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🧠 Mental Health Nursing II - 6th Semester

(ABVMU / INC Syllabus) | Theory: 40 Hours | Practicum: 160 Hours

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📘 UNIT I: Nursing Management of Patients with Substance Use Disorders (6 Hrs)

Key Terminologies

Classification of Psychoactive Substances (DSM-5)

• Alcohol
• Cannabis
• Opioids (heroin, morphine, codeine)
• Stimulants (cocaine, amphetamines)
• Sedatives/Hypnotics/Anxiolytics (benzodiazepines, barbiturates)
• Hallucinogens (LSD, PCP)
• Inhalants (glue, solvents)
• Tobacco/Nicotine

DSM-5 Diagnostic Categories

1. Substance Use Disorder - prolonged use/abuse; diagnosed with specific substance (e.g., "Alcohol Use Disorder")
   • Mild: 2-3 symptoms
   • Moderate: 4-5 symptoms
   • Severe: 6+ symptoms
2. Substance Intoxication - specific signs/symptoms from recent ingestion
3. Substance Withdrawal - syndrome from abrupt cessation of heavy prolonged use
4. Substance-Induced Mental Disorder

DSM-5 Diagnostic Criteria for Substance Use Disorder (11 criteria)

1. Taking more than intended
2. Unable to cut down
3. Spending a lot of time obtaining/using
4. Craving
5. Failure to fulfil role obligations
6. Continued use despite social problems
7. Giving up important activities
8. Use in hazardous situations
9. Continued use despite medical/psychological problems
10. Tolerance
11. Withdrawal

Psychodynamics/Etiology

• Biological: Genetic predisposition, altered dopamine reward pathway, brain changes in prefrontal cortex
• Psychological: Low self-esteem, depression, anxiety, trauma, poor coping
• Social: Peer pressure, family dysfunction, unemployment, easy availability

Nursing Assessment

• Substance History: CAGE questionnaire (for alcohol), type, route, frequency, last use, amount
• Physical Assessment: Vital signs, signs of intoxication/withdrawal
• Mental Status Examination: Orientation, mood, cognition
• Drug assay: Urine/blood toxicology screen

CAGE Questionnaire (Alcohol)

• C - Have you ever felt you should Cut down?
• A - Have people Annoyed you by criticizing your drinking?
• G - Have you felt bad or Guilty about drinking?
• E - Have you ever had a drink first thing in the morning (Eye-opener)?

2 or more YES = significant indicator of alcohol problem

Treatment Modalities

Nursing Management

• Establish therapeutic relationship (non-judgmental attitude)
• Monitor vitals during detoxification
• Administer medications as ordered
• Seizure precautions during alcohol withdrawal
• Health education: consequences of substance use
• Referral to de-addiction centres
• Family counselling
• Relapse prevention strategies
• Follow-up and rehabilitation (AA - Alcoholics Anonymous, NA - Narcotics Anonymous)

Special Populations

• Pregnant women: risk of fetal alcohol syndrome, neonatal abstinence syndrome
• Adolescents: early intervention critical
• Elderly: higher sensitivity to substances

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📘 UNIT II: Nursing Management of Patients with Personality & Sexual Disorders (6 Hrs)

Personality Disorder - Definition

Classification (DSM-5 Clusters)

Key Personality Disorders

Treatment

• Psychotherapy (DBT - Dialectical Behaviour Therapy for Borderline PD)
• Cognitive Behaviour Therapy (CBT)
• Medications: Mood stabilizers, antidepressants (symptomatic)
• Long-term, consistent therapeutic relationship

Sexual Disorders

• Exhibitionistic Disorder (exposing genitals)
• Voyeuristic Disorder (watching others)
• Fetishistic Disorder (objects)
• Pedophilic Disorder
• Sadism/Masochism

