Foundations of Psychiatric Mental Health Nursing Shija K K, Jija D
INDEX
Page numbers followed by f refer to figure and t refer to table, respectively.
A
Acetylcholine 68, 69
Acne 107
Acquired immunodeficiency syndrome 136
Adjustment disorders 191, 195
Adverse drug reaction 260
Agitation 76, 101
Agoraphobia 100, 191
Agranulocytosis 96
AIDS 255
dementia complex 139, 137
Akathisia 94, 95
Akinetone 110
Alcohol 71, 146148, 256, 260
abuse 75
dependence
complications of 150
treatment of 149
intoxication 257, 258
use 148t
disorder 148
Alcoholism 121, 216, 255
chronic 105
effects of 148
Alexithymia 83
Allergic
reactions 107
side effects 94, 96, 98, 103
Alogia 93, 164
Alprazolam 193
Alzheimer's disease 131
Amenorrhea 96, 198, 213, 214
American Nurses Association 17
American Psychiatric Association 7
Amino acids 68
Amitriptyline 101
Amnesia 85
dissociative 195
retrograde 85
Amnestic syndrome, organic 131, 132, 140
Amniotic fluid 234
Amoxapine 101
Amygdala 65
Anankastic personality disorder 202, 207
Anhedonia 83, 93, 164
Anorexia 97, 259
nervosa 212
Anterograde amnesia 85
Antianxiety 91
drugs 109, 219
Anticholinergics 95
drugs 110
side effects 97, 111
Antidepressants 91, 100, 101, 183, 213, 214, 219
classification of 101, 101t
side effects of 102, 102t
tetracyclic 101
therapy 101, 103
tricyclic 101
Antihistamine 110
side effects of 111
Antiparkinsonian drugs 91, 95, 110
Antipsychotics 91, 178, 183, 190, 213, 219
atypical 9294
classification of 92, 92t
contraindications of 92
conventional 93
drugs 91
first generation 93
side effects of 94, 97
target symptoms of 92
typical 92, 93
Antisocial and borderline personality disorders 258
Anxiety 43, 121, 190, 191, 216, 257, 263
depression 124
disorders 101, 120, 191
generalized 100, 192, 216
phobic 191, 241
separation 100, 240
types of 192
levels of 191, 191t
mild 191
moderate 191
neurosis 75
panic 191
severe 191
Anxiolytics 178
Anxious avoidant personality disorder 202, 208
Anxiousness 262
Apathy 93, 259
Appetite 87
disturbances 101
Arrhythmia, risk of 101
Asperger's syndrome 236
Asthma 75, 198
Ataxia 109
Attack, panic 100
Attention 56
deficit hyperactive disorder 236
disorders of 75, 84
Attitude 31, 42, 52, 53, 246
Autism 226, 232
atypical 236
etiology of 233
Autistic
disorder 232
thinking 163, 164
Automatism 77
Autonomic
nervous system 96
side effects 94, 96, 97
Autonomy 8
Aversion therapy 120, 121
B
Backache, low 198
Barbiturates 109
intoxication symptoms 152
Behavior 6, 50
abnormal 6, 11
pattern, Abnormal 233
therapy 183, 196, 213, 219, 235
Behavioral therapy
indications of 120
types of 120
Benzodiazepines 95, 109
classification of 110t
Benztropine 110
Biochemical theories 161, 176, 182
Biological
theories 160, 176, 182
therapies 89, 168
Biopsychosocial therapies 89
Bipolar
affective disorder 181f
depression 100, 216
disorder 108, 182
classification of 182
mood disorders 120, 176, 181, 255, 258, 298
Birth asphyxia 234
Bizarre delusion 80
Blood
dyscrasias 107
glucose 59
pressure 94
sugar 94
Blue gray metallic discoloration 97
Borderline personality disorder 100, 205
Brain
anatomy of 62
damage 71, 131
disease, parenchymatous
parts of 63f, 64, 64t, 6567
pathology 161
physiology of 62
tumors 71
Brainstem 67
Brittle nails 213
Bromocriptine 110
Bruxism 217
Bulimia nervosa 212, 214
Bupropion 101
C
Cancer 255
Cannabis 147, 151
Carbamazepine 104, 108
Carbidopa 110
Cardiac diseases 107
Cardiomyopathy 150
Cardiovascular
disease 101
system 150, 198
Carphologia 133
Catalepsy 77
Catatonia 77, 112
non-organic 112
Catatonic
behavior 164
excitement 167
posturing 78
schizophrenia 112, 160, 167
stupor 77, 167, 259
Catecholamines 68
Catharsis 263
Central nervous system 94, 102, 233
Cerebellar degeneration 150
Cerebellum 67
Cerebral lesions 133
Cerebrovascular accident 112
Cerebrum 64
Chest X-ray 59
Child and adolescent psychiatric disorders 223
Childhood psychiatric disorder 91, 100, 119, 124
Chills 262
Chlorpromazine 92
Cholecystokinin 68
Cholestatic jaundice 96, 109
Cingulate gyrus 66
Citalopram 101
Clomipramine 101
Clonazepam 193
Clonidine 95
Closed angle glaucoma 110
Clozapine 92, 96
Cocaine 147, 152
dependence 105
effects of 152
Cognitive
behavior therapy 124, 184, 213, 214
functions 55, 281
impairment 93
theories 182
therapy 120, 168
Cogwheel rigidity 106
Colonial period 22
Coma 84
Communication 30
barriers of 32, 32t
elements of 30
nonverbal 31
skills 33
therapeutic 33
transpersonal 31
types of 31
verbal 31
Community
mental health 245
center 250
facilities 250
services 245, 250
team 245
psychiatry 245
Computed tomography scan 59
Conduct disorder 75, 238, 239
Confusion 84, 106
Congenital rubella 234
Consciousness 55
clouding of 84
disorders of 75, 84
Constipation 96, 97, 102, 213
Contact dermatitis 97
Conversion disorder 191, 195, 196
Cornea 97
Coronary artery disease 150
Couple therapy 124
Creutzfeldt-Jakob disease 138
Crisis 5, 261, 262t
adolescent 261
adventitious 261
intervention 249, 262, 264
severity of 262
situational 261
Current episode mania 298
Cyclothymia 105, 184
Cyclothymic temperament 76
Cytomegalovirus 234
D
Defamation 273
Deficiency dementia 137
Dehydration 213
Delirious mania 177, 177t
Delirium 84, 91, 131, 132, 140, 257, 258
drug induced 134
etiology of 133
tremens 91, 149
Delusion 79, 102, 164166, 177
primary 79
Delusional disorders 91, 159, 160, 173
Dementia 91, 120, 131, 132, 136140, 216, 256
alcoholic 150
causes of 137
drug induced 138
metabolic 137
neoplastic 137
praecox 159
primary degenerative 137
traumatic 137
types of 137
vascular 131, 137, 138
Dental enamel, erosion of 214
Dependent personality disorder 202, 208
Depersonalization
disorder 195
syndrome 197
Depression 75, 91, 100, 119, 120, 126, 185t, 216, 259, 262
acute 100, 105
atypical 100
post-schizophrenic 160, 167
reactive 124
secondary 100
Depressive
cognitions 183
disorder, recurrent 176, 184
episode 176, 182
etiology of 182
neurosis 75
symptoms 105
Derealization syndrome 197
Dermatological side effects 94, 97, 99, 107
Desipramine 101
Detoxification 149
Diabetes 96
mellitus 94, 198
Diarrhea 107, 262
Diphenhydramine 110
Diplopia 109
Disaster 7, 261, 264
Dissocial personality disorder 202, 204
Dissociative disorder 120, 191, 195
types of 195, 195t
Dissociative fugue 195
Distraction 84
Distress 6
District Mental Health Programme 28
Disulfiram 150f
Diuretic therapy 107
Domestic violence 126
Dopamine 68, 69
hypothesis 161
Dopaminergic 110
drugs, side effects of 111
Double bind theory 162
Doxepin 101
Drowsiness 84, 102, 109
Drug 71, 146
abuse 75, 255
adherence 99
therapeutic index of 90
withdrawal 257, 260
Dry mouth 96, 97, 102
Dry skin 213
Duloxetine 101
Dyscalculia 231
Dyslalia 230
Dyslexia 231
Dysmenorrhea 198
Dyspareunia 219
Dysphoric mood 101
Dyssomnia 215
types of 215
Dysthymia 100, 184
Dysthymic disorder 184
Dystonia, acute 94, 95, 260
E
Eating disorder 100, 120, 126, 212
