of knowledge on the treatment availability & potential benefits of seeking treatment are
important causes for the high treatment gap. The Government of India has launched the
National Mental Health Programme (NMHP) in 1982, with the following objectives:
● To ensure the availability and accessibility of minimum mental healthcare for
all in the foreseeable future, particularly to the most vulnerable and
underprivileged sections of the population;
The District Mental Health Program (DMHP) was launched under NMHP in the year
1996 (in IX Five Year Plan). The DMHP was based on ‘Bellary Model’ with the
following components:
References:
Below mentioned websites link were used:
1. www.google.com
2. www.wikepedia.com
3. www.shodhganga.com
ASSIGNMENT
ON
BEHAVIOUR THERAPY
BEHAVIOUR THERAPY
Introduction
Behavior therapy involves changing the behavior of the patients to reduce the dysfunction
and to improve the quality of life. The principles of behavior therapy are based on the early
studies of Classical conditioning by Pavlov (1927) and operant conditioning by Skinner
(1938).
Techniques based on classical conditioning
Classical conditioning is the learning of involuntary responses by pairing a stimulus that
normally causes a particular response with a new, neutral stimulus after enough parings, the
new stimulus will also cause the response to occur. Through classical conditioning ‘the old
and undesirable responses can be replaced by the desirable ones.
There are several techniques that have been developed using this type of learning to treat the
disorders such as phobias, obsessive compulsive disorder, and similar anxiety disorder. The
techniques are,
Relaxation Therapy
Cognitive Therapy
Cognitivebehavioraltherapy (CBT) is a form of psychological treatment that has been
demonstrated to be effective for a range of problems including depression, anxiety disorders,
alcohol and drug use problems, marital problems, eating disorders and severe mental illness.
Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been
demonstrated to be effective for a range of problems including depression, anxiety disorders,
alcohol and drug use problems, marital problems, eating disorders and severe mental illness.
Numerous research studies suggest that CBT leads to significant improvement in functioning
and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more
effective than, other forms of psychological therapy or psychiatric medications.
It is important to emphasize that advances in CBT have been made on the basis of both
research and clinical practice. Indeed, CBT is an approach for which there is ample scientific
evidence that the methods that have been developed actually produce change. In this manner,
CBT differs from many other forms of psychological treatment.
CBT treatment usually involves efforts to change thinking patterns. These strategies might
include:
● Learning to recognize one's distortions in thinking that are creating problems, and
then to re-evaluate them in light of reality.
CBT treatment also usually involves efforts to change behavioral patterns. These strategies
might include:
● Using role playing to prepare for potentially problematic interactions with others.
Not all CBT will use all of these strategies. Rather, the psychologist and patient/client work
together, in a collaborative fashion, to develop an understanding of the problem and to
develop a treatment strategy.
CBT places an emphasis on helping individuals learn to be their own therapists. Through
exercises in the session as well as “homework” exercises outside of sessions, patients/clients
are helped to develop coping skills, whereby they can learn to change their own thinking,
problematic emotions and behavior.
CBT therapists emphasize what is going on in the person's current life, rather than what has
led up to their difficulties. A certain amount of information about one's history is needed, but
the focus is primarily on moving forward in time to develop more effective ways of coping
with life.
Positive-Negative Reinforcement
For positive reinforcement, think of it as adding something positive in order to
increase a response. For negative reinforcement, think of it as taking something negative
away in order to increase a response.
Reinforcement
● Reinforcement is used to help increase the probability that a specific behavior will
occur in the future by delivering or removing a stimulus immediately after a behavior.
Positive Reinforcement
● A mother gives her son praise (reinforcing stimulus) for doing homework (behavior).
● The little boy receives $5.00 (reinforcing stimulus) for every A he earns on his report
card (behavior).
● A father gives his daughter candy (reinforcing stimulus) for cleaning up toys
(behavior).
Negative Reinforcement
● Bob does the dishes (behavior) in order to stop his mother’s nagging (aversive
stimulus).
● Natalie can get up from the dinner table (aversive stimulus) when she eats 2 bites of
her broccoli (behavior).
