Guide to Mental Health & Psychiatric Nursing

Chapter 1 Perspectives of Mental Health and Mental Health Nursing 1
Mental Health 1
Definitions 1
Components of Mental Health 1; Indicators of Mental Health 2; Characteristics
of a Mentally Healthy Person 2
Mental Illness 2
Definition 3
Characteristics of Mental Illness 3
Evolution of Mental Health Services and Treatment 3
Some Important Milestones 3; Indian Psychiatric Association 6
Development of Modern Psychiatric Nursing 7
Some Important Milestones 7; Indian Society of Psychiatric Nurses (ISPN) 9; Current
Issues, Future Prospects and Challenges – India 9
Prevalence and Incidence of Mental Health Problems and Disorders 10
Mental Health Act 12
The Mental Health Care Bill, 2013 12; Reasons to the Bill 12
National Mental Health Policy Vis-À-Vis National Health Policy 13
National Mental Health Policy 2014 13; National Health Policy (NHP) 16
National Mental Health Program 17
Aims 17; Objectives 17; Strategies 17; Approaches 17; Components 17
Mental Health Team or Multidisciplinary Team 18
Nature of Mental Health Nursing 19
The Philosophical Beliefs of Psychiatric Nursing Practice 20
Scope of Mental Health Nursing 20
Roles of the Psychiatric-Mental Health Nurse in Contemporary Mental Health
Care 21; Focused areas of psychiatric nursing practice 24; Current Issues and
Trends in Care 24; Challenges in psychiatric nursing 25; Educational Programs for
the Psychiatric Nurse 25; Standards of Mental Health Nursing 26; Development of
Code of Ethics 26; Legal Aspects in Psychiatric Nursing 26; Promotion of Research
in Mental Health Nursing 26; Cost Effective Nursing Care 26; Focus of Care 26
Functions of Mental Health Nurse in Various Settings 26
Practice Setting for Psychiatric Nurses 26; Functions of Psychiatric Nurse in Various
Settings 27
Factors Affecting Level of Nursing Practice 29
Concepts of Normal and Abnormal Behavior 30
Medical Model 30; Statistical Model 30; Socio-cultural Model 30; Behavior
Model 31
The Mental Health- Mental Illness Continuum 31
Mental Health Continuum Model 32
xvi A Guide to Mental Health and Psychiatric Nursing
Chapter 2 Principles and Concepts of Mental Health Nursing 36
Psychiatry 36
Psychiatric Nursing 36
Signs and Symptoms of Mental Illness 36
Alterations of Personality and Behavior 36; Alterations of Biological Functions 36;
Disorders of Consciousness 37; Disorders of Attention and Concentration 38;
Disorders of Orientation 38; Volitional Disturbances 38; Disorders of Motor
Activity 38; Disturbances of Posture and Expression 39; Disturbances of Motor
Speech 39; Disorders of Perception 39; Disorders of Mood 41; Disorders of
Memory 42; Disorders of Thought 42; Disorders of Intelligence 44; Disorders of
Insight and Judgment 44
Classification of Mental Disorders 44
Purposes of Classification 44; 1. ICD10 (International Statistical Classification
of Disease and Related Health Problems)–1992 45; 2. DSM-5 45; 3. Indian
Classification 46
Review of Personality Development 46
Factors Influencing Personality 47; Theories of Personality Development 49
Defense Mechanisms 55
Maladaptive Behavior of Individuals and Groups: Stress, Crisis and Disaster (S) 55
Etiology: Bio-Psychosocial Factors 57
Predisposing Factors 58; Precipitating Factors 58; Perpetuating Factors 58;
Biological Factors 58; Physiological Changes 58; Psychological Factors 58;
Social Factors 59
Psychopathology of Mental Disorders 59
Review of Structure and Functions of Brain, Limbic System and Abnormal
Neurotransmission 60
Nervous System 60; Brain and Behavior 63; Integrative Function of the Nervous
System 63; Neuron 64; Neurotransmitters 65
General Principles of Mental Health Nursing 67
1. Patient is Accepted Exactly as He is 67; 2. Use Self-understanding as a Therapeutic
Tool 69; 3. Consistency is used to contribute to Patient’s Security 69; 4. Reassurance
should be given in a Subtle and Acceptable Manner 69; 5. Patient’s Behavi
