MOST important golden key points about psychiatric

MOST IMPORTANT golden key points about psychiatric

1. Linda Richards is considered as First Psychiatric Nurse. 

2.Sigmund Freud is the father of Modern Psychiatry. 

3.Freud's model of development which comprised id, ego and superego' is called Structural Model.

4. Psychoanalytic therapy was developed by Sigmund Freud. 

5.The term Psychiatry was coined by Christian Reil. 

6.The Nobel Prize for experiments on split brain was given to Roger Sperry. 

7.Pavlov's experiment is an example of Classical Conditioning.

8. The theory of operant conditioning was experimented by B F Skinner. 

9.Cognitive model suggests that psychological disorders result from acquiring dysfunctional ways of Thinking and Acting.

10. The Indian Lunacy Act was passed in the year 1912. 

11.The Indian Mental Health Act was passed in the year 1987.

12. Mental Healthcare Act 2017 (MHA 2017) received presidential assent on April 7th, 2017 and replaced the 1987 Act. 

13.Mental Health Act 2017 decriminalizes suicide attempt by mentally ill person. 

14.As per MHA 2017, No ECT therapy without use of muscle relaxants and No ECT therapy for Minors. 

15.Mental Health Act (MHA 2017) empowers a mentally ill person to have the right to make an advance directive toward the way he/ she wants to be treated. 

16.Reception order refers to an order for admission and detention of a mentally ill person in a psychiatric hospital. 

17.Temporany discharge of the patient from the psychiatric hospital is referred to as Parole. 

18.Diagnostic and Statistical Manual (DSM) classification of mental disorders is published by American Psychiatric Association. 

19.ICD stands for International Classification of Diseases.

20. International Classification of Diseases is published by World Health Organization (WHO). 

21.The National Mental Health Program (NMHP, 1982) was launched in 1982 by the Government of India.

 22.National Mental Health Programme (NMHP) was re-strategized in 2003 to include two schemes, viz. Modernization of State Mental Hospitals and Up-gradation of Psychiatric Wings of Medical Colleges/General Hospitals.

23.The Manpower development scheme (Scheme-A & B) became part of NMHP in 2009.

24. Three main components of NMHP include treatment of mentally ill, rehabilitation and prevention and promotion of positive Mental Health

25.Trust is the most important factor in a therapeutic relationship. 

26.Termination of interpersonal relationship starts in orientation phase.

27. Transference is a phenomenon in which the person in treatment redirects feelings for others onto the therapist.

28. Countertransference occurs when a therapist transfers emotion to a person in therapy. 

29.Process recording is the recording of conversation between the nurse and patient in a psychiatric set up.

30. The best approach in helping a severely withdrawn patient is to provide a trusting relationship. 

31.Giving advice to the patient is one of the barriers of therapeutic nurse-patient communication.

32. Open-ended questions are used during psychiatric history collection. 

33.Presenile dementia occurs in younger person (<65years) causes Alzheimer's disease,picks disease ,parkinson's disease

(substantia nigra. Part of the brain that is responsible for emotional aspects of behaviour is limbic system. The part of the brain that regulates cognitive function is cerebrum. Mini mental status examination is used to assess cognitive impairment. 1otal score of Mini Mental Status Examination (MMSE) is 30. A score of 24 or more indicates a normal cognition. Vini Mental Status Examination (MMSE) score of 19 to 23 indicates mild cognitive impairment; scores of 10 to 18 indicate moderate cognitive impairment. Scores below 10 indicate severe cognitive impairment. E oS SIgniicant characteristics experienced by a patient with depression is depressed mood and loss of pleasure or interest. 'Omega sign' is seen in depressed patient. mental health. Depressed mood and loss of pleasure or interest are the most significant characteristics experienced by a patient with depression. Deficiency of Serotonin or 5 HT (5-hydroxytryptamine) is found to cause depression Common risk factor in patient with severe depression is suicidal tendency. Contd..