● Joe presses a button (behavior) that turns off a loud alarm (aversive stimulus)
When thinking about reinforcement, always remember that the end result is to try to increase
the behavior, whereas punishment procedures are used to decrease behavior. For positive
reinforcement, think of it as adding something positive in order to increase a response. For
negative reinforcement, think of it as taking something negative away in order to increase a
response.
Bio Feedback
Biofeedback therapy is a technique that trains people to improve their health by
controlling certain bodily processes that normally happen involuntarily, such as heart rate,
blood pressure, muscle tension, and skin temperature.
Biofeedback therapy is a non-drug treatment in which patients learn to control bodily
processes that are normally involuntary, such as muscle tension, blood pressure, or heart rate.
It may help in a range of conditions, such as chronic pain, urinary incontinence, high blood
pressure, tension headache, and migraine headache.
As it is noninvasive and does not involve drugs, there is a low risk of undesirable side effects.
This could make it suitable for those who wish to avoid medications, or those who cannot use
them, such as during pregnancy.
EEG biofeedback may help patients with attention deficit hyperactivity disorder (ADHD),
addiction, anxiety, seizures, depression, and other types of brain condition.
During a biofeedback session, the therapist attaches electrodes to the patient’s skin, and these
send information to a monitoring box.
The therapist views the measurements on the monitor, and, through trial and error, identifies
a range of mental activities and relaxation techniques that can help regulate the patient’s
bodily processes.
Eventually, patients learn how to control these processes without the need for monitoring.
It remains unclear why or how biofeedback works, but it appears to benefit people with
conditions related to stress, according to The University of Maryland Medical Center
(UMM). When a person experiences stress, their internal processes — such as blood pressure
— can become irregular. Biofeedback therapy teaches relaxation and mental exercises that
can alleviate symptoms.
Guided Imagery
Various forms of guided imagery have been used for centuries, as far back as ancient Greek
times, and the technique is an established approach in Chinese medicine and American Indian
traditions as well as other healing and religious practices. Jacob Moreno’s technique of
psychodrama, developed in the 1940s, can also be linked to guided imagery, as the enactment
of the person in therapy’s unique concerns can be understood as a method of directing a
person’s own imagery. In fact, Hans Leuner, who further developed psychodrama, called the
approach guided affective imagery.
In the 1970s, Dr. David Bressler and Dr. Martin Rossman began establishing support for
guided imagery as an effective approach for the treatment of chronic pain, cancer, and other
serious illnesses. Their work led them to co-find the Academy for Guided Imagery in
1989. Throughout the 80s, a number of health advocates and professionals began to publish
materials exploring the positive impact of guided imagery on health concerns both mental
and physical. Ulrich Schoettle, Leslie Davenport, and Helen Bonny were a few such
individuals.
Guided therapeutic imagery is a technique used in a wide range of therapeutic modalities and
settings including group and individual therapy. Once learned, the technique can also be
practiced independently, without the direction of a therapist. Guided imagery scripts can be
found online and in self-help books. Many individuals may obtain benefit from practicing
guided imagery on their own, but seeking instruction from a trained professional
before attempting to use guided imagery alone is typically recommended. Instruction in the
technique can help individuals obtain maximum effect from the intervention.
Typically a therapist using this approach will provide verbal prompts to direct the focus of
the imagery, often encouraging the participant to notice various sensory aspects of the scene.
A person in therapy may, for example, be asked to envision a peaceful place, including in this
vision any aromas, sounds, and textures present. In this way, guided therapeutic imagery
expands beyond visualization because it involves all five senses. Guided imagery is designed
to impact the body as well as the mind, and breathing typically becomes slower and more
controlled during the process while muscles relax, creating a state of calm and relaxation.
Some practitioners may use music as part of the technique.
The process of guided therapeutic imagery has some similarities to other techniques designed
to invoke a state of relaxation, such as hypnosis. Both techniques involve some visualization,
a focus on the inner mental experience, and a relaxed state of mind. However, hypnosis tends
to place more focus on suggestion while guided imagery emphasizes the senses. When used
therapeutically, hypnosis can utilize the relaxed state to help a person become more receptive
to new ideas and beliefs. Guided imagery works to incorporate a person's senses in order to
better direct and focus attention on a particular area of concern, imagining a desired outcome
for that concern.