Contents xvii
the Patient 73; 7. Reliability 73; 8. Professionalism 73; 9. Accountability 73; 10. The
Ability to Think Critically 73
Psychiatric Nursing Skills 73
Prerequisites for a Mental Health Nurse 73
Conceptual Model and the Role of A Nurse 75
Existential Model 75; Psychoanalytical Model 75; Behavioral Model 77; Interpersonal Model 78; Medical Model 79; Nursing Model 80; Summary of Selected
Nursing Theories 80; Holistic Model 82
Chapter 3 Nursing Process in Psychiatric Nursing and Assessment of
Mental Health Status 87
Nursing Process 87
Definition 87; Nursing Assessment 88; Nursing Diagnosis 92; Planning 92;
Implementation 93; Evaluation 94
Methods of Assessment in Psychiatry 94
Mini-Mental Status Examination 94; Neurological Examination 94
Investigations in Psychiatry 100
I. Routine Investigations 100; II. Electrophysiological Tests 101; III. Brain Imaging
Tests (Cranial) 101; IV. Neuroendocrine Tests 101; V. Genetic tests 101
Psychological Tests 101
Instruments for Assessment of Symptoms 101; Instruments for Assessment of
Personality Traits and Disorders 102; Instruments for Assessment of Cognitive
Functioning 102; Instruments for Assessment of Psychodynamics 102; Instruments
for Assessment of Environmental Stressors 102; Role of a Nurse in Psychological
Assessment 102
Chapter 4 Therapeutic Communication and Nurse-Patient Relationship 104
Communication—Elements and Types 104
Types of Communication 104
Therapeutic Communication 104
Principles or Characteristics of Therapeutic Communication 105; Therapeutic
Communication Techniques 105; Ineffective/Nontherapeutic Communication 106
Therapeutic Nurse-Patient Relationship 106
Types of Relationships 106; Components of Therapeutic Nurse-Patient Relationship 107;
Characteristics of Therapeutic Nurse-Patient Relationship 108; Ethics and Responsibilities 108; Dynamics of Therapeutic Nurse-Patient Relationship 108; Phases
and Tasks of Therapeutic Relationship 110; Therapeutic Impasses 115; Interventions to overcome Therapeutic Impasses 116
Process Recording 116
Purpose and Uses 116; Prerequisites for Process Recording 117; Suggested
Outlines for Process Recording 117; Summary 118
Chapter 5 Therapeutic Modalities and Therapies used in Mental Disorders 120
Physical Therapies 120
Psychopharmacology 120
Core Concept 120; General Guidelines regarding Drug Administration in
xviii A Guide to Mental Health and Psychiatric Nursing
Psychiatry 122; Patient Education related to Psychopharmacology 123; Classification of Psychotropic Drugs 124
Antipsychotics 124
Classification 124; Indications 124; Pharmacokinetics 126; Mechanism of Action 126;
Adverse Effects of Antipsychotic Drugs 126; Nurse’s Responsibility for a Patient
Receiving Antipsychotics 127
Antidepressants 128
Classification 128; Indications 128; Pharmacokinetics 129; Mechanism of Action 129;
Side Effects 129; Nurse’s Responsibility for a Patient Receiving Antidepressants 129
Lithium and Other Mood Stabilizing Drugs 130
Lithium 130; Indications 130; Pharmacokinetics 130; Mechanism of Action 130;
Dosage 130; Blood Lithium Levels 130; Side Effects 131; Contraindications of
Lithium Use 131; Nurse’s Responsibilities for a Patient Receiving Lithium 131;
Carbamazepine 132; Indications 132; Dosage 132; Mechanism of Action 132;
Side Effects 132; Nurse’s Responsibilities 133; Sodium Valproate (Encorate chrono,
valparin, Epilex, Epival) 133; Indications 133; Mechanism of Action 133; Dosage 133;
Side Effects 133; Nurse’s Responsibilities 133
Anxiolytics (Anti-Anxiety Drugs) and Hypnosedatives 133
Classification 133; Indications for Benzodiazepines 133; Dosage (mg/day) 134;
Mechanism of Action 134; Side Effects 134; Nurse’s Responsibility in the Administration of Benzodiazepines 134
Antiparkinsonian Agents 134
Anticholinergics 134; Dopaminergic Agents 134; Monoamine Oxidase Type B
Inhibitors 134; Trihexyphenidyl (Artane, Trihexane, Trihexy, Pacitane) 134