Incidence of suicide in India is 10-11/1,00,000 population. Hanging is the most common method of suicide in India according to National Crime Records Bureau 2014. he behavioural clues for impending suicide include giving away valuable possessions, becoming energetic after a period of server epression, withdrawals from social activities, farewell quotes and letters, and avoiding serious decision making. rora patient with severe depression, the setting where there are simple daily routines will| be least stresstu. Aphonia is the inability to produce voiced sound. Apathy Isa state of indifference, or the suppression of emotions such as concern, excitement, motivation, and passion. Kleptomania means irresistible desire to steal things. World's "No Tobacco Day" is observed on 31st May. World Mental Health Day is observed on 10th October For deternmining the serum lithium, the blood specimen to be obtained before breakfast. Tardive dyskinesia is the adverse effect resulting from the chronic use of antipsychotics. The term schizophrenia is coined by Eugene Bleuler. Meaning of term 'Schizophrenia' is split mind. Negative symptoms of Schizophrenia include Affective flattening, Alogia, Avolition, and Apathy. First rank symptoms of schizophrenia (FRSS) was described by Schneider. Four As of Schizophrenia (According to Eugen Bleuler) are: Associative looseness, ambivalence, autistic thinking, and affective changes. In schizophrenia, gradual subtle behavioural changes occur in the prodromal phase. Inability to maintain adequate boundaries is the feature of schizophrenic patients. Increased dopamine level will cause Schizophrenia. Impaired insight is a common feature in Schizophrenia. The affect that is most commonly seen in patients with schizophrenia is apathy and flatness. Waxy flexibility, mutism, bizarre posture and stupor are characteristics of catatonic schizophrenia. Persecutory delusion and/or suspiciousness is common in paranoid schizophrenia. Late adolescence to early adulthood is the most common period of onset of schizophrenia. Flight of ideas is typical feature of mania. Type of diet is recommended for a patient with manic episode is finger foods. Most appropriate intervention to manage manipulative behaviour of a manic patient is to set limits on patient behaviour. Calling hospital security should be the first step by the nurse followinga violent episode on a psychiatric unit. False sensory perceptions with no basis in reality (no external stimuli) is known as hallucination. llusion is a distortion of senses characterized by misinterpretation of stimuli. Formed visual hallucinations are usually from lesion of temporal region. Unformed hallucinations are common with disorders of the occipital lobe. Auditory hallucination is the most common type of hallucination experienced by patients with mental illness. Mood congruent hallucination refers to hallucination whose content represents or reflects the mood state of the individual. Fixed false belief of a person which cannot be changed by logical reasoning is known as delusion. The belief that oneself, a part of one's body, or the real world does not exist is known as nihilistic delusion. Schizophrenia is treated by antipsychotics. Risperidone is the treatment of choice for patients with schizophrenia, who refuses to take treatment. Gradual onset is one of the poor prognostic factors in schizophrenia. Presenting the patient with a "hypothetical situation helps in the assessment ofjudgement. Catharsis is the process of releasing strong emotions through a particular activity or experience. Confabulation is a symptom of various memory disorders in which made up stories fill in any gaps in memory. Unfamiliarity of familiar things is seen in Jamais vu. Déjà vu is a feeling of having already experienced the present situation. Catatonia is a state of psychomotor immobility and behavioural abnormality manifested by stupor Cataplexy is a sudden and transient episode of muscle weakness accompanied by full conscious awareness which is precipitated or triggered by emotions as laughing, crying etc. A state of diminished consciousness in which the patient remains mute and still with the eyes open is called as stupor. Systematized delusions occur in the dementia only. It does not occur in delirium. Delirium is an acute confusional state but dementia develops over time with slow progression of cognitive decline. The most common cause of dementia is Alzheimer's disease. Hypothyroidism is one of the most important causes of potentially reversible dementia. Recent memory loss is a feature of Alzheimer's disease. Best test for diagnosis of organic mental disorder is Bender gestalt test. Rorschach Test (RT) and Thematic Apperception Test (TAT) are projective tests to assess personality structure, pattern of thoughts, emotional problems and mental disorders. Rorschach's projective test is designed to measure unconscious intentions. The extreme feeling of happiness is known as Euphoria. . Circumstantiality is a disorder of thought in which thinking proceeds slowly with many unnecessary trivial details, but finally the point is reached. Contd.