classification of 212
Ebstein anomaly 107
Echolalia 79, 165
Echopraxia 77
Ecstasy 84, 177
Edema, intermittent 214
Ego defense 1
Elation 84, 177
Electrocardiogram 59
Electroconvulsive therapy 111, 168, 178, 190, 194
Electroencephalogram 59, 139
Electrophysiological tests 59
Emotion 280
disturbance of 75
Emotional disorders 75, 240
Empathy 18, 40
Encephalitis 71, 234
Encopresis, nonorganic 242
Endocrine
side effects 94, 96, 98, 103, 106
system 198
Enuresis 100
nonorganic 242
Epidemiology 230
Epinephrine 68, 69
Episodic paroxysmal anxiety 192
Erotomania 80
Esophageal erosion 213
Euphoria 84, 177
Excess somnolence, disorder of 217
Expansive mood 83
Expressive language disorder 230
Extrapyramidal symptoms 93, 94
F
Family
theories 161
therapy 124, 168, 184, 213, 214
types of 124
tree, symbols in 51f
Fantasy 79
Fatigue 106
Fear 216, 262, 263
Febrile illness 133
Fetishism 219
Fetishistic transvestism 219, 220
Fluid and electrolyte abnormalities 214
Fluoxetine 101
Fluphenazine 92
Fluvoxamine 101
Forensic psychiatry 266
Fugue 84
Functional psychosis, functional 75
G
Galactorrhea 96
Galanin 68
Gamma-aminobutyric acid 68, 70, 176, 192
Gastritis 150
Gastrointestinal system 150, 198
Genetic hypothesis 160, 176, 182
Genitourinary system 198
Genogram 276
Glutamate 68, 70
Grandeur, delusion of 80
Granular deposits 97
Grief reaction, abnormal 100
Group therapy 125, 126, 168, 219
adjunctive 125
goals of 125
indications of 126
therapeutic 125
types of 125
Guilt 262
delusion of 80
H
Habit disorders 243
Hair loss 107
Hallucinations 82, 102, 148, 153, 164, 166
auditory 82
command 82
gustatory 82, 166
haptic 82
olfactory 82
second person 82
third person 82
visual 82
Hallucinatory voices 163
Hallucinosis, alcoholic 149
Haloperidol 92
Head
injury 108, 133, 137, 138, 150, 258
trauma 71
Headache 133, 198
Health education 264
Heavy metal intoxication 137
Heller's syndrome 236
Hemogram 59
Hepatic diseases 137
Hepatitis 150
Histamine 68, 69
Histrionic personality disorder 202, 206
HIV infection 71, 139
Homogenous group 125
Homosexuality 121
Humanitarian period 21
Huntington's chorea 91
Huntington's disease 138
Hyperactivity 76, 237
Hyperkinetic disorders 236, 237
Hypermnesia 85
Hypersensitivity 110
Hypersomnia 87, 217
nonorganic 215
symptoms of 217
treatment of 217
Hypertension 198
malignant 112
Hypertensive crisis 103
Hyperthyroidism 198, 216
Hyperventilation 198
Hypnosedatives 91
Hypnosis 119
Hypoactive sexual desire disorder 218
Hypoalbuminemia 213
Hypochondriacal
delusion 80
disorder 197
Hypomania 177, 177t
Hypotension, orthostatic 96, 97, 102
Hypothalamus 67
Hypothesis
neuroendocrine 182
neurophysiological 176, 182
viral 162
Hypothyroidism, severe 107
Hysterical neurosis 75
I
Imipramine 101
Indian Lunacy Act 267
Indian Penal Code 266
Infection 71, 213
Inflammatory bowel disease, chronic 213
Injury 71
Insomnia 86, 215
causes of 216
middle 101
nonorganic 215
terminal 101
Insulin shock therapy 116
Integumentary system 198
Interpersonal therapy 124, 183
Intestinal obstruction 110
Intoxication 71, 133, 152
Intranatal
care 229
period 50
problems 224
Irritable bowel syndrome 198
Isolation 4
Itching 107
J
Jaundice 97
obstructive 97
Jitteriness syndrome 102
L
Language
disorder 232
specific developmental disorders of 230
Lead 71, 97
Leucopenia 109
Levodopa 110
Lewy body dementia 138
Light therapy 116
Limbic system 63f, 65
Lithium 104, 105, 108
side effects of 106
therapy 107
contraindications of 107
toxicity
signs of 106, 106t
symptoms 106, 106t
Liver
carcinoma of 150
cirrhosis of 150
disease 101
function test 59
Loxapine 92
L-tryptophan 68
M
Magnetic resonance imaging scan 59
Major depressive disorder 255
Malaise 97
Male erectile disorder 219
Malnutrition 213
Mania 75, 91, 112, 179t, 257
acute 108, 177, 177t
organic 108
precipitation of 102
types of 177
Manic depressive psychosis 181
Manic episode 176
Maprotiline 101
Marital
conflicts 150, 255
schism or skew 161
status 255
therapy 124, 184
Mathematic disorder, developmental 231
Maturational crisis 261
McNaughton rule 266
Meconium 234
Medical disorders 91, 255
Melancholia, involutional 185
Melancholic traits 76
Melatonin 68
Memory 55
disorders of 75, 85
Meningitis 234
Menstrual abnormalities 214
Mental
disorders 10, 11, 62, 64t, 69, 70, 73, 131, 212, 216
classification of 73
encyclopaedia of 190
organic 131, 141
psychopathology of 62
statistical manual of 74
symptomatic 131
health 7, 8, 12
assessment 48
authorities 268
education 249
indications of 8
nursing 12, 1, 16, 275, 284, 285
program 252
team 18
illness 6, 7, 1012, 86, 247t
causes of 71
signs of 75
symptoms of 75
retardation 75, 119, 223, 225
classification of 223
mild 223
moderate 223
prevention of 228
severe 223
types of 225t
status examination 53, 166, 275, 279, 292
symptoms 96
tension 216
Mental Health Care Act, 2017 271
Metabolic
disorders 139
syndrome 94
Migraine 100, 133, 198
Milieu therapy 126, 128, 168
goals of 126
Mini mental status examination 58, 139
Minimal brain damage 238
Mobile crisis programs 264
Monoamine 68
oxidase inhibitors 101
Mood 175t, 177
congruent delusion 81
disorders 124, 175, 176
classification of 176
epidemiology of 175
etiology of 176
stabilizers 104, 178
symptoms 93
Motor
activity, disorders of 75, 76
behaviour, disorders of 165
function, specific developmental
disorders of 231
restlessness 95
retardation 101
symptoms 96, 196
Multi-infarct dementia 138
Multiple family group therapy 124
Muscarinic cholinergic blockade action 102
Muscular weakness 106
Musculoskeletal system 198
Myasthenia gravis 110
Mydriasis 96, 102
Myocardial infarction 112, 198
N
Narcissistic personality disorder 206
Narcolepsy 86
Narcotic Drugs and Psychotropic Substances Act, 1985 272
Narrow angle glaucoma, aggravation of 102
National Mental Health Programme 27, 252
Natural opiates 151
Nausea 97, 107, 109, 262
Neologism 79, 165
Neoplasms 139
Nervous system 150, 198
side effects 106
Neurasthenia 197
Neurocognitive disorder 136
Neurodermatitis 198
Neuroendocrine tests 59
Neuroleptic malignant syndrome 94, 95, 260
Neurological disorder 108
Neuropathy, peripheral 150
Neuropeptides 68
Neuropsychological tests 139
Neurosis 6, 75, 190, 190t
phobic 75
Neurosyphilis 71
Neurotic
depression 184, 184t
disorder 6, 191, 197, 198t
stress-related and somatoform disorders 190, 191
Neurotransmission 68, 89, 90
Neurotransmitters
classification of 68t
dysfunctions of 69, 69t
functions of 69, 69t
Night terror 215, 217
Nightmares 215, 217
Non-dependence-producing substances, abuse of 212
Nontherapeutic communication technique 36
Norepinephrine 68, 69
dopamine reuptake inhibitor 101
Nortriptyline 101
Nucleus accumbens 66
Nurse
clinician 26
educator 26
role of 128, 248, 249, 252
stressful life events of 45
therapist 26
Nursing
care plan 154, 154t, 169t, 185t, 198t, 218t, 227t
format for 284
considerations 135, 209