Nursing Management for Personality Disorders

• Set clear, consistent limits/boundaries
• Non-judgmental, therapeutic attitude
• Document behavior objectively
• Team consistency (avoid splitting by staff)
• Teach healthy coping strategies
• Encourage verbalization of feelings
• DBT skills (mindfulness, distress tolerance, emotion regulation)

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📘 UNIT III: Nursing Management of Organic Brain Disorders (8 Hrs)

Types of Organic Brain Disorders

1. Delirium

• Ensure safety (side rails, falls prevention)
• Reorient frequently (clock, calendar, familiar objects)
• Adequate lighting (reduce sundowning)
• Treat underlying cause
• Minimize unnecessary stimulation
• Keep familiar people at bedside
• Medications: Haloperidol (most common), risperidone

2. Dementia / Major Neurocognitive Disorder

• Mild: Forgetfulness, memory lapses, intact ADLs
• Moderate: Wandering, personality changes, unable to recall family members
• Severe: Bedridden, incontinence, requires full care

• Reality orientation therapy
• Reminiscence therapy
• Validation therapy (for severe stages)
• Structured daily routine
• Ensure safety (prevent wandering, door alarms)
• Address nutrition and hydration
• Caregiver support and education
• Medications: Donepezil, Rivastigmine (Cholinesterase inhibitors)

3. Delirium vs Dementia - Comparison

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📘 UNIT IV: Nursing Management of Childhood & Adolescent Disorders (8 Hrs)

1. Intellectual Disability (Mental Retardation)

• Definition: Deficits in intellectual functions AND adaptive behavior, onset before age 18
• Prevalence: ~1% of population

2. Autism Spectrum Disorder (ASD)

• Core Features (DSM-5):
  1. Persistent deficits in social communication and interaction
  2. Restricted, repetitive patterns of behavior/interests/activities
• Onset: Early developmental period (usually before age 3)
• Higher prevalence in males (4:1 ratio)

• Poor eye contact, doesn't respond to name
• No pointing or waving (lack of joint attention)
• Stereotyped movements (hand flapping, rocking)
• Rigid routines, distress at change
• May have exceptional skills (splinter skills)
• Echolalia (repeating words/phrases)

• Applied Behaviour Analysis (ABA therapy)
• PECS (Picture Exchange Communication System)
• Social skills training
• Sensory integration therapy
• Structured environment with predictable routines
• Parent training and support

3. ADHD - Attention Deficit Hyperactivity Disorder

• Types: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, Combined
• Age of onset: Before age 12, symptoms in 2+ settings

• Inattention: Easily distracted, forgetful, loses things, doesn't follow instructions
• Hyperactivity: Fidgety, leaves seat, runs about, talks excessively
• Impulsivity: Blurts out answers, interrupts, can't wait for turn

• Stimulant medications: Methylphenidate (Ritalin), Amphetamines
• Non-stimulants: Atomoxetine, Clonidine, Guanfacine
• Behavioral therapy, parent training
• School accommodations

4. Eating Disorders

• Weight restoration (nutritional rehabilitation)
• Monitor food intake and bathroom use
• CBT as gold standard therapy
• Family-based therapy (adolescents)
• Treat electrolyte imbalances

5. Learning Disorders

• Dyslexia (reading), Dyscalculia (math), Dysgraphia (writing)
• Managed with special education, remedial teaching

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📘 UNIT V: Psychiatric Emergencies & Community Mental Health (12 Hrs)

Psychiatric Emergencies

1. Suicidal Behavior

• Never leave patient alone (1:1 supervision)
• Remove all potentially harmful objects (sharps, belts, cords)
• Establish therapeutic alliance - ask directly about suicidal intent
• Safety contract (limited value but standard practice)
• Hospitalize if imminent risk
• Monitor after starting antidepressants (increased energy before mood lifts)

2. Homicidal/Violent Behavior

• Calm, non-threatening approach
• Give personal space
• Speak in low, clear voice
• Avoid direct confrontation
• Offer choices
• Call for help if needed
• Restraint (physical/chemical) as last resort