Antabuse Drugs 135
Anti-Craving Drugs 135
Drugs Used in Child Psychiatry 135
Clonidine 135; Methylphenidate (Ritalin) 136
Geriatric Considerations 136
Electroconvulsive Therapy 137
Parameters of Electrical Current Applied 137; Type of Seizure Produced 137;
Mechanism of Action 137; Types of ECT 137; Frequency and Total Number of
ECT 137; Application of Electrodes 137; Indications 137; Contraindications 138;
Complications of ECT 138; Side Effects of ECT 138; ECT Team 138; Treatment
Facilities 138; Role of the Nurse 139
Light Therapy 139
Indications 139; Adverse effects 140; Contraindications 140; Nurse’s Role 140
Repetitive Transcranial Magnetic Stimulation 140
Therapeutic Community 140
Definition 140; Objectives 140; Elements of Therapeutic Community 140;
Components of Therapeutic Community 140; Advantages of Therapeutic Community 141; Disadvantages of Therapeutic Community 141; Role of the Nurse 141
Psychotherapy 141
Psychoanalytic Therapy 142
Contents xix
Therapy Process 142; Free Association 142; Dream Analysis 143; Hypnosis 143;
Catharsis 143; Abreaction Therapy 143
Individual Psychotherapy 144
Indications 144; Therapy Process 144; Approaches 144
Cognitive Therapy 145
Fundamental Assumptions 145; Techniques of Cognitive Therapy 145; Therapy
Process 146; Indications 146
Supportive Psychotherapy 146
Phases of therapy 147
Family and Marital Therapy 147
Indications 147; Components of Therapy 147; Patient Selection 147; Types of
Family Therapy 147
Group Therapy 148
Selection 148; Contraindications 148; Group Size 149; Frequency and Length of
Sessions 149; Approaches to Group Therapy 149; Therapeutic Factors involved in
Group Therapy 149; Some Techniques Useful in Group Therapy 149
Behavior Therapy 150
Major Assumptions of Behavior Therapy 150; Behavior Techniques 150
Play Therapy 152
Curative Functions 152; Diagnostic Functions 152; Types of Play Therapy 152
Psychodrama 153
Music Therapy 153
Advantages 153
Dance Therapy 153
Advantages 153
Recreational Therapy 153
Aims 153; Points to be kept in Mind 154; Types of Recreational Activities 154;
Suggested Recreational Activities for Psychiatric Disorders 154
Relaxation Therapies 154
Progressive Muscular Relaxation 154; Mental Imagery 154; Yoga 155; Meditation
155; Biofeedback 155; Physical Exercise 156; Deep Breathing Exercise 156;
Psychoeducation 156
Role of a Nurse in Psychological Therapies 156
Complementary and Alternative Therapies in Psychiatry 157
Principles Underlying Alternative Healing 158; Acupuncture 158; Ayurvedic
Medicine 158; Homeopathic Medicine 158; Naturopathy 159; Art, Music and
Dance therapy 159; Spiritual Healing and Prayer 159; Herbal Therapies 159;
Aromatherapy 159; Special Diet Therapies, Mega Doses of Vitamins or Minerals 160;
T’ai chi and Qi Gong 160; Massage 160; Biofield Therapies 160; Psychiatric Disorders and Related CAM Therapies 161; Psychiatric Nurse and CAM 161
Occupational Therapy 163
Goal 164; Settings 164; Advantages 164; Points to be Kept in Mind 164; Process
of Intervention 164; Types of Activities 164; Suggested Occupational Activities for
Psychiatric Disorders 164
xx A Guide to Mental Health and Psychiatric Nursing
Chapter 6 Nursing Management of Patient with Schizophrenia, and
Other Psychotic Disorders 170
Schizophrenia Classification (ICD10) 170
Definition 170
Epidemiology 170
Etiology 170
Biological Theories 170; Psychodynamic Theories 171; Vulnerability-stress Model 171;
Social Factors 172
Psychopathology 172
Clinical Features 172
Thought and Speech Disorders 173; Disorders of Perception 174; Disorders of
Affect 174; Disorders of Motor Behavior 174; Other Features 174
Clinical Types 174
Paranoid Schizophrenia 174; Hebephrenic (Disorganized) Schizophrenia 175; Catatonic Schizophrenia 175; Residual Schizophrenia 176; Undifferentiated Schizophrenia 176; Simple Schizophrenia 176; Post-schizophrenic Depression 176
Course and Prognosis 176
Diagnosis 176
Investigations 176