diagnoses 220, 227, 258, 263
interventions 214, 221, 263
management 97, 141, 154, 169,
179, 185, 198, 214, 218, 220, 227, 235, 256, 260
Nutritional deficiency 139
O
Obesity 94, 198
Obsessive compulsive disorder 75, 100, 120, 121, 191, 193, 216, 255
Occupational therapy 128, 129
categories of 129
Olanzapine 92
Opioid 147, 151
intoxication 151
Oppositional defiant disorder 239
Oral tricyclic antidepressants 102
Organ system 198
Organic disorder 212, 218
Orientation, disorders of 75, 84
Oxcarbazepine 104
P
Pain 216
abdominal 107
chronic 100
Pancreatitis 150
Panic disorders 192
Papular eruptions 107
Paramnesia 85
Paranoid 166
personality disorder 202, 203
Parasomnia 215, 217
types of 217
Parkinson's disease 138
Paroxetine 101
Pedophilia 219, 220
Peplau's interpersonal theory 42
Peptic ulcer 150, 198
disease 100
Perception, disorders of 75, 82, 165
Persecution, delusion of 80
Persistent depressive disorder 184
Persistent mood disorder 176, 184
types of 184
Personality 6
disorder 75, 201, 202, 209
classification of 102, 209
specific 202
pattern, specific 72
Pervasive developmental disorders 232, 236
Pharmacokinetics 102, 105
Pharmacotherapy 168, 213, 219, 235
Phenylketonuria 234
Pheochromocytoma 112
Phobia 79, 120, 121
school 100
social 100, 191
specific 191
types of 191
Phonological disorder 230
Photosensitivity 97, 109
Pick's disease 138
Pimozide 92
Polysomnography 59
Positron emission tomography 59
Postnatal
care 229
period 50
problems 225
Post-traumatic stress disorder 100, 120, 195, 216, 255
Poverty, delusion of 80
Pregnancy and lactation, first trimester of 107
Premorbid personality 52, 278
Prochlorperazine 92
Professional performance, standards of 17
Propranolol 95
Prostatic hypertrophy 96, 110
Prostatitis 198
Pruritus 97
Psoriasis 75, 198
exacerbation of 107
Psychiatric
disorders 11, 70, 100, 108, 255, 260, 266, 267
functional 91
organic 91
emergencies 254, 261
types of 254
history 48, 289
mental health nurse, role of 26
nurse, qualities of 17
nursing 25
development of 24
paraprofessionals 19
rehabilitation 249
components of 250
principles of 249
social worker 19
Psychiatry 5, 21, 22
Psychoactive
drugs, use of 216
substance use 53, 154t, 279
Psychoanalytic theory 162, 176, 182
Psychodynamic theories 202
Psychoeducation 99, 125
format for 287
Psychological
development, disorders of 230
tests 59
theories 161
Psychomotor
activity 54, 177
retardation 78
Psychopathology 6
Psychopharmacology 89, 178, 183, 194
Psychophysiological disorders 75
Psychosis 6, 75, 112, 190, 190t
acute 91, 260
affective 75
disintegrative 236
organic 75
severe 112
substance induced 91
Psychosocial
theories 176, 182
therapies 89, 117, 150, 168, 178, 183
Psychosomatic disorder 120, 124, 197, 198t
types of 198
Psychosurgery 116, 117, 190, 194, 196, 213, 219
Psychotherapy 117
supportive 119, 183, 197
types of 118
Psychotic
depression 184, 184t
disorder 6
symptoms, aggravation of 102
Psychotropic drugs 89, 133
classification of 91
Puerperium 212
Q
Quetiapine 92
R
Rape 150, 261
Reading disorder
developmental 231
specific 231
Receptive language disorder 231
Regression 3
Relaxation
technique 216
training 121
Renal
diseases, chronic 137
dysfunctions 107
function test 59, 105
side effects 106
Repression 3
Respiratory system 198
Retinopathy, pigmentary 97
Rett's syndrome 236
Rheumatoid arthritis 198, 216
Ryle's tube feeding 215
S
Schizoaffective disorder 91, 105
Schizoid personality
disorder 202, 203
traits 76
Schizophrenia 75, 91, 112, 119, 120, 124, 159, 160, 162, 162t, 166, 216, 255, 257, 258
etiology of 160
hebephrenic 160, 167
paranoid 160, 166
residual 160, 167
simple 160, 167
types of 166, 166t
Schizotypal disorder 160, 172, 204
Schneider's first rank symptoms 159, 163
Scholastic skills, specific developmental disorders of 231
Scientific attitude, period of 22
Segregation, period of 21
Seizure 101, 102, 106, 133
alcoholic 149
disorder 108
Selective serotonin reuptake inhibitor 101, 140
Selegiline 101
Serotonin 68, 69
norepinephrine reuptake inhibitor 101
Sertraline 101
Serum creatine phosphokinase 59
Sexual
aversion disorder 218
desire 87
disorder 120, 121, 212
dysfunction 212, 218, 221, 257
history 52, 278
masochism 220
preference, disorder of 219
problems 98
sadism 220
side effects 103
Sexually transmitted disease 255
Sibling rivalry disorder 241
Single family therapy 124
Skin rashes 109
Sleep 212
disorders 215, 218
international classification of 215
nonorganic 212, 215
terror 215, 217
Sleeplessness 259
Sleep-wake
pattern, reversal of 86
schedule, non-organic disorder of 215
Social
anxiety disorder 241
functioning, disorders of 241
skill training 168
stigma 246
Socialized conduct disorder 239
Sociocultural theories 162
Sodium valproate 104, 108
Somatic
complaints 101
delusion 80
passivity 164
therapies 111
Somatization disorder 197
Somatoform
autonomic dysfunction 197
disorders 120, 191, 196
classification of 197
Somnambulism 87, 100, 215, 217
Somnolence 87
Specific arithmetic disorder 231
Specific developmental disorders, management of 231
Speech 54, 166, 280
disorders of 75, 81, 164, 232, 243
poverty of 81, 165
pressure of 78, 81
slurring of 106
specific developmental disorders of 230
stereotype 78
Spelling disorder, specific 231
Stigma 246
Stomach 262
carcinoma of 150
Stress 5, 72, 182, 216
reaction, acute 119
severe 191, 195
vulnerability hypothesis 161
Stupor 84, 112
Substance abuse 75, 120, 124, 126
Substance use disorders, prevention of 157
Suicide 112, 166, 183, 254, 256
attempt 256, 261
causes of 255
epidemiology of 254
ideation 256, 259
method of 255
prevention centers 251
risk 112
types of 256
warning signs of 256
Supportive psychotherapy, techniques of 119
Suppression 3
Synthetic opioids 151
Systemic infections 134
T
Tachycardia 110
Tardive dyskinesia 94, 95
Teeth, gnashing of 217
Temporal lobe 65
Testamentary capacity 266
Thalamus 66
Therapeutic communication
techniques of 33, 33t
types of 3335
Therapeutic impasses
management of 46
types of 46
Therapeutic nurse-patient relationship 30
Thiamine 149
Thioridazine 92
Thrombocytopenic purpura 109
Thyroid function test 59, 105
Tic disorders 77, 91, 241
Tinnitus 106
Tobacco intoxication 154
Toxic dementia 137
Transcranial magnetic stimulation 117
Tremor 77, 102, 106, 262
Tricuspid valve, downward displacement of 107
Trifluoperazine 92
U
Ulcerative colitis 198
Uremic encephalopathy 137
Urethritis 198
Urinary
obstruction 110
retention 96, 97, 102
V
Vaginismus 219
Venlafaxine 101
Victim outreach program 264
Violence
causes of 258
symptoms of 258
treatment of 258
Vision, blurring of 97, 106
Vitamin deficiency 71
Volatile solvents intoxication 154
Vomiting 97, 107, 109
W
Waxy flexibility 77
Weight
gain 96
loss 214, 259
Withdrawal syndrome 102
Y
Yoga 216
Z
Ziprasidone 92
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Chapter Notes