3. Panic Attack

• Sudden intense fear, palpitations, sweating, trembling, feeling of dying
• Management: Stay with patient, calm reassurance, controlled breathing, benzodiazepines if needed

4. Alcohol Withdrawal Emergency

• Delirium Tremens (DTs): 48-72 hours after last drink
• Features: Tremors, confusion, hallucinations, fever, autonomic instability, seizures
• Management: IV benzodiazepines (diazepam/lorazepam), thiamine, IV fluids, seizure precautions

5. Neuroleptic Malignant Syndrome (NMS)

• Caused by: Antipsychotic drugs
• Features: Hyperthermia, "lead-pipe" rigidity, altered consciousness, autonomic instability
• Management: Stop antipsychotic, dantrolene, bromocriptine, supportive care

Mental Health Care Act (MHCA) 2017 - India

• Independent Admission (Section 86): Voluntary, can leave after 24 hrs notice
• Supported Admission (Section 89): With nominated representative consent
• Admission for treatment (Section 90): For persons with high support needs
• Emergency admission (Section 92): For 72 hours only

Community Mental Health Nursing

• Launched under National Mental Health Programme (NMHP) 1982
• Provides community-based mental health services at district level

1. Case finding and early identification
2. Home visits and follow-up
3. Medication administration and monitoring
4. Health education to family and community
5. Rehabilitation services
6. Liaison with other health workers (ASHA, ANM)
7. Crisis intervention at community level
8. Advocacy and reducing stigma
9. Referral to mental health facilities
10. School mental health programs

• Day care centres
• Halfway homes
• Sheltered workshops
• Occupational therapy
• Independent living skills training
• Social skills training
• Supported employment (clubhouse model)

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📋 Important Drugs in Mental Health Nursing II

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📝 Quick Revision - High-Yield Points

1. CAGE = Alcohol screening (2+ = positive)
2. DSM-5 SUD = 11 criteria; mild=2-3, moderate=4-5, severe=6+
3. Cluster B PD = most dramatic; Borderline treated with DBT
4. Delirium = acute, reversible; Dementia = gradual, chronic
5. Alzheimer's = most common dementia; Donepezil is drug of choice
6. ASD = core features: social deficits + restricted/repetitive behaviors
7. ADHD = onset before age 12; Methylphenidate is first-line drug
8. NMS = antipsychotic emergency; stop drug + give Dantrolene
9. MHCA 2017 = attempted suicide NOT a crime; advance directive allowed
10. DTs = 48-72 hrs post alcohol cessation; treat with IV benzodiazepines
11. Anorexia = highest mortality among psychiatric disorders
12. SAD PERSONS = suicide risk assessment tool

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🔖 Practical Competencies (Practicum - 160 Hours)

• Apply nursing process for SUD patients
• Perform mental status examination
• Administer and monitor psychotropic medications
• Conduct crisis intervention under supervision
• Perform admission/discharge under MHCA 2017
• Identify and respond to psychiatric emergencies
• Community mental health visits with follow-up

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🧠 Mental Health Nursing I - 5th Semester

(ABVMU / INC Syllabus) | Theory: 60 Hours | Practicum: 80 Hours

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📘 UNIT I: Introduction to Mental Health Nursing (6 Hours)

Definitions

• Mental Health: A state of well-being in which an individual realizes their own abilities, can cope with normal stresses, can work productively, and is able to contribute to the community (WHO definition)
• Mental Illness: A clinically significant pattern of behavior or psychological syndrome associated with distress, disability, or significantly increased risk of suffering or loss of functioning
• Mental Health Nursing: A specialized area of nursing practice that uses theories of human behavior as its scientific framework and purposeful use of self as its art

WHO Criteria of a Mentally Healthy Person

1. Positive self-concept
2. Ability to grow, develop and self-actualize
3. Integration (ability to cope with stress)
4. Autonomy and self-determination
5. Accurate perception of reality
6. Mastery of the environment (ability to love, work, and play)