Treatment Modalities 177
Pharmacotherapy 177; Electroconvulsive Therapy (ECT) 177; Psychological Therapies
177; Psychosocial Rehabilitation 178
Nursing Management 178
Nursing Assessment 178; Nursing Diagnosis I 178; Nursing Diagnosis II 180; Nursing
Diagnosis III 180; Nursing Diagnosis IV 181; Nursing Diagnosis V 181; Nursing
Diagnosis VI 181; Nursing Diagnosis VII 181; Nursing Diagnosis VIII 184; Nursing
Diagnosis IX 184; Evaluation 184
Other Psychotic Disorders 186
Persistent Delusional Disorder 186; Acute and Transient Psychotic Disorders 186;
Induced Delusional Disorders 186; Schizoaffective Disorder 186; Capgras
Syndrome (The Delusion of Doubles) 187
Geriatric Considerations 187
Follow up, homecare and rehabilitation for schizophrenia patient 187
Patient and Family Teaching 187; Expressed Emotions 187; Rehabilitation of
Schizophrenia Patients 188
Chapter 7 Nursing Management of Patient with Mood Disorders 192
Mood Disorders 192
Classification of Mood Disorders 192
Manic Episode 192
Classification of Mania (ICD10) 192; Etiology 192; Psychopathology of Mania 193;
Clinical Features 193; Diagnosis 194; Treatment Modalities 194; Nursing Management
for Mania 194; Nursing Diagnosis I 195; Nursing Diagnosis II 195; Nursing
Diagnosis III 195; Nursing Diagnosis IV 195; Nursing Diagnosis V 197; Nursing
Diagnosis VI 197; Evaluation 197; Nursing Management for Hypomania 197; Nursing
Diagnosis I 199; Nursing Diagnosis II 199; Nursing Diagnosis III 199; Nursing
Diagnosis IV 199; Evaluation 199
Contents xxi
Depressive Episode 199
Classification of Depression (ICD10) 201; Etiology 201; Psychopathology 202;
Clinical Features 202; Other features 203; Diagnosis 203; Treatment Modalities 203;
Nursing Management of Major Depressive Episode 204; Nursing Diagnosis
I 205; Nursing Diagnosis II 205; Nursing Diagnosis III 206; Nursing Diagnosis
IV 206; Nursing Diagnosis V 207; Nursing Diagnosis VI 207; Nursing Diagnosis
VII 207; Nursing Diagnosis VIII 207; Evaluation 208
Bipolar Mood Disorder (Bipolar Affective Disorder, Manic Depressive Disorder) 208
Classification 209; Etiology 210; Diagnosis 210; Treatment 210; Course and Prognosis
of Mood Disorders 210; Recurrent Depressive Disorder 210
Persistent Mood Disorder 210
Classification 210; Cyclothymia 210; Dysthymia 211
Geriatric Considerations 212
Follow-Up, Home Care and Rehabilitation 212
Patient and Family Teaching (Depression) 212; Patient and Family Teaching
(Mania) 213
Rehabilitation 213
Chapter 8 Nursing Management of Patient with Neurotic, Stress-related
and Somatization Disorders 216
Classification [ICD10] 216
Phobic Anxiety Disorder 217
Classification [ICD10] 217; Types of Phobia 217; Etiology 218; Course 218;
Diagnosis 218; Treatment 219; Nursing Management 219; Nursing Diagnosis
I 219; Nursing Diagnosis II 220; Evaluation 220
Panic Disorder 221
Classification [ICD10] 221; Etiology of Anxiety Disorders (both panic disorder and
Generalized anxiety disorder [GAD]) 221; Clinical Features 221; Course 221;
Diagnosis 222; Treatment Modalities 222
Generalized Anxiety Disorder 222
Clinical Features 222; Course 223; Diagnosis 223; Treatment Modalities 223;
Nursing Management 223; Evaluation 224
Obsessive-compulsive disorder (OCD) 224
Definition 224; Classification (ICD10) 225; Etiology 225; Clinical Features 226; Course
and Prognosis 226; Diagnosis 226; Treatment 227; Nursing Management 227;
Nursing Diagnosis I 227; Nursing Diagnosis II 227; Evaluation 227
Reaction to stress and adjustment disorder 229
Acute Stress Reaction 229; Post-traumatic Stress Disorder (PTSD) 229; Adjustment
Disorders 229
conversion disorder 230
Dissociative Motor Disorders 230; Dissociative Convulsions (hysterical fits or
pseudo-seizures) 230; Dissociative Sensory Loss and Anesthesia 230
Dissociative Disorder 231
Dissociative Amnesia 231; Dissociative Fugue 231; Dissociative Identity Disorder
(Multiple Personality Disorder) 232; Trance and Possession Disorders 232; Other