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IntroductionCHAPTER 1

The concepts of health, mental health and mental illness have evolved after many years of efforts by theorists/scientists and become more refined after discussions.
An overview of defense mechanisms will help in easy understanding of mental health and mental illness.
 
REVIEW OF DEFENSE MECHANISMS
 
Defense Mechanisms (Ego Defense)
These are the psychological means of coping with conflict or anxiety, that operates at an unconscious level, and help the individual to be away from unpleasant feelings or help to feel better.
Unpleasant or unacceptable memories, drives or wishes that are banished to the unconscious or subconscious mind do not disappear. They continue to exert a powerful influence on behavior. The forces, which try to keep painful or socially undesirable thoughts and memories out of the conscious mind, are termed defense mechanisms.
Defense mechanisms are used to protect ourselves from feelings of anxiety or guilt, which make us feel threatened. As id or superego are very much demanding, conflicts arise. But these are not under one's conscious control. With the ego, one involuntarily use one or more mental mechanisms to protect self from stressful situations in life. Ego-defense mechanisms are natural and normal.
When the ego defenses become out of proportion, or inappropriate, neuroses such as anxiety states, phobias, obsessions, or hysteria occur. Maladaptive use of defense mechanisms promotes disintegration of ego and will lead to loss of ability to deal with reality, with interpersonal relations and with occupational functioning.
 
Types
There are many mental mechanisms that are commonly used in everyday life. They are:2
 
Compensation
Consciously covering one's own weakness by giving more emphasize on it or by making up this weakness by focusing on a desirable trait that is already existing.
Example: A student who is weak in mathematics will overwork on mathematics to compensate for the weakness. or
A student who is weak in academic performance will compensate by focusing on arts/sports which he likes, feels more comfortable.
 
Displacement
Displacement is the redirection of an impulse (usually aggression) from the real target to a less powerful substitute target. The target can be a person or an object that can be a symbolic one.
Example: Someone who gets shouting from the superior may go home and kick the pet or shout at or beat up a family member.
 
Denial
Denial is the blocking of existence of real events and its associated feelings from awareness as if they are unreal. Individual unconsciously refuses to admit an unacceptable event or refuses to face the difficult situation. He will try to avoid the stressful situation by denying it.
Example: Alcoholics may refuse to admit to themselves that it is bad for their health.
 
Substitution
It is the mechanism in which unattainable goals are replaced with an attainable goal and thus frustrations are avoided.
Example: A student who desires to be a doctor, but not qualified in medical entrance will substitute it with nursing.
 
Identification
Individual's effort to increase self-worth by acquiring or imitating the characteristics of someone else who is a famous or hero. Seen during adolescence by identifying themselves with film actors or actress. This helps the child further develop the adult ego state and the parent ego state.
Example: After joining in student police cadet, a student decide to become a police by identifying himself with the police officers.
 
Introjection
Characteristics of significant person (attitudes, messages, prejudices) are subconsciously integrates to self and separation of it from self is difficult. It is the internalization of another person's believes and values.3
Example: After joining nursing, the student integrates herself with the senior staff nurse who won a national award for service.
 
Reaction Formation
The person behaves by showing exaggerated form of opposite feelings and behavior for preventing the expression of real unacceptable thoughts.
Example: The student who does not like a very strict teacher may display himself or herself as over polite and very much loving.
 
Sublimation
It is a mental mechanism with which unacceptable emotions and drives are displaced in a socially acceptable manner, rather than in destructive. It is the healthy redirection of an emotion.
Example: Instead of acting out of anger on your friends, the boy may go to the gym for physical workout.
 
Repression
This is the most important and first defense mechanism that Freud discovered. Repression is an unconscious mechanism employed by the ego to keep disturbing, unpleasant threatening thoughts from becoming conscious, or it is unconscious forgetting.
Repression is the involuntary or unconscious blocking of painful or unpleasant thoughts and memories out of awareness and forgetting them.
This is not a very successful defense in long-term as it pushes the wishes, ideas or memories into the unconscious mind.
Example: A person with history of physical abuse in childhood may forget about it and will be unable to memorize it as he/she grows.
 
Suppression
Suppression is the voluntary blocking of distressing thoughts or feelings from one's awareness. But it can be memorized as it is pushed to the subconscious mind.
Example: A girl voluntarily blocks the memories of witnessing an accident.
 
Regression
This is an unconscious return to the childish or primitive psychological time when one is in stress. When we are frightened, our behaviors often become more childish or primitive. A child when faces a change or stress he/she may begin to restart thumb sucking or bedwetting.
Example: A girl starts bedwetting after the arrival of her father from military, who is strict in dealings.4
 
Rationalization
Rationalization is the cognitive distortion of 'the facts' to justify unacceptable feelings. Individual justifies his failures and socially unacceptable behavior by giving socially approved reasons.
This may take two forms as sour grape mechanism and sweet lemon mechanism.
In sour grape mechanism, individual himself blames the unattainable task or things by showing its negative side of it as in case of wolf and the grapes story. It is an intellectual way to diminish pain or guilt.
In sweet lemon mechanism, the individual justifies his status or limitations by highlighting the advantages of what he has.
 