● Stress
● Anxiety
● Depression
● Substance abuse
● Grief
● Posttraumatic stress
● Relationship issues
● Diminished self-care
The Academy for Guided Imagery offers professional certification in guided therapeutic
imagery, or Interactive Guided Imagery, as it is also known. Interested practitioners must
complete 150 hours of training, 33 hours of independent study, and be licensed to practice as
a mental health professional. Health educators, personal coaches, body
workers,andcounselors may also pursue training in this method.
Training, which consists of three levels that must be completed within 24 months, is offered
through home-study modules and online group study workshops. Additional continuing
education trainings are also available through AGI's website.
Although the use of guided therapeutic imagery is supported by research, some studies
suggest it can lead to false memories. However, there are typically other factors contributing
to the recovery of false memories, such as group pressure, personality factors, and personal
experiences.
Guided imagery may not work for every individual, and some people may prefer to address
their concerns with other approaches.
This technique is generally considered to be safe for use by most people, whether they choose
to seek the support of a mental health professional or use guided imagery on their own. The
initial guidance of a therapist is encouraged, and when a person experiences a serious
concern, the support of a mental health professional is always recommended.
Abreaction Therapy
Abreaction Therapy focuses on reliving a traumatic event and going through the emotions
associated with them to heal and move forward. Originally created by Sigmund Freud the
method gives patients a way to release their unconscious pain and escape from the memories
and feelings that have kept them from moving forward. Therapists who work as Abreaction
counselors use catharsis or the cleansing of emotions to get rid of the spirit and thoughts
associated with the experience. As a process that brings out difficult emotions the client will
go through an emotional removal that takes away the burden of the traumatic event after
treatment.
The goal of Abreaction Therapy is to cleanse the patient's body by going through their trauma
yet again and letting go of painful thoughts and emotions. When the client has completed
their treatment they should be able to speak openly about the event without feeling
uncomfortable or unable to cope. Therapy clears up what has happened and heals the
individual so that they can move forward and prevent the trauma from ruining their personal
lives and relationships. As a traditional and direct form of therapy this is an awareness tool
that helps clear up the conscious tension which can be extremely dramatic when it is
associated with heavy emotions and painful memories.
As a form of "reliving" in psychotherapy, Abreaction Treatment may take longer than other
treatment plans. Currently Abreaction is not used in its current form but as a combination
approach which outlines the traumatic event to integrate the past and constructively deal with
the pain associated with it. Being that the trauma is complex and affects the patients in
various ways the counselor works with the technique carefully to relive memories and
overcome the patient's disassociation from the event and pain. The treatment works by
acknowledging the flashbacks and distrust. It is likely that the patient will also undergo
disorientation toward the beginning of treatment. The counselor has to be careful when they
are reliving the event being that it often promotes flashbacks as an unavoidable element in
working with trauma. The therapist will have to ensure that a trusting relationship has been
put in place with the patient before thoughts are expressed. Security between the two will
create safety in the presence of the therapist during Abreaction.
Toward the beginning of the treatment the counselor creates stabilization in the room and
provides the patient with a psycho-education so that they can possess a deeper understanding
of what's happening and why. The moment when the event is relived could occur quickly
because of a trigger that's been made accidentally. Although it may feel like internal pressure
and conflict for a period of time the counseling will release the unprocessed emotions and
material for the purpose of bringing them closer to the surface. The pressure may feel like a
power struggle although it results in conscious and sub-conscious clarity.
When the thoughts and feelings are released the client gains understanding, clarity and a new
identity. This is a beneficial strategy in working with hostile memories because it creates a
new role for the individual. This is a collaboration platform between the therapist and patient
to rid of disturbing memories, close them and move forward in life. Being that the counselor
is a hand to hold during the process it acts as a physical anchor. The creation and
development of the relationship is essential and it could take a lengthy session time until the
client is ready to relive the event. For patients that are severely damaged it can take many
sessions before internalizing the security and commitment.