dissociative disorders 232; Etiology of Conversion and Dissociative Disorders 232;
xxii A Guide to Mental Health and Psychiatric Nursing
Diagnosis 232; Treatment Modalities 232; Nursing Management 233
Somatoform Disorders 234
Somatization Disorder 234; Hypochondriasis 234; Somatoform Autonomic
Dysfunction 234; Persistent Somatoform Pain Disorder 234; Diagnoses 234;
Treatment Modalities 234; Nursing Interventions (somatoform) 235
Other Neurotic Disorders 235
Geriatric Considerations 235
Follow Up, Home Care and Rehabilitation—Neurotic Disorders 235
Chapter 9 Nursing Management of Patient with Substance Use Disorder 240
Classification 240
Commonly Used Psychotropic Substance 240
Etiological factors in psychoactive substance use 241
Biological Factors 241; Behavioral Theories 241; Psychological Factors 241; Social
Factors 241; Easy Availability of Drugs 241; Psychiatric Disorders 242; Risk factors
for alcohol dependence 242
Consequences of Substance Abuse 242
Alcohol Dependence Syndrome 242
Properties of Alcohol 242; Epidemiology 242; ICD10 Criteria for Alcohol Dependence 243; Signs and Symptoms of Alcohol Dependence 243; Psychiatric Disorders
due to Alcohol Dependence 243; Complications of Alcohol Abuse 244; Diagnosis
245; Treatment 246; Agencies Concerned with Alcohol-related Problems 249; Nursing
Management 249; Nursing Diagnosis I 250; Nursing Diagnosis II 250; Nursing
Diagnosis III 250; Nursing Diagnosis IV 251; Evaluation 252
Other Substance Use Disorders 253
Opioid Use Disorders 253; Cannabis Use Disorder 254; Cocaine Use Disorder 254;
Amphetamine Use Disorder 254; LSD Use Disorder (Lysergic acid diethylamide) 254;
Barbiturate Use Disorder 255; Inhalants or Volatile Solvent Use Disorder 255
general nursing interventions for a patient with acute drug intoxication 255
During an Acute Episode 256; During Drug Withdrawal 256
Prevention of Substance Use Disorder 256
Primary Prevention 256; Secondary Prevention 257; Tertiary Prevention 257
Rehabilitation 257
Geriatric Considerations 257
Follow Up and Home Care 258
Patient and Family Teaching 258
Chapter 10 Nursing Management of Patient with Personality,
Sexual and Eating Disorder 261
Personality Disorder 261
Definition (ICD9) 261; Incidence 261; Classification 261; DSM Classification 261;
Etiology 262; Clinical Features of Abnormal Personalities 262; Nursing Interventions for Antisocial Personality Disorder 263; Histrionic Personality Disorder 264;
Narcissistic Personality Disorder 264; Borderline Personality Disorder 264; Nursing
Interventions for Borderline Personality Disorder 264; Anxious (Avoidant) Personality Disorder 264; Dependent Personality 265; Obsessive-compulsive (Anankastic)
Personality Disorder 265; Treatment Modalities 265; Nursing Interventions for
Patients with Personality Disorders 266; Geriatric Considerations 266; Follow-up,
Homecare and Rehabilitation for Personality Disorders 266
Contents xx
xxiv A Guide to Mental Health and Psychiatric Nursing
Nursing Interventions 310
Delirium (Acute Organic Brain Syndrome) 310
Incidence 310; Etiology 310; Clinical Features 310; Course and Prognosis 311;
Treatment 311; Nursing Intervention 311
Organic Amnestic Syndrome 311
Etiology 311; Clinical Features 312; Management 312
Mental Disorders due to Brain Damage, Dysfunction and Physical Disease 312
Personality and Behavioral Disorders due to Brain Disease, Damage and
Dysfunction 312
Etiology 312; Management 312
Geriatric Considerations 312
Chapter 13 Psychiatric Emergencies and Crisis Intervention 316
Initial Approach during Emergency 316
Types of Psychiatric Emergencies and their Management 316
Suicidal Threat 316; Etiology 316; Suicidal Tendency in Psychiatric Wards 317;
Management 317
Violent or aggressive Behavior or excitement 318
Etiology 319; Management 319
Panic Attacks 320
Management 320
Catatonic Stupor 320
Management 320
Hysterical Attacks 320