Normal vs Abnormal Behavior

Historical Development of Mental Health Nursing

Mental Health Team (Multidisciplinary)

Role of the Psychiatric Nurse

• Clinician: Direct patient care, medication administration
• Educator: Patient and family teaching
• Counsellor: Therapeutic communication and support
• Advocate: Patient rights and welfare
• Case manager: Coordinating care
• Researcher: Evidence-based practice
• Consultant: Expert advice to other healthcare providers
• Milieu manager: Creating a therapeutic environment

Settings of Mental Health Nursing

• Inpatient psychiatric units (closed/open wards)
• Outpatient/OPD clinics
• Community mental health centres (CMHC)
• De-addiction centres
• Halfway homes/rehabilitation centres
• Schools (school mental health programs)
• Forensic psychiatry settings
• Geriatric psychiatry units

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📘 UNIT II: Principles and Concepts of Mental Health Nursing (10 Hours)

Classification of Mental Disorders

• Published by American Psychiatric Association (APA)
• Multi-axial system replaced by a non-axial documentation
• Dimensional approach added
• Key feature: Removes all NOS categories; adds "Other Specified" and "Unspecified"

• Published by WHO
• Chapter V (F00-F99) covers mental disorders
• Used globally; ICD-11 now operational (2022)

Etiology of Mental Disorders - Bio-Psycho-Social Model

Neurobiology Basics (Important for Exams!)

Defense Mechanisms (Psychodynamic - Freud)

Personality Development Theories

1. Physiological needs (food, water, sleep)
2. Safety needs
3. Love and belonging
4. Esteem needs
5. Self-actualization

Principles of Mental Health Nursing

1. Accept the patient as a whole person (holistic care)
2. Non-judgmental attitude
3. Establish trust and therapeutic relationship
4. Maintain confidentiality
5. Respect patient's dignity and rights
6. Encourage participation in care
7. Set realistic limits/boundaries
8. Promote independence
9. Consistent approach
10. Use self therapeutically

Preventive Psychiatry (Caplan's Model)

Conceptual Models of Mental Health Nursing

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📘 UNIT III: Mental Health Assessment (6 Hours)

Mental Status Examination (MSE)

Grades of Insight

Types of Hallucinations

• Auditory - hearing voices; most common in schizophrenia
• Visual - seeing things; most common in delirium/organic disorders
• Tactile - feeling things on skin (formication in cocaine use - "cocaine bugs")
• Olfactory - smelling things (temporal lobe epilepsy)
• Gustatory - tasting things

Types of Delusions

• Persecutory - most common; belief of being persecuted/harmed
• Grandiose - belief of special powers/identity
• Reference - TV/radio speaking specifically to them
• Somatic - false belief about body (e.g., worms in brain)
• Nihilistic - belief that self/world doesn't exist
• Erotomania (de Clérambault's) - belief that someone important loves them
• Capgras syndrome - belief that a loved one has been replaced by an imposter
• Fregoli syndrome - belief that different people are the same person in disguise

Mini-Mental State Examination (MMSE)

• Maximum score: 30 points
• Tests: Orientation (10), Registration (3), Attention/Calculation (5), Recall (3), Language (8), Copy design (1)
• Scoring: Normal ≥24; Mild cognitive impairment 18-23; Moderate 10-17; Severe <10

History Taking in Psychiatry

1. Identifying data
2. Chief complaints (in patient's own words)
3. History of present illness (onset, duration, course, precipitating factors)
4. Past psychiatric history
5. Past medical/surgical history
6. Family history (psychiatric illness)
7. Personal history (birth, development, education, occupation, marriage, sexual history)
8. Premorbid personality
9. Social history (support systems, financial status)
10. Substance use history

Investigations in Psychiatry

• EEG: Epilepsy, organic brain disorders
• CT/MRI Brain: Structural abnormalities, dementia, tumors
• Blood Chemistry: CBC, LFT, KFT, thyroid function tests (rule out organic causes)
• Urine Drug Screen: Substance use
• Psychological Tests: IQ tests (Binet-Simon, WISC), Personality tests (MMPI, Rorschach, TAT)