References:
Below mentioned websites link were used:
4. www.google.com
5. www.wikepedia.com
6. www.shodhganga.com
ASSIGNMENT
ON
ROLE OF NURSE IN
PSYCHO-
PHARMALOGICAL
THERAPY
SUBMITTED TO: SUBMITTED BY:
MRS. DEEKSHA MS. JYOTI BATRA
ASSISTANT PROFESSOR M.SC. NURSING 1ST YEAR
MENTAL HEALTH NURSING MENTAL HEALTH NURSING
Antianxiety Agents
Agents that alleviate ANXIETY, tension, and ANXIETY DISORDERS, promote sedation,
and have a calming effect without affecting clarity of consciousness or neurologic conditions.
ADRENERGIC BETA-ANTAGONISTS are commonly used in the symptomatic treatment
of anxiety.
Antidepressants Agents
Antidepressants are drugs used to prevent or treat depression. The available
antidepressant drugs include the selective serotonin reuptake inhibitors (SSRIs),
norepinephrine-dopamine reuptake inhibitors (NDRIs), monoamine oxidase inhibitors
(MAOIs), tricyclic antidepressant, tetracyclic antidepressants, and others.
The antidepressants are some of the most commonly prescribed medications in current use.
They are also important causes of drug induced liver injury accounting for 2% to 5% of
clinically apparent cases. The antidepressants can be grouped into four categories: monamine
oxidase inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, and
miscellaneous agents.
The monamine oxidase inhibitors are a large group of hydrazide derivatives which were
found to have antidepressant activity when first used in the therapy of tuberculosis in the
1950s. These agents inhibit the enzyme monamine oxidase that is responsible for inactivation
of many amine neurotransmitters such as norepinephrine and serotonin, thus increasing their
levels and activity in the brain. MAO inhibitors (with initial trade name and year of approval)
currently in clinical use for depression include phenelzine (Nardil: 1961), tranylcypromine
(Parnate: 1961), and isocarboxazid (Marplan: 1959). MAO inhibitors are currently not widely
used, having been replaced by the tricyclic antidepressants and selective serotonin reuptake
inhibitors which have greater potency and fewer adverse side effects. The MAO inhibitors
can cause serum aminotransferase elevations and rarely lead to clinically apparent liver
injury, generally with a hepatitis-like clinical presentation 1 to 3 months after starting
therapy.
The tricyclic antidepressants share a tricyclic chemical structure somewhat resembling the
phenothiazines. The tricyclics are believed to act by inhibition of reuptake of serotonin and
norephinephrine, thus increasing levels of these neurotransmitters. Tricyclic antidepressants
in current use includeANCHALriptyline (Elavil: 1961), clomipramine (Anafranil: 1989),
desipramine (Norpramin: 1964), doxepin (Sinequan: 1969), imipramine (Tofranil: 1959),
nortriptyline (Aventyl or Pamelor: 1964) and protriptyline (Vivactil: 1967). Two more
recently approved agents are usually categorized as tricyclics, but have some unique
characteristics: trimipramine (Surmontil: 1979) and amoxapine (Asendin: 1992). The various
tricyclic antidepressants are capable of causing transient serum aminotransferase elevations to
varying degrees and, in rare instances, clinically apparent acute liver injury. Various pattern
of hepatic injury have been associated with different tricyclic antidepressants.
The selective serotonin reuptake inhibitors (SSRIs) are a group of structurally unrelated
agents characterized by a common mechanism of action, the inhibition of reuptake of
serotonin in synaptic clefts which results in an increase in brain serotonin activity. These
agents are considered selective, because they have little activity in blocking reuptake of
norepinephrine or other neurotransmitters. The SSRIs are currently the most commonly used
antidepressants. Those in current use include citalopram (Celexa: 1998), escitalopram
(Lexapro: 2002), fluoxetine (Prozac: 1987), fluvoxamine (Luvox: 1994), paroxetine (Paxil:
1992), sertraline (Zoloft: 1991), venlafaxine (Effexor: 1965) and duloxetine (Cymbalta:
2004). Two more recently approved serotonergic agents are unique in that they have bimodal
activity, inhibiting serotonin reuptake like typical SSRIs, but also having partial agonist-
antagonist activity directly against serotonin receptors: vilazodone (Viibryd: 2011) and
vortioxetine (Brintellix: 2013). Serum aminotransferase elevations occur in up to 10% of
patients taking conventional SSRIs. Varying patterns of acute liver injury have been
described with most agents, but clinically apparent liver injury due to these agents is rare.