Projection
Individuals attribute their unacceptable thoughts, feeling and motives to another person, or they are projected to others and thus seeks relief from anxiety. Unconsciously or consciously individual blames others for one's own problems.
Example: Aggressive thoughts, sexual fantasies, etc. may be attributed to others.
Blaming the teacher for the failure in exam.
 
Isolation
Here memory or thoughts are separated from emotions related to it. Individual can remember and talk about a traumatic experience without feeling any emotion. The person talks about the incident as a third person's perception, or as a happening to another person.
Example: A person who is kidnapped by terrorist explains about his sufferings, without any emotional response.
 
Intellectualization
Avoidance of emotions of a painful event by using intellectual process. Individual realizes/acknowledges the facts, but not the emotions related to that.
Example: Individual will not show any emotions while describing the accident and death of his father by realizing the underlying mistake or problem.
 
Undoing
Doing something consciously to make up for a wrong doing that had occurred previously.
Example: Taking the child for an outing after beating him or punishing.5
 
Conversion
It is the defense mechanism by which mental conflict or anxiety is converted to a physical symptom as paralysis, blindness without any medical basis. This anxiety is usually arousing from repressed feelings or wishes.
Example: A soldier on being deployed into battle is conflicted about his desire to serve country but believes it is wrong to kill for any reason develops paralysis, blindness, or deafness with no medical cause.
 
Dissociation
Unconscious separation of painful feelings/emotions from unacceptable idea, situation or object.
 
DEFINITION OF TERMS USED IN PSYCHIATRY
  • Mind: Mind is a set of neurocognitive functions including consciousness perception, thinking, judgment and memory that keeps one alert and oriented. There is no globally accepted definition for mind.
  • Psychiatry: It is the branch of medicine that deals with the diagnosis, treatment and prevention of mental illness.
  • Psychiatrist: Medical doctor with special training in psychiatry—as diploma/PG in psychiatry, accountable for diagnosis and treatment of mentally ill.
  • Stress: A state of disequilibrium resulting from a disharmony between demands occurring within environment of the individual (internal/external) and his/her coping ability with that demands (Townsend M).
  • Crisis: Psychological disequilibrium resulting from hazardous circumstances that constitute important problems that are difficult for the individual to solve or to escape from (Townsend M).
  • Adjustment: It is the behavioral process of balancing conflicting needs or needs against obstacles in the environment (Encyclopaedia Britannica).
    A series of adjustments begin when there is a need and they ends when the need is satisfied.
  • Adaptation: It is the ability to adjust to new information and experiences or it is the restoration to homeostasis or equilibrium following a stress.
  • Eustress: Positive and motivating stress, where individual shows ability to master a challenge or a stressor.6
  • Behavior: It is the sum total of all activities of a human being, with cognitive, affective and psychomotor elements.
  • Psychopathology: It is the scientific study of mental disorders that include etiology, classification, manifestations and treatment.
  • Abnormal behavior: Deviation of covert and overt activities of a person from normal behavior as per the social norms.
    There are 4D's which define abnormality.
    1. Distress: It is the negative feelings by the individual as deeply troubled and affected by their illness.
    2. Dysfunction: It is the maladaptive behavior in individual's ability to perform normal daily functions.
    3. Deviance: Specific thoughts, behaviors and emotions that are unacceptable and unusual in a society or culture is considered as deviance.
    4. Danger: Dangerous or violent behavior directed to individual himself or to others in the environment (homicidal and suicidal activities).
  • Mental illness: Maladaptive responses to stressors evidenced by thoughts, feelings and behaviors that are not appropriate to the social norms and interferes with one's social, occupational and physical functioning (Townsend M).
  • Insanity: It is a term that indicates that the individual is incompetent to manage his affairs and unable to foresee the effect of his action.
  • Maladaptation: A failure of the body to regain homeostasis, following stress responses that are physiological and/or psychological, and disrupts the personal integrity of the individual. Maladaptation is an adaptation that is less helpful than harmful (Townsend M).
  • Personality: Deeply ingrained patterns of behavior, which include the way one related to, perceives and thinks about the environment and oneself (Townsend M).
  • Psychosis: A mental state in which there is loss of contact with reality and symptoms as delusions, hallucinations, disorganized speech patterns and bizarre or catatonic behavior (Townsend M).
  • Neurosis: An unconscious conflict that produces anxiety, and other symptoms and leads to maladaptive use of defense mechanisms (Townsend M).
  • Psychotic disorder: A serious psychiatric disorder in which there is a gross disorganization of the personality, marked disturbance in reality testing, impairments in interpersonal functioning and relationship to the external world (Townsend M).
  • Neurotic disorder: Less serious psychiatric disorder characterized by excessive anxiety and/or depression, disrupted bodily functions, unsatisfying interpersonal relationship, and behaviors that interferes 7with routine functioning. There is no loss of touch with the reality (Townsend M).
  • Disaster: A natural or man made occurrence that overwhelms the resources of an individual or community and increased the need for emergency evacuation and medical services (Townsend M).
 
CONCEPT OF MENTAL HEALTH AND MENTAL ILLNESS
 
Introduction
The concept of health had become more refined with long-term efforts at international level. World Health Organisation (WHO) defines health as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. This definition itself shows that there is no health without mental health. Body-mind relationship shows that physical and mental health is interrelated. Mental health being the invisible part of health, people are not giving the due concern for it. But in the present scenario, the relevance of mental health is increasing because poor mental health is the basis for most of the social problems. Mental health is essential for the well-being of individual, family, society and thus that of nation.
 
Mental Health
Mental health is not merely the absence of major mental illness like schizophrenia or mood disorders and/or minor mental disorders like anxiety disorders or obsessive compulsive disorders. It is the ability to adapt to the changes and challenges in personal and social life and thus to maintain a state of harmony between self and others. Personality development, intelligence, attitude, habits and support systems contribute to one's mental health.
 
Definitions
  • Mental health is ‘simultaneous success at working, loving and creating with the capacity for mature and flexible resolutions of conflicts between instincts, conscience, other important people, and reality’. (American Psychiatric Association —APA, 1980)
  • Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. (WHO 2001)
  • Mental health is the state of simultaneous success at establishing and sustaining harmonious relationship with others by realizing one's own strength and weakness, by managing stress effectively and by working productively for the society.8
 
Indicators of Mental Health
Many theorists have attempted to define/conceptualize mental health. Jahoda (1958) had pointed out six major indicators of mental health, and got wide acceptance.
  1. Positive attitude towards self: The individual who has strong sense of personal worth and identity will feel secure in his environment. Real perception of self (awareness and acceptance of strength and weakness of self) will help one to have positive outlook.
  2. Growth, development and the ability for self-actualization: The individual successfully achieves the definite tasks with each developmental stage, and thus gains motivation to his or her highest potentials.
  3. Integration: This involves the person's ability for successful adaptation to the environment and ability for development of own philosophy of life. This will help him/her to keep anxiety at manageable levels during stressful situations. All these contribute to a balance among various life process.
  4. Autonomy: It is the individual's ability to make own choices and to accept responsibilities for the outcome. This will enable one to perform tasks in an independent and self-directed manner.
  5. Perception of reality: It is the real perception of the environment without distortions and necessitates respect and concern for the needs and wants of others. Or empathy and social sensitivity are of special concern here.
  6. Environmental mastery: It is the ability of individual to achieve satisfactory role within the group, society or environment. The individual is able to love others and to accept the love of others. Individual will be able to strategize, make decisions, change, adjust and adapt to the environment and thus mastery give satisfaction.
 