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📘 UNIT IV: Therapeutic Communication & Nurse-Patient Relationship (6 Hours)

Therapeutic Communication

Principles of Therapeutic Communication

1. Listen actively (give undivided attention)
2. Non-judgmental attitude
3. Empathy (not sympathy)
4. Maintain confidentiality
5. Accept silence
6. Respond to feelings, not just words
7. Use open-ended questions
8. Maintain therapeutic distance (personal space)

Therapeutic Communication Techniques

Non-Therapeutic Communication Techniques (Avoid These!)

Phases of Nurse-Patient Relationship (Peplau's Model)

• Before meeting patient
• Nurse reviews patient's history, reflects on personal feelings/biases
• Prepares physically and psychologically

• First meeting; establishing trust
• Patient may be anxious, resistant
• Goals: Establish trust, define roles and boundaries, identify patient's needs, formulate a contract
• Nurse tasks: Introduce self, explain purpose and confidentiality, begin data collection

• Longest and most productive phase
• Goals: Identify and work through problems, develop coping skills, behavioral changes
• Nurse tasks: Use therapeutic communication, problem solving, cognitive restructuring, maintain boundaries

• Planned ending of relationship
• Patient may show regression, denial, anger (similar to grief)
• Goals: Review achievements, prepare for independence, referral if needed
• Nurse tasks: Summarize work done, reinforce gains, discuss feelings about ending

Therapeutic Impasses (Barriers to Relationship)

• Resistance: Patient refuses to discuss or explore problems
• Transference: Patient transfers feelings (positive/negative) from past relationships onto nurse
• Counter-transference: Nurse's emotional reaction to patient (must be recognized and managed)
• Boundary violations: Sexual, financial, social relationships with patients (strictly prohibited)

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📘 UNIT V: Treatment Modalities in Psychiatry (6 Hours)

1. Pharmacotherapy (Psychotropic Drugs)

• Benzodiazepines: Diazepam, Lorazepam, Alprazolam - short-term anxiety/insomnia (risk of dependence!)
• Buspirone: Non-benzodiazepine anxiolytic (no dependence risk)

Extrapyramidal Side Effects (EPSE) - Very Important!

2. Electroconvulsive Therapy (ECT)

• Severe depression (with suicidal risk, psychotic features, refusal to eat)
• Acute mania (when medications fail)
• Catatonic schizophrenia
• Treatment-resistant depression
• Contraindication to antidepressants (pregnancy, elderly)

• Pre-ECT: Informed consent, NPO 6-8 hrs, anesthetic review, baseline vitals, remove dentures/jewelry
• During: General anesthesia + muscle relaxant (succinylcholine), oxygen, EEG monitoring, current 70-150 V for 0.5-2 sec
• Post-ECT: Monitor vitals, position laterally (recovery position), reorient on waking, headache/muscle aches common

3. Psychotherapies

4. Milieu Therapy (Therapeutic Environment)

• Creating a structured, safe, therapeutic community in the ward
• Components: Safety, structured activities, community meetings, patient participation in rules
• Goals: Social learning, behavioral normalization, responsibility

5. Activity/Occupational Therapy

• Art therapy, music therapy, dance/movement therapy
• Work therapy/ergotherapy
• Play therapy (children)

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📘 UNIT VI: Nursing Management of Schizophrenia & Psychotic Disorders (8 Hours)

Schizophrenia - Overview

• Chronic, severe mental disorder affecting thinking, feeling, and behavior
• Prevalence: ~1% worldwide
• Peak onset: Males 15-25 years; Females 25-35 years
• Male = Female prevalence but earlier onset in males

Symptoms Classification

DSM-5 Diagnostic Criteria for Schizophrenia

• 2 or more of the following for ≥1 month (at least one must be 1, 2, or 3):
  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms
• Continuous disturbance for ≥6 months
• Significant impairment in functioning