Several antidepressant medications have been withdrawn from use because of their potential
for hepatotoxicity. Thus, the initial MAO inhibitor and hydralazine derivative iproniazid was
introduced into clinical use in 1956, but withdrawn in 1961 because of multiple reports of
acute hepatic injury more than 10% of which were fatal. Amineptine is a tricyclic
antidepressant that was introduced in 1978 in Europe, but subsequently withdrawn because of
several reports of prolonged cholestatic hepatic injury associated with its use in rates higher
than with other tricyclic antidepressants. Finally, nefazodone, an antidepressant related in
structure to trazodone that was approved for use in 1997, was withdrawn by the sponsor in
2003 after multiple reports of acute liver failure arising in patients treated for more than 4 to
6 months. Nefazodone, however, remains available in generic forms.
Mood Stabilizers
Mood stabilisers are a type of medication that can help if you have unhelpful moods
swings such as mania, hypomania and depression They help to control and ‘even out’ these
mood swings.
Mania
● feeling happy or excited, even if things are not going well for you,
● talking very quickly, jumping from one idea to another, racing thoughts,
● not being able to sleep, or feel that you don’t want to sleep,
● doing things you normally wouldn’t which can cause problems. Such as:
Hypomania
Hypomania is like mania but you will have milder symptoms. Treatment for hypomania is
similar to the treatment for mania.
Depression
● low mood,
● being less interested in things you normally like doing or enjoying them less,
Your doctor may prescribe mood stabilisers if you have an episode of mania, hypomania or
depression that changes or gets worse suddenly. This is called an acute episode. Some people
need to take mood stabilisers as a long-term treatment to stop this from happening. You may
experience mania or depression if you have a condition such as bipolar disorder,
schizoaffective disorder, depression or personality disorder.
Antipsychotics
Psychosis is a medical term. If you have psychosis, you might see or hear things
(hallucinations) that are not there or you might have ideas or beliefs that do not match reality
(delusions). Some people describe it as a break from reality. Doctors may call these
‘psychotic symptoms’, a ‘psychotic episode’ or a ‘psychotic experience’.
If you have psychosis, your doctor may offer you antipsychotic medication to help you with
your symptoms. Antipsychotics can help to control symptoms of psychosis. This can help
you feel more in control of your life, particularly if you are finding the psychotic symptoms
distressing.
According to the Royal College of Psychiatrists, 4 out of 5 people who take antipsychotics
find they are successful in treating their symptoms. It is not possible to predict which one will
work best for you, so you may have to try a few before you find the right one.
Some antipsychotics are used to treat mania (which is a symptom of illnesses such as bipolar
disorder) and psychotic symptoms of depression.
Your brain contains chemicals which help to carry messages from one part of the brain to
another. One of these chemicals is called dopamine. It is thought that high levels of dopamine
may cause the brain to function differently and may cause the symptoms of psychosis.
Antipsychotic medications reduce the amount of dopamine in the brain or restore the balance
of dopamine with other chemicals in the brain.
Types of antipsychotics
● Typical or ‘first generation’. These medications have been used since the 1950s.
● Atypical or ‘second generation’. These medications have been used since the 1990s.
The main difference between these types is in their side effects. First generation
antipsychotics may have more of an effect on your movement than newer ones. Although this
does not mean newer generation antipsychotics don’t have any side effects on your
movement.
This distinction can make it easier to talk about the different medications. But you should
think about each antipsychotic individually. This is because everyone reacts differently to
medication. You can never be certain how you will be affected by side effects or whether the
medication will work for you. This can mean that the first medication you try may not be the
right one for you.
If you have been on an antipsychotic for a few weeks and the side effects are too difficult to
cope with, you should ask your doctor about trying a different one.
Antipsychotic medication can come as tablets, a syrup or as an injection. The injections are
called a depot. You may find a depot useful if you struggle to remember to take your
medication, or might take too much. Your doctor should take your views into account when
prescribing you medication.
The first generation of antipsychotics have been prescribed since the 1950s. The following
medications are typical antipsychotics. They have been listed by their generic name with the
brand name in brackets.