Factors Affecting Mental Health
  • Genetic factors: Mental health as well as mental illness are seems to be inherited. Studies have proven that mental illness is more in some families or it runs in families. In such families mental health will be poor.
  • Physiological factors: Mental health is influenced by the hormonal changes in our body during different developmental stages and endocrine disorders, e.g. puberty, pregnancy and puerperium, menopause, and disorders like hypo/hyperthyroidism.
  • Physical ill health: Physical illness, disabilities, and injuries also may affect one's mental health.
  • Psychological factors: Good parenting, happy childhood, good family relationships, schooling and social relations can contribute 9to good mental health, which is indicated by self-esteem or positive self-image, feeling of being loved, accepted and self-confidence. Maternal deprivation, and deprivation of physical and emotional care, abuse/trauma in childhood are some factors that can negatively affect mental health. Abuse—physical, sexual, psychological or verbal can lead to poor mental health and sometimes can lead to mental illness in future.
  • Social factors/environmental factors: Good socioeconomic status, social norms, healthy living conditions, healthy lifestyle, mutually respecting cultural attitude and relations can add mental health.
    Poor socioeconomic background, unhealthy living conditions, strained relationships, slum areas, strict social rules—all these can negatively affect mental health.
For the maintenance of good mental health, good interpersonal relations, effective use of defense mechanism and good support system (family, society, friends and service from other resources) are essential.
 
Characteristics of Mentally Healthy Individual
A mentally healthy individual is with the following features:
  • High self-esteem, self-discipline and self-confidence.
  • Altruistic and has capacity for intimacy.
  • Social competence and maintains satisfying relationship.
  • Respects and love themselves and others.
  • Resilience: It is the ability to bounce back from adversity.
  • Control over their emotions: They are not overwhelmed by emotions like anger, fear, love, happiness.
  • Autonomy: They will be independent in all their decisions and activities.
  • Environmental mastery: They have a sense of control over their lives and meets challenges and solve problems. They are able to accept disappointments also. They have their own philosophy of life.
  • Desire for self-actualization: They take reasonable risk to grow and also balance with work, rest and recreation.
  • Creativity: They are creative and appreciates the creativeness of others.
  • Emotional intelligence: Emotional intelligence is the ability to identify and mange your own emotions and the emotions of others.
 
Mental Illness
Due to the changes in cultural factors, a universal concept of mental illness is difficult. Mental illness is indicated by abnormal behavior. But the concepts of normal and abnormal behavior are difficult to find out, because they are influenced by and varied with sociocultural factors.10
 
Definitions
APA in its DSM V classification defines mental disorders as—A syndrome characterized by clinically significant disturbances in a individual's cognitions, emotions, regulations or behavior that reflects a dysfunctions in the psychological, biological and developmental process underlying mental functions (APA 2013).
Mental and behavioral disorders are understood as clinically significant conditions characterized by alterations in thinking, mood (emotions) or behavior associated with personal distress and/or impaired functioning (WHO 2001).
Mental disorders are syndromes characterized by disturbance in one's thoughts, perception, cognition, emotions and behaviors that are not culturally appropriate.
 
Characteristics of Mental Illness
  • Mental illness is characterized by maladjustment in usual life situations and thus causes disharmony in individual's ability to do self-care in an effective manner.
  • Change in thinking, perception, emotions, memory, judgment and insight results in changes in speech and behavior, which are not matching with one's previous personality and also with the norms of society.
  • The behavior changes result in sufferings or distress to the individual, others or both, thus will affect the activities of daily living and relationship with others.
  • Changes in activities further add the distress and leads to social and vocational dysfunction (disturbances in daily activities, work and relationship with important others).
Characteristics of mentally ill person: Some characteristic features of mental illness are listed. But all these features will not coexist in single patient.
  • Deviation from social norms.
  • Biological dysfunctions (change in sleep, appetite, sexual desire, and activity level)
  • Maladaptive/bizarre behavior
  • Inappropriate emotions
  • Abnormal perceptions
  • Inability to resolve conflicts
  • Self-destructive behavior
  • Lack of insight or impaired insight
  • Disturbance in thought process
  • Irrational beliefs11
  • Lack of real perceptions of environment
  • Impaired cognitive functions
  • Poor interpersonal relationships
  • Constant anxiety and fear
  • Poor impulse control
  • Ritualistic behavior
  • Difficulty with adaptation
  • Dependence on chemicals.
 
MISCONCEPTIONS RELATED TO MENTAL ILLNESS
There are many misconceptions about mental disorders, that divert people from treating it as an illness. These myths make the early detection and treatment more difficult.
Common myths about mental illness in India are as follows:
  • Mental illness is the result of evil spirit or black magic: Even now people are consulting astrologists and attends prayer sessions in treating mental illness.
    • Fact: Mental illness usually occur due to biopsychosocial factors and this can only be treated with drugs and psychosocial therapies. Prayer and religiosity can increase their confidence and optimism.
  • Psychiatric disorder means a single disease and reflects personal weakness or personality flaw.
    • Fact: Mental disorders indicate a group of illness that vary in nature. Neurotransmitters or the chemical messengers are responsible for normal mental functioning. An imbalance of these chemicals lead to serious mental illness. Persistent stressors can also lead to mental illness. Personal weakness itself is not the single responsible factor.
  • Mental disorders are hereditary:
    • Fact: Hereditary factors when combined with psychological and social factors, it can lead to mental illness. Like any physical illness, there is some genetic background for mental illness also.
  • Mental disorders affect very few people or prevalence of mental illness is low:
    • Fact: Mental illness is common. It affects people of all ages, gender, education and culture.
  • Abnormal behavior is bizarre and mentally ill are dangerous and violent:
    • Fact: Mentally ill persons show maladaptive behavior. Most of them don't show bizarre/dangerous behavior.12
  • Normal person can never be abnormal:
    • Fact: Behavior is said to be normal or abnormal by considering the social norms. A person cannot remain normal all the time. Anybody can become abnormal at any time due to biopsychosocial factors.
  • Patients admitted to mental hospital are more problematic than those in general hospitals:
    • Fact: Whether the person is admitted in mental hospital or general hospital, they will be treated by psychiatrists, and like physical illness, mental illness also has effective treatment.
  • Mental health and physical health are not related to each other:
    • Fact: Body and mind are interrelated. Mentally ill people have its effect in physical health and people who suffer from physical illness may experience mental health problems like anxiety or depression.
  • Once mentally ill, it will persist in the entire life:
    • Fact: Mental illness can be effectively treated with drugs and psychosocial therapies. Newer drugs are more effective and with less side effect.
  • Mentally ill need to be treated separately—in mental hospitals:
    • Fact: Now there is mental health services at District hospitals, and at PHC/CHC's via District Mental Health Programme clinics. Many of them are treated on outpatient basis.
  • Mental illness is something to be ashamed of:
    • Fact: There is nothing to be ashamed for seeking treatment from mental health center. Like physical illness, mental illness also can occur at any time and can be treated. Do not hesitate in treating any illness.
  • Mental illness can be treated with marriage:
    • Fact: Marriage is not a treatment for mental illness. Marriage usually increases the risk for relapse.
  • Mental illness will not affect children:
    • Fact: Mental illness can occur at any age.
 