Types/Subtypes (DSM-IV - may still appear in exams)

• Paranoid: Predominant delusions/hallucinations, better prognosis
• Disorganized (Hebephrenic): Disorganized speech/behavior, flat/inappropriate affect, worst prognosis
• Catatonic: Psychomotor disturbances (stupor, waxy flexibility, negativism, echopraxia)
• Undifferentiated: Criteria met but no specific subtype
• Residual: Past episode, now only negative symptoms

Related Psychotic Disorders

Treatment of Schizophrenia

• Antipsychotics: First-line; atypicals preferred (risperidone, olanzapine); clozapine for treatment-resistant
• Psychoeducation: Patient and family
• CBT: For residual symptoms
• Social skills training
• Vocational rehabilitation

Nursing Management of Schizophrenia

• Build trust gradually; be honest and consistent
• Use simple, clear, direct communication
• Do NOT argue with or reinforce delusions
• Do NOT deny hallucinations (acknowledge without reinforcing: "I don't hear the voices but I can see you're distressed")
• Ensure safety (especially command hallucinations)
• Administer and monitor antipsychotics
• Monitor for EPS and tardive dyskinesia
• Promote self-care (hygiene, nutrition, sleep)
• Activity scheduling to reduce isolation
• Family education and support
• Long-acting injectable antipsychotics for non-compliance

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📘 UNIT VII: Nursing Management of Mood Disorders (8 Hours)

Depression (Major Depressive Disorder)

• S - Sleep disturbance (insomnia or hypersomnia)
• I - Interest loss (anhedonia)
• G - Guilt / worthlessness
• E - Energy loss (fatigue)
• C - Concentration difficulty
• A - Appetite change (increase or decrease)
• P - Psychomotor changes (agitation or retardation)
• S - Suicidal thoughts / thoughts of death

Diagnosis: ≥5 symptoms including depressed mood OR anhedonia, lasting ≥2 weeks

• ↓ Serotonin, ↓ Norepinephrine, ↓ Dopamine
• HPA axis dysregulation (elevated cortisol)
• Abnormal Dexamethasone Suppression Test (DST)

• Safety: Assess suicide risk, remove harmful objects, close observation
• Do NOT leave severely depressed patient alone
• Establish therapeutic relationship
• Encourage verbalization of feelings
• Activity therapy: start with simple, low-effort activities
• Promote sleep hygiene
• Nutritional support (may need assistance with meals)
• Administer antidepressants; monitor for initial increased energy (suicide risk!)
• ECT if severe, psychotic, or treatment-resistant
• Cognitive restructuring (challenging negative thoughts)

Mania (Bipolar I Disorder - Manic Episode)

• Elevated, expansive or irritable mood + increased goal-directed activity for ≥7 days
• 3 or more (4 if irritable mood) of DIG FAST:
  • D - Distractibility
  • I - Impulsivity / Indiscretion (pleasure-seeking, risky activities)
  • G - Grandiosity
  • F - Flight of ideas
  • A - Activity increase (goal-directed)
  • S - Sleep decreased (no need for sleep)
  • T - Talkativeness (pressured speech)

• Safety: Protect from impulsive dangerous behaviors, set clear limits
• Decrease stimulation (quiet, low-stimulation environment)
• Redirect hyperactive energy to simple physical activities
• Monitor nutrition (patient too active to eat - finger foods, high-calorie snacks)
• Monitor sleep
• Administer mood stabilizers (Lithium, Valproate)
• Monitor Lithium levels and toxicity signs

Lithium Toxicity - KEY EXAM TOPIC!