● Benperidol (Anquil)
● Chlorpromazine (Largactil)
● Flupentixol (Depixol)
● Fluphenazine (Modecate)
● Haloperidol (Haldol)
● Levomepromazine (Nozinan)
● Pericyazine
● Perphenazine (Fentazin)
● Pimozide (Orap)
● Promazine
● Trifluoperazine (Stelazine)
● Zuclopenthixol (Clopixol)
The second generation of antipsychotics have been used more since the 1990s. Although
some of them were developed before then. They have been listed by their generic name with
the brand name in brackets.
● Amisulpride (Solian)
● Olanzapine (Zyprexa)
● Quetiapine (Seroquel)
⮚ Clozapine
Clozapine works slightly differently to others. It is sometimes given to people who are
treatment resistant. This means other medication hasn’t helped their symptoms. The National
Institute for Health and Care Excellence (NICE) says that people with schizophrenia should
only be offered clozapine after having tried 2 other drugs.
Clozapine can cause your white blood cell numbers to drop, but this is rare. This could mean
that you get infections more easily. If you take clozapine, you will need regular blood tests to
make sure your white blood cell count is healthy.
If your white blood cell numbers start dropping, you will be asked to stop taking the
medication. You will have another blood test after you have stopped clozapine to make sure
they are back to normal. Your doctor might decide to change your dose of clozapine or offer
you another type of medication.
● Stiffness and shakiness. This can often be reduced by lowering the dose. But, if a high
dose is necessary, the shakiness can be treated with anticholinergic drugs. This is the
same kind of medication that is used for Parkinson’s disease.
● Weight gain.
● A higher risk of getting diabetes.
● Constipation.
● Dry mouth.
● Blurred vision.
Not all antipsychotics will have these side effects. Second generation or atypical
antipsychotics are less likely to cause movement side effects, but you might still experience
them. If you do then your doctor might change your medication.
Sedative – Hypnotics
Sedative-hypnotics are a class of drugs that cause a dose-dependent depression of the
CNS function, inducing sedation, sleep, and unconsciousness with increasing dose. Agents in
this class of drugs include benzodiazepines and Z-drugs, barbiturates, and melatonin agonists.
Sedative-hypnotics are a class of drugs that cause a dose-dependent depression of the
CNS function, inducing sedation, sleep, and unconsciousness with increasing dose. Agents in
this class of drugs include benzodiazepines and Z-drugs, barbiturates, and melatonin agonists.
Most of the sedative-hypnotic drugs affect GABAergic transmission, increasing the inhibition
of neuronal excitability, with the exception of melatonin agonists, which act on
hypothalamicmelatonin receptors. Sedative-hypnotic drugs are used as anxiolytics, sedatives,
muscle relaxants, anesthetics, and anticonvulsants. Common side effects result from
excessive CNS depression and include confusion, drowsiness, somnolence, and respiratory
depression. Long-term use of sedative-hypnotics is associated with a risk of dependence.
Side effects
● Blunted affect
● Increased appetite
● Drug tolerance
● Paradoxical excitability
Treatment
Supportive therapy
● Single dose of activated charcoal if the patient is fully conscious and presents within
30 minutes of overdose
Purpose
Centralnervous system stimulants are used to treat conditions characterized by lack of
adrenergic stimulation, including narcol epsyandneonatalapnea.Additionally,
methylphenidate (Ritalin) and dextroamphetamine sulfate (Dexedrine) are used for their
paradoxical effect in attention—deficit hypera ctivity disorder (ADHD).
Theanerexiants,benzphetamine(Didrex),diethylpropion(Tenuate),phendimetrazine(Bontril,Ple
gine),phentermine(Fastin,Ionamine),andsibutramine(Meridia)areCNSstimulantsusedforappeti
tereduction in severeobesity. Although these drugs are structurally similar to amphetamine,
they cause less sensation of stimulation, and are less suitedforuse in conditionscharacterized
by lack of adrenergic stimulation.
Phenyl propanolamine and ephedrine have been used both as dietaidsand as vasoconstrictors.
Description
The majorities of CNS stimulants are chemically similar to the neuro hormone
norepinephrine, and simulate the traditional"fight or flight" syndrome associated with
sympathetic nervous system arousal. Caffeine is more closely related to the xanthines, such as
theophylline. A small number of additional members of the CNS stimulant class do not fall
into specific chemical groups.