MENTAL HEALTH NURSING
Due to rapid urbanization, social, economic, demographic and technological changes, mental health and behavioral problems are increasing and it imposes many challenges worldwide.
In India also substance abuse, and other psychiatric disorders are increasing. This increases the scope and relevance of Mental Health and Psychiatric Nursing. Mental health nursing has application in other specialties of nursing, because psychological aspects of care is vital in developmental stages, crises and in any illness—physical or mental.13
 
Definitions
Psychiatric nursing is a specialized area of nursing practice, employing the wide range of explanatory theories of human behavior as its science and purposeful use of self as its art (American Nurses Association, 2000).
Psychiatric nursing focuses on the care and rehabilitation of people with identifiable mental illness or disorders.
Mental Health Nursing aims the prevention of mental illness by focusing on well and at risk population or to provide immediate treatment for those with early signs of disorders.
Psychiatric-mental health nursing is the diagnosis and treatment of human response to actual or potential mental health problems (ANA and International Society of Psychiatric-Mental Health Nurses, 2000).
In Mental health and Psychiatric Nursing, care may be focused at an individual, family, group, organizations or community or specific population (elderly, women, children, adolescents, youth, mentally challenged and people with chronic mental illness).
 
Principles of Mental Health Nursing
In mental health nursing some basic principles should be followed:
  1. Patient is accepted exactly as he is: Acceptance conveys a feeling of being loved and cared. Acceptance does not mean complete permissiveness, but setting of positive behavior to convey respect as an individual human being. Nurse should convey that she may not approve everything; and he will not be judged or rejected because of his behavior.
Acceptance can be expressed in the following ways:
  • Being non-judgmental and non-punitive: Patient's behavior should not be judged as right or wrong, good or bad, and should not be punished for his/her undesirable behavior. Any sort of punishment (direct punishment like chaining/restraining, keeping in separate room) and indirect punishment as ignoring the presence, withdrawing attentions, etc.) should be avoided.
  • Show interest in the patient as a person: Sincere interest to the Patient can be shown by:
    • Observing and studying the patient behavior pattern.
    • Being aware of patient's like and dislikes.
    • Permitting him to make his choices and decisions.
    • Be honest and avoid false reassurance.
    • If any demand cannot be met, explain the reason.
    • Deal his comments, complaints and expressions in realistic manner.
    • Spend time with patient and listen to him with interest.
    • Accept his fears as real to him.
    • Avoid sensitive topics and issues.14
  • Recognize and reflect on feelings which the patient may express: Nurse should have the skill to identify the actual feeling which is expressed, while they talk. Both the content of speech and the expressed feelings underlying that will be recognised and reflected.
    Example: ‘I am a dead person’—it means he feels worthless.
  • Talk with a purpose: Nurses’ interaction with the patient must revolve around patient's needs, wants and interests. Nurses’ talk or responses must guide the patient. Use of understanding responses and avoidance of hostile, evaluating and probing questions can help the patient to explore his feelings.
  • Listening: Nurse should actively listen to what the patient says and allow him/her to express the strongly held feeling. Both verbal and non-verbal responses should be considered.
  • Permit the expression of strongly held feelings: Allow the patient to express strong feelings without disapproval or punishment. Accept strong negative feelings (anxiety, fear, hostility) quietly and calmly.
  1. Use self-understanding as a therapeutic tool: Awareness of one's own feelings, attitudes and responses will help a psychiatric nurse to understand others. Nurses can understand themselves by:
    • Exchanging personal experience with colleagues.
    • Discussing our personal reactions with an experienced person.
    • Participating in group conferences relatives to patient care.
    • Introspecting why he/she feel, act and did.
  2. Consistency is used to contribute to patients’ security:
    • Consistency must be reflected in our attitudes, ward routine, and in setting limitations in patients.
    • Consistency should be maintained from nurse to nurse and shift to shift by definite planning (e.g. consistency in routine, health teaching, limit setting).
  3. Reassurance should be given in suitable and acceptable manner: Reassurance builds patient's confidence or help to restore it. But do not make false promises.
    • Be truly interested in patient's problems.
    • Pay attention to patient's matters, even if they are not much significant.
    • Nurse has to analyze and understand the situation according to patient's level. Try to meet his/her needs without his/her demands and appreciate improvement.
    • Agree that patient has problems and think together to solve this and accept outlet of anxiety in him/her.
  4. Patients’ behavior is changed through emotional experience and not by rational interpretations: Major focus in psychiatry is 15on the feeling aspect and not on the intellectual aspect. Advising or explaining is not effective in changing behavior. Corrective emotional experience given through psychodrama or role play can help the patient to gain insight about his behavior and may leads to desired behavior.
  5. Unnecessary increase in patient's anxiety should be avoided: Factors that cause/increase anxiety in a patient will vary from individual to individual. But in general, nurses can avoid:
    • Showing attention or highlighting patient's deficits/failures.
    • Showing nurse's own anxiety.
    • Allowing patient to face repeated failures.
    • Putting difficult tasks/demands that cannot be fulfilled by patient.
    • Direct contradictions of patient's psychotic ideas.
    • Use of professional terms and sharp comments to the patient.
  6. Objective observation of patient helps to understand his behavior: Objectivity is the ability to evaluate exactly what the patient wants to say, by not mixing it with one's own feeling, opinion or judgment. For this nurse should introspect and be sure that her own emotional needs are not influencing patient's needs.
  7. Maintain realistic nurse-patient relationship: Realistic and professional relationship focuses on personal and emotional needs of patients, and not on nurse's needs. Nurse should be able to empathize and understand the feelings and behavior of patients.
  8. Avoid physical and verbal force as much as possible: Nurse should be able to predict the patient's behavior, so that undesirable behavior can be prevented. Any sort of punishment should be avoided. Anger, annoyance, non-verbal comments must be avoided.
  9. Nursing care is centered on the patient as a person and not on the control of symptoms: Nursing care should be focused on person's need, not on symptoms—because patients with same symptoms may have different needs. At the same time symptoms should be analyzed for understanding its meanings.
  10. Explanation of procedures and routines should be according to the level of understanding of the patient: While giving explanations, consider the patients’ level of anxiety, understanding and decision making ability. Explanations should not be withheld by thinking that patient has no touch with reality.
  11. Many procedures are modified, but basic principles remain unaltered: Based on patient's needs, methods can be adapted, but underlying principles should remain the same.16
 