Synopsis 587 When a patient is not aware of his/her mental disorder, it is called lack of insight. A person who is aloof, isolated and does not socialize, is considered to be withdrawn. Verbal utterance that are often obscene is known as Coprolalia. Echolalia is the repetition of the words spoken by others. Echopraxia is the repetition of movements performed by others. .Neologism is the coining of new words without any meaning. . Persistent and inappropriate repetition of the same thoughts is known as Perseveration. . An unwanted thought that a person finds intrusive and distressing is called as obsession. A behavior that a person feels compelled to perform is defined as compulsion. Polysomnography, also called a sleep study, is a test used to diagnose sleep disorders. .Most vivid dreams occur during REM sleep. Penile erection or clitoris engorgement occurs during REM sleep. Non-Rapid Eye Movement (NREM) sleep is also known as Orthodox sleep or Synchronized or 'S' sleep. Restless leg syndrome (Ekbom's Syndome) - Painful condition lead to severe insomnia and periodic limb movement during sleep. Sleep walking is otherwise called somnambulism. Systemic desensitization is developed by Joseph Wolpe. This therapy is useful for phobic anxiety disorder, OCD and certain sexual disorder. Flooding or implosion is useful therapy for phobia. Shaping is suitable for speech therapy in autistic child. Extinction is a behavioural therapy technique that is useful in temper tantrum. Repetitive, uncontrollable thoughts and acts are termed as Obsessive-compulsive disorders (OCDs). Exposure and response prevention (ERP) is the most important type of Cognitive Behaviour Therapy (CBT) for OCD. Brief Cognitive Behavioral Therapy (CBT) focuses on solving current problems. It focuses on 'here and now' approach. Gradual disappearance of conditioned response to stimuli is referred to as Extinction. Aversion therapy is useful alcoholism, impulsive behaviour, and paraphilias. Chlorpromazine (typical antipsychotic) was discovered in 1950 and was the first antipsychotic. Extra pyramidal symptoms are most common with Fluphenazine and Haloperidol. Orthostatic hypotension is most common with Chlorpromazine, Thioridazine, Clozapine. Agranulocytosis is more common with typical than atypical antipsychotics (except Clozapine). The major side effect of Clozapine is agranulocytosis. So periodical complete blood count is suggested. Bromocnyptine or dantrolene is the treatment of choice for Neuroleptic Malignant syndrome (NMS). Anticholinergics (e.g. Benztropine) are used to treat extrapyramidal symptoms (EPS). .The drug of choice for treatment and management of bipolar mania is lithium carbonate. .Daily adult dosage of lithium for acute mania is 1800-2400 mg. For maintenance - 900-1200 mg. .Therapeutic Plasma Range for acute mania - 1.0 -1.5 mEa/L; For maintenance -0.6-1.2 mEq/L. Patient who is on lithium therapy should drink 6 to 8 large glasses of water each day and avoid excessive use of beverages containing caffeine (cofee, tea, colas), which promote increased urine output. The client must consume a diet adequate in sodium. The goal of milieu therapy is to manipulate the environment so that all aspects of the client's hospital experience are considered therapeutic. Concepts of milieu therapy include containment, validation, structured interaction, and open communication. Neurotransmitter serotonin plays a role in the psychopathology of OCD. Medication with a serotoninreuptake inhibitor is helpful for many OCD patients. The type of loss in which the client is aware that a loss will occur is known as anticipatory loss. Willis Ekbom Syndrome is also known as Restless legs syndrome. Excessive sleep is termed as Hypersomnia. Dhat syndrome: It is considered as a culture-bound syndrome (CBS) specific to the Indian subcontinent. Kleine-Levin syndrome is a rare sleep disorder mainly affecting teenage boys in which the main features are intermittent hypersomnolence. Ganser syndrome is a type of factitious disorder, in which a person deliberately and consciously acts as if he or she has a physical or mental illness when he or she is not really sick. The immediate nursing intervention for the patient who has just awakened from an electroconvulsive therapy (ECT) treatment is to orient the patient. The most common indication of ECT is Major depression. type of schizophrenia best responds to ECT is Catatonic Schizophrenia. The voltage needed to produce seizures while giving ECT is 70 to 130 volts. Succinylcholine (smooth muscle relaxant) is administered during ECT to prevent injuries to patient during seizure. Atropine is given to patient before Electroconvulsive Therapy (ECT) is to minimize secretions and to prevent transient postictal brady arrhythmia due to excessive vagal tone. Most common side effect of ECT is temporary memory loss. Contd...