Precautions
Amphetamines have a high potential for abuse. They should be used in weight reduction
programs only when alternative therapies have been ineffective. Administration for
prolonged periods may lead to drug dependence.These drugs are classified as schedule II
under federal drug control regulations.
The amphetamines and their cogeners are contraindicated in advanced arteriosclerosis,
symptomatic cardiovascular disease, and moderate to severe hypertension and hyperthyroidism.
They should not be used to treat patients with hypersensitivity or idiosyncrasy to the
sympathomimeticamines, or with glaucoma, a history of agitatedstates, a history of drugabuse,
or during the 14 days following administration of monoamineoxidase (MAO) inhibitors.
Methyl phenidate may lower the seizure threshold.
Benzphetamine is category X during pregnancy. Diethylpropion is category B. Other
anorexiants have not been rated; however their use during pregnancy does not appear to be
advisable. Safety for use of an orexiants has not been evaluated.
There have been reports that when used in children, methyl phenidate and amphetamines may
retard growth.Although these reports have been questioned, it may be suggested that the
drugs not be administered outside of school hours (because most children have behavior
problems in school), in order to permit full stature to be attained.
The most common adverse effects of CNS stimulants are associated with their primary
action. Typical responses include over stimulation, dizziness, restlessness, and similar
reactions. Rarely, hematologic reactions, including leukopenia, agranulocytosis, and bone
marrow depression have been reported. Lowering of the seizure thre shold has been noted
with most drugs in this class.
References:
Below mentioned websites link were used:
7. www.google.com
8. www.wikepedia.com
9. www.shodhganga.com
DRUG STUDY
ON
PSYCHIATRIC DRUGS
SUBMITTED TO: SUBMITTED BY:
MRS. DEEKSHA MS. JYOTI BATRA
ASSISTANT PROFESSOR M.SC. NURSING 1ST YEAR
MENTAL HEALTH NURSING MENTAL HEALTH NURSING
NAME CLASS INDICATIO MECHANIS CONTRAIND SIDE ADVERS NURSING
N M OF I CATION EFFECT E RESPONSIBILITIES
ACTION S EFFECTS
Generic Therapeuti Acute chronic Alters Contraindicate dro CNS: 1. Asses patients
Name: c class: psychosis d wsiness neuroleptic mental status
Chlorpromazin Antipsychoti particularly the dry malignant 2. Monitor blood
e c when effect in mouth or syndrome , pressure
accompanied of hypersensitivit stuffy sedation 3. Keeppatient
Brand Name: Pharmacol by increased dopamine y: nose; ENT: recumbent for
Thorazine, ogic class: psychomotor in blur red blurred at least
Chlorpromanyl phenothiazi activities. the CNS. Has cross vision; vision, 30 minutes
nes significant sensitivity with constipatio dry eyes following
Availability: Nausea anticholinergi other n; or CV: parenteral
Tablets c phenothiazines imp hypotensio administration
and vomiting, may occur otence, n 4. Advise to take
Route of intractable alpha- trouble GI: medication as
administratio hiccups adrenergic having an constipatio directed
n: blocking orgasm. n, dry 5. Caition
PO, IM, IV pre- operative activity. mouth to avoid alcohol
sedation DERM: or other CNS
photosens depressants
etivity 6. Inform that this
may turn urine
NAME CLASS INDICATIO MECHANIS CONTRAIND SIDE ADVERSE NURSING
N M OF I CATION EFFECTS EFFECTS RESPONSIBILITIE
ACTION S
Generic Therapeuti To Block Contraindicate >weigh CNS: • Use
Name: c class: dopamine d to t gain drowsiness, clozapine cautiously
Clozapine Antipsychot treat severe receptors in patients >dizziness sedation, in patients with
ic schizophreni the with allergy to >tremor seizures,dizzi hepatic, renal, or
Brand a unresponsiv clozapine, CNS >fast heart ness, cardiovascular
Name: Pharmacol e to standard brain, depression, rate syncope, disease and in elderly
Clozaril, ogic class: drugs; depresses the comatose >headache headaches patients
FlazaClo, Dibenzapine to states, >drowsines CV:tachycard with dementia-
Versacloz derivatives reduce RAS; s ia, related psychosis
risk of anticholinergi history of >nausea hypotension, because they have
Avaulabi c, >constipatio potentially increased risk of
l ity: recurrent antihistaminic seizure n fatal serious or fatal
Tablets suicidal , and alpha- disorders, >dry mouth myocarditis adverse
behavior adrenergic lactation, >vision GI: nausea, reactions. Also use
Route: in blocking therapy vomiting, cautiously in patients
problems
PO schizophreni activity with constipation with risk
>fever
a may other GU: urinary factors for a stroke
>increased
or contribute abnormalities because drug
sweating.