Bipolar Disorder - Types

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📘 UNIT VIII: Nursing Management of Neurotic, Stress-Related & Somatoform Disorders (8 Hours)

Anxiety Disorders

• Normal: Proportionate to the stressor, time-limited, adaptive
• Pathological: Disproportionate, persistent, interferes with functioning

Anxiety Disorders

OCD (Obsessive-Compulsive Disorder)

• Obsessions: Recurrent, intrusive, unwanted thoughts (ego-dystonic) that cause anxiety
• Compulsions: Repetitive behaviors or mental acts to reduce anxiety
• Common: Contamination + washing; doubt + checking; symmetry + ordering
• Treatment: Fluvoxamine/SSRIs + ERP (Exposure and Response Prevention) - gold standard
• Clomipramine (TCA) also effective

Trauma & Stress-Related Disorders

• After exposure to actual or threatened death/serious injury/sexual violence
• Symptoms (3 clusters):
  1. Re-experiencing: Flashbacks, nightmares, intrusive memories
  2. Avoidance: Avoiding reminders of trauma
  3. Hyperarousal: Hypervigilance, sleep disturbance, irritability, exaggerated startle response
• Duration: >1 month after trauma
• Treatment: Trauma-focused CBT, EMDR (Eye Movement Desensitization Reprocessing), SSRIs

Somatoform/Somatic Symptom Disorders

Dissociative Disorders

• Dissociative Amnesia: Inability to recall autobiographical information (usually trauma-related)
• Dissociative Fugue: Purposeful travel + amnesia about identity
• Dissociative Identity Disorder (DID): 2 or more distinct personality states (previously "Multiple Personality Disorder")
• Depersonalization/Derealization Disorder: Feeling detached from self (depersonalization) or feeling world is unreal (derealization)

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📋 Key Drugs Summary - MHN I

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📝 Quick Revision - HIGH-YIELD Points for MHN I

1. Hildegard Peplau = "Mother of Psychiatric Nursing" + 4 phases of nurse-patient relationship
2. Philippe Pinel = Removed chains from psychiatric patients
3. Defense mechanism most associated with OCD = Undoing/Isolation of affect
4. Neurotransmitter: Dopamine excess → Schizophrenia; Serotonin deficit → Depression/OCD
5. Schizophrenia DSM-5: 2 symptoms × ≥1 month; total duration ≥6 months
6. Positive symptoms respond better to typical antipsychotics; Negative symptoms respond better to atypicals
7. Depression SIG E CAPS = 5 criteria + depressed mood/anhedonia + 2 weeks
8. Mania DIG FAST = 3+ criteria + elevated mood + 7 days
9. Lithium toxicity: Low sodium intake → Lithium toxicity (inversely related)
10. ECT: Gold standard for severe/psychotic/treatment-resistant depression
11. Clozapine: ONLY antipsychotic for treatment-resistant schizophrenia; risk = agranulocytosis
12. Transference = patient's feelings projected onto nurse; Counter-transference = nurse's feelings toward patient
13. Conversion disorder = "la belle indifférence"
14. PTSD = re-experiencing + avoidance + hyperarousal; duration >1 month
15. OCD treatment = ERP therapy + SSRIs (Fluvoxamine); or Clomipramine (TCA)
16. Panic level anxiety = most severe; no learning occurs
17. MSE grades of insight: Grade 1 = complete denial; Grade 6 = true emotional insight
18. Primary prevention: Health education; Secondary: Early detection; Tertiary: Rehabilitation

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🔖 Practical Competencies (MHN I - 80 Hours)

• Mental status examination and history taking
• Therapeutic communication (role-play)
• Nursing process application (psychiatric patient)
• Medication administration and monitoring (psychotropics)
• ECT preparation and post-procedure care
• Activity therapy participation
• Ward observation and documentation

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• Therapeutic communication techniques (which IS therapeutic vs which is NOT)
• Peplau's phases of nurse-patient relationship
• Schizophrenia symptoms (positive vs negative) and nursing care
• Depression vs Mania comparison + mnemonics (SIG E CAPS / DIG FAST)
• Lithium toxicity levels
• ECT - indications, procedure, nursing care
• Defense mechanisms with examples