Agoraphobia is fear of open spaces. It is the most common type of phobia seen in clinical practice. Irrational fear related to closed spaces is referred to as claustrophobia. Fear of high places is called acrophobia. Preoccupation with a fear of having a serious physical illness, not based on real or organic pathologY is hypochondriasis. The part of mind that distinguishes right from wrong and acts as censor of behavior is known as superego. An attempt to integrate values learned from parents and society is referred to as superego. Another term for superego is conscience. As per psychoanalytic theory the ability to tolerate frustration is seen in Ego. As per Freud, the development of Oedipus Complex (male) and Electra Complex (female) occurs during the phallic (3-6 years) stao. of development. Amale child's unconscious sexual desire for the parent of the opposite sex is termed as Oedipus Complex. A female child's unconscious sexual desire for the parent of the opposite sex is termed as Electra complex. Topographical model of mind by Freud is Conscious - Preconscious-Unconscious. Father of Intelligence Test is Alfred Binet (Early 1900s). Milieu theory insists on community participation by abiding unit rules. in psychoanalytic terms, obsessive compulsive disorder is fixed at Anal Stage. Separation of a thought or memory from its associated feeling or emotion is known as Isolation. Ego defense mechanism is a mechanism designed to reduce stress and conflict caused by specific experiences. *Rechanneling of socially unacceptable drives into activities that are more tolerable and constructive is known as Sublimation. Ayoung man who is dealing with aggression by playing football is an example of Sublimation (Defense Mechanism). Attributing unacceptable feeling to others is the mechanism known as Projection. Rationalization is an adaptive mechanism of giving excuses when a person cannot solve a problem. Repression involves placing uncomfortable thoughts in relatively inaccessible areas of the subconscious mind. Intellectualization is an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis. Most commonly using defensive mechanism by a physically abusive individual is Displacement. Situational crisis is term given to a person whose coping mechanisms are affected due to their circumstances, e.g. job loss, financial crisis, etc. In conversion disorder, anxiety is expressed through physical symptoms. The ability of a person to readily recover from stressful situations is called Resilience. Integrative approach is a combined approach to psychotherapy that brings different elements of specific therapies. Eradication of unwanted habits by associating unpleasant condition with it is called Aversive Conditioning. Systematic desensitization therapy is useful in the treatment of Phobias. Flooding is a behavioral therapy in which the patient is suddenly exposed to a direct and maximum fear producing stimulus. Supportive confrontation can be used in a patient with narcissistic personality disorder to point out discrepancies between what the client states and what actually exists. The iodeal size for group therapy is 8 to 10 members. Most common symptom of alcohol withdrawal is tremor. The health education to a group of alcoholic people should be able to change their behavior. Korsakoff's Psychosis is a long-term effect of "Medical Complication of Alcoholism'. Itoccurs due to deficiency of the Vitamin Thiamine Chronic alcoholic patients are treated initially by IM injection of thiamine 100 mg. Heroin (like opium and morphine) is made from the resin of poppy plants. Total abstinence is the only effective treatment for alcoholism, particularly in short-term alcoholic addicts. Regular coffee is contraindicated in a patient who is on alcohol withdrawal phase. .Alcohol anonymous group is a self-help group, who meets together to maintain sobriety. Most severe alcohol vwithdrawal syndrome is Delirium tremens. Chlordiazepoxide is used to treat withdrawal symptoms of alcoholism. Acamprosate is an anti-craving agent used in maintenance phase of treatment of alcohol dependence. .Disulfiram is the deterrent agent used in the maintenance phase of treatment of alcohol dependence syndrome. .Combination of alcohol and Disulfiram results in nausea and hypertension as a result of accumulation of Acetaldehyde. Flumazenil is an antidote of benzodiazepines. Naloxone is an antidote of opioids. Naltrexone is an opioid antagonist. Suspiciousness and mistrust of others (paranoia) is a characteristic feature of schizotypal personality disorder. Patient with schizotypal personality has great difficulty in establishing and maintaining close relationships with others. Characteristic of schizoid personality disorder is introverted and emotionally withdrawn. Dependent personality disorder is characterized by intense lack of self-confidence, low self-esteem, and inability to make decist Clients with borderline personality disorder are likely to develop dysfunctional coping and act out in self-destructive ways su binge eating. 88 Section A age sions. 