schizoaffecti to drugs Hematologic use may increase
ve disorders some of that cause bone risk of
:arganulocyto A transient increase
Clozapine sis above 100.4° F (38°
produces Others: C) may occur, most
fewer fever, weight often within the first 3
extrapyramid gain, rashes weeks of therapy.
al •When therapy ends,
expect to check WBC
effects count and ANC
than weekly for at least 4
weeks or until WBC
other count is 3,500/mm3 or
antipsychotic more and ANC is
s. 2,000/mm3 or more.
•Monitor
patients,
especially
patient
taking
orally disintegrating
tablets (Fazaclo) to
leave tablet in blister
pack until ready to
take it. Tell him to peel
foil back to remove
tablet (rather than
pushing tablet through
foil) and then to
immediately place
tablet in mouth and let
it dissolve before
swallowing. Explain
that no water is
needed.
•Inform patient that
he’ll need weekly
blood tests. Review
NAME CLASS INDICATIO MECHANIS CONTRAI SIDE ADVERSE NURSING
N M OF N EFFECT EFFECTS RESPONSIBILITIES
ACTION DICATIO S
N
Therapeu General: Absorption: Blood >restlessn CNS: Ataxia, 1. Monitor the
Generic tic class: Acute Well- dycrasias, ess cerebral patient’s
Name: Antipsych absorbed after bone >mask-like edema, blood
Fluphenazin o tic and chronic marrow facial dizziness, pressure
e psychoses. PO/IM depression, expression drowsiness, routinely.
hydrochlori Pharmaco administratio cerebral >greatly headache, 2. Assess
d e/ logic n, deconoate arterioscleri increased insomnia, mental status
Fluphenazin class: salt in same osis, saliva lightheadedn (mood,
e deconoate Phenothia oil >tremors ess behaviour,
zines has coma >unusual orientation)
,
Brand delayed concomitant mental/mo 3. Administer oral
nervousness,
Name: release from use of large od doses with
seizures,
Modecate oil amounts of changes food, milk, or
slurred
(CAN), CNS >frequent full glass of
speech,
Modecate vehicle and depressant, urination water.
syncope,
Concentrate subsequent coronary >unusual 4. To prevent
worsening
release from artery dreams contact
fatty tissues. disease, dermatitis,
avoid getting
Prolixin
Availabili
ty
(CAN), Metabolism hepatic psychotic ion hands.
and dysfunction, symptoms. 5. Advise patient
Excretion: hypersensiti not to mix oral
CV: AV
Mostly vity solution with
conduction
Injection metabolized beverages that
disorder,
, tablets, by to contain
bradycadia,
elixir. phenothiazi caffeine
cardiac
liver; undergo nes, (coffee, cola),
arrest,
Rout of enterohepatic myeloprolife tannins(tea), or
Hypercholest
Administr recurculation. rative pectins (apple
erolemia,
a tion: disorder, juice).
hypertension,
PO, IM severe 6. Observe
orthostatic
hypertention patient
hypotension,
or carefully when
QT-interval
hypotension administering
prolongation,
, subcortical medication to
shock, ST-
brain ensure that
segment
damage medication is
depression,
taken not
tachycardia
hoarded or
cheeked.
EENT: 7. Document
blurred given
impaction
, ileus,
increased
appetite,
nausea,
vomiting
GU:
Amenorrhea,
bladder
paralysis,
decreased
libido,
enuresis,
menstrual
irregularities,
polyuria,
urinary
frequency,
urinary
incontinence,
urine
retentions