Standards of Mental Health Nursing
In order to provide quality nursing care and to fulfill the profession's obligations, it is essential to have certain standards and these have to be maintained.
Standards of psychiatric nursing includes:
  1. Professional practice standards:
    • Standard I—Theory: Nurse applies scientifically sound and suitable theory as the basis for nursing practice.
    • Standard II—Assessment: Nurse continuously do assessment and collects data in systematic, accurate and comprehensive manner. Data will be collected by behavioral observation, interviewing and physical and mental health assessment and sound judgments are made. A good rapport with the patient and family is essential for this. Assessment or data collection will lead to a conclusion and helps in further planning.
    • Standard III—Diagnosis: Nursing diagnosis will be used as a basis for providing nursing care. Nurses provide care based on actual or potential problems that are within the scope of nursing. Collected data will be analyzed by comparing with norms, and finally identifies the problems with the patient and formulate nursing diagnoses and prioritize it.
    • Standard IV—Outcome identification: Nurse's goal will be to influence the mental health outcome/to improve the patients’ health status. So the expected outcome should be documented.
    • Standard V—Planning: Nurses develop nursing care plan based on specific goals. This plan of care is used to guide interventions. Nurses identify appropriate nursing activities based on individual needs of each patient. Planning becomes more effective when it is done in collaboration with the patient, family and other members of mental health team.
    • Standard VI—Implementation/intervention: Nurse implements the planned care for promotion and maintenance of physical and mental health and also for prevention of illness. Nurses can also focus on rehabilitation of the mentally ill.
      Intervention usually include psychoeducation, promotion of self-care activities, somatic therapies, providing therapeutic environment, counseling and psychotherapy. Nurse can also involve in community based services.
    • Standard VII—Evaluation: Evaluation of the nursing care and patient's progress should be done in terms of the goal or expected outcome. Ongoing evaluation of the treatment and nursing care and modification of nursing process should be done. Needs of patients will vary from day-to-day and individual to individual.17
  2. Standards of Professional Performance (American Nurses Association, 1991):
    • Standard I—Quality of care: It can be done by evaluating the quality of nursing through peer review and performance appraisal.
    • Standard II—Performance appraisal: Nurse has to evaluate herself in terms of knowledge and practice and has to maintain the standards of performance. Performance can be appraised by the superior officers, and their feedback and suggestions also will be helpful in improvement of nursing care.
    • Standard III—Education: Nurses have to update their knowledge and skill through continuing education. Professional learning should be enhanced by attending conferences and workshops and has to be maintained throughout the service.
    • Standard IV—Collegiality: Psychiatric nurses have to share their knowledge, both theoretical and clinical practice, with the colleagues for the professional growth. Sharing knowledge, giving feedback and constructive criticism, motivation and support of colleagues will enable team work and mutual respect.
    • Standard V—Ethics: Psychiatric nurse has to maintain ethical consideration and standards in all her dealings with the patients and their caregivers because these patients are vulnerable population. We have to safeguard the patient's well-being and confidentiality is also important. Nurse needs to be thorough with the ethical code and should practice it as a legal/ethical responsibility.
    • Standard VI—Collaboration: Interdisciplinary collaboration with all health care professionals may contribute to effective planning, and decision making.
    • Standard VII—Research: Psychiatric nurses should participate in research activities—like conducting scientific studies, dissemination of findings and application of research findings in nursing practice.
    • Standard VIII—Resource utilization: Nurse should do patient advocacy on individual or group basis for utilizing cost effective resources and service. For this nurse should be a creative thinker and decision maker and must be aware of the political and economic status of that area.
 
Qualities of a Mental Health Nurse/Psychiatric Nurse
  • Awareness of self and acceptance of self: Psychiatric nurse should have awareness of one's own feelings, professional and personal 18strengths and weakness and accepts them without feeling great or guilty. He/she should have his/her own philosophy of life.
  • Acceptance of the patient: Nurse should accept the patient exactly as he is. It means unconditional acceptance as a person—not in terms of his behavior, color, socioeconomic class, etc.
  • Sincerity and interest in patient care: This can be expressed by considering patient's interest, likes, problems and behavior. Nurse should show her interest in patient by listening and showing her concern to the clients and their families by instilling hope and at the same time by being honest. Nurse should try to anticipate and meet the needs of patients and their families, before they demand. These will help in adding their trust in nurse.
  • Empathy: Empathy is the ability to keep yourself in other's position to experience their feelings and problems. Nurse must be able to imagine the feelings and experiences like hallucinations and delusion of patients, their distress and related problems in the family.
  • Reliability: Nurse must be reliable person in all his/her duties and promises. Then only trusty relationship can be established.
  • Professionalism: Maintain professionalism in all dealings with the patient and relatives.
  • Accountability: Nurse should be accountable for quality care of life of patients.
  • Good knowledge and critical thinking: Knowledge about abnormal behavior, different disorders, treatment, rehabilitation and nursing care along with critical thinking, problem-solving are essential. Theoretical knowledge should be correlated to clinical practice.
 
MENTAL HEALTH TEAM
Mental health team is a multidisciplinary team which is a collaboration of all professionals who belong to different discipline, and involved in the care of mentally ill. Interdisciplinary collaboration helps better coordination of their work in a complementary way. The final product of this will be a therapeutic environment.
The team members include mental health professionals like:
  • Psychiatrist: It is a medical doctor who is specialized in mental health with postgraduation in Psychiatry. Their major responsibilities are diagnosis, medical care of mentally ill planning and deciding for other therapies. They take initiation in prevention of mental illness through their involvement in community based activities. He suggests other therapies and prescribes medication.
  • Clinical psychologist: Needs to have doctoral degree in clinical psychology and should be a registered person. They perform diagnostic tests and involve in interpretation of findings of tests 19and assessments. He/She can perform different psychosocial therapies. They can help the patients and their caregivers for better understanding, support and coping. They conduct counseling sessions to the patients and caregivers.
  • Psychiatric nurse: A registered nurse with special training in psychiatric nursing. He/she has a central role in the care of psychiatric patients. She can work in both hospital and community settings. Nurses can provide both physical and psychological care to their patients, and must provide essential support and encouragement to the patient's families.
    • Nurse's responsibility include—daily care of patient, involvement in in-patient services, education of students, patients and their families, and community groups. The nurse can help the patient and family for better utilization of supportive services. She can conduct group therapies, counseling to individuals and family, and works as a part of organization. She can plan recreational sessions for the patients. Community psychiatric nurse can do follow-up after discharge from the hospitals.
  • Psychiatric social worker: Psychiatric social worker should have a master degree in social work with special training in mental health settings. She/he will be accountable for community placement of patients and do the family case work, group therapy sessions and counseling also. They act as a liaison between the family, society and the hospital.
 
 
Psychiatric Paraprofessionals
  • Occupational therapists: They are responsible for providing occupational training and other activity/programs related to it in the hospital settings. He/she should be a qualified occupational therapist and must have experience in mental health care settings. Based on the capacity and interest of patients, they are helped to gain skills, to gain an employment or to use leisure time creatively.
  • Counselor: A person with qualification and experience in counseling can provide supportive counseling and psychoeducation if sufficient number of clinical psychologists are not available.
  • Recreational therapists/activity therapist: Plans and engage the patients in some activities that stimulate them. This will help in improving interpersonal relationships, socialization and muscle coordination and thus more refined activities occur. This should be based on patient's interest and ability, otherwise it may increase their anxiety.
  • Play therapist: Can do good observations and can provide good opportunities for play/recreation of children.20
 
CONCLUSION
This chapter has dealt with the basics of mental health and mental health nursing. These concepts should always be there in mind when a mental health nurse deals with her patients in hospital or in community.
BIBLIOGRAPHY
  1. Frisch N, Frisch L. Psychiatric Mental Health Nursing (Fourth Edition). Delmar Cengage Learning,  New York, 2011.
  1. Kapoor B. Textbook of Psychiatric Nursing. Delhi: Kumar Publishing House,  2014.
  1. Lalitha K. Mental Health and Psychiatric Nursing. Delhi: CBS Publishers,  2009.
  1. Sreevani R. A Guide to Mental Health and Psychiatric Nursing (Third Edition). New Delhi: Jaypee Brothers Medical Publishers (P) Ltd,  2016.
  1. Stuart GW, Laraia MT. Principles and Practice of Psychiatric Nursing. St Louis: Mosby,  2001.
  1. Townsend CM. Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice (7th Edition). Philadelphia: FA Davis Company,  2012.