Dissociative fugue or psychogenic fugue is a dissociative disorder characterized by reversible amnesia for personal identity. A nurse who is caring for a client with antisocial behavior should stress on setting clear rules and expectations about the client's behavior. Sheldon's classification of personality includes Ectomorphs, Endomorphs, and Mesomorphs. Characteristic of histrionic personality is dramatic, theatrical and attention seeking. People with anti-social behavior lack ego and super-ego that controls behavior. They have little or no concern for others. A naive, inappropriate lack of emotion or concern for the perceptions by others of one's disability is known as La belle indifference. Derealization and Depersonalisation are seen in Dissociative disorder. A person who is kind, quiet, submissive, sympathetic and gloomy has Melancholic personality. Loss of personal identity and wandering away from psychiatric hospital is referred to as Dissociative Fugue. Uncertainty and excessive sense of responsibility is seen in Generalized anxiety disorder Diagnostic interview with sodium amytal or hypnosis is a special feature of Post-traumatic neurosis. Release of feelings that takes place by talking about an emotionally charged areas is known as abreaction. .Treatment of choice is for Cognitive Behaviour Therapy. Grief is a reaction of an individual to a significant loss. The loss may be real or anticipated one. The basis of ritualistic behavior seen in Obsessive Compulsive disorder (OCD) is aimed at controlling guilt and inadequacy b maintaining an absolute set pattern of behavior. The most common psychotherapy used to help a person with Obsessive Compulsive Disorder is behavior modification. In a client with OCD, the rituals performed by the client will help to control the anxiety. Drug most useful in treatment of obsessive compulsive disorder is Fluoxetine (SSRI). Lateral hypothalamus (to start) and Ventromedial Nuclei (to stop) of hypothalamus controls hunger and eating Establishing a consistent eating plan and monitoring the client's weight are important in developing care plan for a client wit anorexia nervosa. Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The most appropriate goal for a client with bulimia nervosa is that the patient must identify anxiety-causing events or situatio that stimulate the bulimic behavior. Trichotellomania is a disorder that involves recurrent irresistible urge to pull out hair. Juvenile delinquency is a legal classification of children's behavior that violates the law. Methylphenidate is the first line drug of choice for the treatment of ADHD. Autistic child turns inward to his/her own self stimulating acts and responds less to environmental stimuli. Language development of an autistic child resembles Echolalia. Dyslexia is a learning disorder that involves difficulty reading. Dyscalculia refers to severe difficulty in making arithmetical calculations. Tic is an abnormal involuntary movement which occurs suddenly, repetitively and purposelessly. Tourette syndrome is a disorder of Tic. Magical thinking is commonly seen in Toddlers and Preschoolers. Haloperidol is the drug of choice to treat Tourette's disorder. Patients who are taking monoamine oxidase inhibitor should avoid taking food rich in tyramine. Examples of tyramine rich foods are aged cheeses, alcohol beverages, cured meats, etc. Antipsychotic drugs are also known as neuroleptic drugs ortranquilizers. Tardive dyskinesia is a side effect of long-term use of certain antipsychotics. Neuroleptic malignant syndrome (NMS) is a life-threatening, neurological disorder most often caused by an adverse reactio antipsychotic drugs. Neuroleptic malignant syndrome (NMS), an adverse effect of antipsychotics, can occur within hours after drug initiation. For determining the serum lithium, the blood specimen is to be obtained before breakfast. It is advisable to take the blood sar after 12 hours of last dose. Chlorpromazine depresses hypothalamic thermoregulatory mechanism, exposure to extreme temperature may cause hyperther Patients who are on haloperidol are advised not to drive or operating machines due to the side effect of dizziness and drowsit Abrupt withdrawal of barbiturate could cause withdrawal symptoms such as seizure, restlessness, insomnia, sweating and anx Drug of choice to reverse a dystonic reaction is Diphenhydramine (Benadryl), 25 to 50 mg IM or IV. Disulfiram therapy is an overt sensitization, a type of aversion therapy which produces unpleasant consequence for undesi behavior. Antidote for methanol is Ethanol. Therapeutic serum level of lithium is 0. 8-1. 2 mEq/L. Atypical antipsychotics has a lower incidence of extra pyramidal effects than the typical antipsychotics. Agranulocytosis is the side effect of Clozapine (atypical antipsychotics). So periodical Blood screening for CBC is required. Psychology is a Natural science. Psychology as a 'Science of Mind, is defined by Psychoanalysts. .E.B. Titchener (1867-1927) defined 'Psychology as the science of mind. Abnormal Psychology is mainly the study of Abnormality of mind.