Management 320
Transient Situational Disturbances 320
Management 320
Delirium Tremens 320
Management 320
Epileptic Furor 321
Management 321
Acute Drug-induced Extrapyramidal Syndrome 321
Management 321
Drug Toxicity 321
Management 321
Victims of disaster 321
Management 321
Rape Victim 322
Signs and Symptoms 322; Management 322
Stress Adaptation Model 322
Models of Stress 323
Stimulus-Based Model (Holmes and Rahes Model-1960) 323; Response-Based
Model 323; Transaction-Based Model 325
Coping Resources 326
Coping Mechanisms 326
Grief 327
Theories of Grief 327
Contents xxv
Grief Process 329
Resolution of Grief 329; Maladaptive Grief Responses 329; Management and
Treatment 330; Nursing Intervention 330
Principles of Counseling 330
Techniques of Counseling 331
Crisis and Crisis Proneness 331
Definition 331; Crisis Proneness 332
Types of Crisis 332
Maturational Crisis 332; Situational Crisis 332; Social Crisis 332
Phases of Crisis 332
Phase I 332; Phase II 333; Phase III 333; Phase IV 333
Signs and Symptoms of Crisis 333
Process of Crisis (Resolution of Crisis) 333
Pseudo-resolution 333; Unsuccessful Resolution 333; Successful Resolution 333
Crisis Intervention 334
Aims of Crisis Intervention Technique 334; Intervention 334
Principles of Crisis Intervention 335
Techniques of Crisis Intervention 335
Geriatric Considerations 335
Role of a Nurse in Crisis Intervention 335
Nursing Assessment 336; Nursing Diagnoses 336; Planning 336; Implementation 336
Modalities of Crisis Intervention 337
Mobile Crisis Programs 337; Telephone Contacts 337; Group Work 337; Disaster
Response 337; Victim Outreach Programs 338; Crisis Intervention Centers 338;
Health Education 338
Chapter 14 Legal Issues in Mental Health Nursing 342
The Indian Mental Health Act (1987) – Sections and their Implications 342
History 342; Reasons for Enactment 342; Objectives of the Indian Mental Health
Act 342; Salient Features of the Act 342
Chapter I 342
Chapter II 343
Chapter III 343
Chapter IV 343
Admission on Voluntary Basis 343; Admission under Special Circumstances (Involuntary
patient) 343; Admission under Authority or Order 344
Chapter V 345
Discharge of a Patient Admitted on Voluntary Basis 346; Discharge of a Patient
Admitted under Special Circumstances 346; Discharge of a Patient Admitted on
Reception Order 346; Discharge of a Patient Admitted by Police 346; Discharge
of a Mentally Ill Prisoner 346; Leave of Absence (Section 45) 346
Chapter VI 347
Chapter VII 347
Chapter VIII 347
Chapter IX 347
Chapter X 347
Positive Qualities of the MHA 1987 347; Nursing Implications 348
xxvi A Guide to Mental Health and Psychiatric Nursing
The Indian Lunacy Act (1912) 348
The Mental Health Care Bill, 2013 348
Reasons to the Bill 348; The key features of the Bill 348; Chapters 349
Basic Rights of Mentally Ill Patients and Nurse’s Responsibilities 349
Some of the Rights of Psychiatric Patients 349; Nurse’s Implications for Protecting
Patient’s Rights 350
Forensic Psychiatry 350
Crime and Psychiatric Disorders 350; Criminal Responsibility 350; Civil Responsibilities of a Mentally Ill Person 351; Laws Relating to Psychiatric Disorders 352;
Admission Procedures of Patients in a Psychiatric Hospital 352; Civil Rights of the
Mentally Ill 352; Psychiatrists and the Court 352
Acts Related to Narcotic and Psychotropic Substances and Illegal Drug
Trafficking 353
The Narcotic Drug and Psychotropic Substances Act of 1985 - Act 61 353;
Contents 353
Admission and Discharge Procedures – Roles and Responsibilities of a Nurse 353
Role of a Nurse in Admission Procedure 353; Role of the Nurse in Leave of Absence
(Parole) 354; Role of the Nurse in Discharge Procedure 354
Legal Responsibilities of a Nurse 354
Nursing Malpractice 355; Confidentiality 355; Informed Consent 355; Substituted
Consent 356; Record Keeping 356; Specific problems in mental hospitals 356
Chapter 15 Community Mental Health Nursing 360
Development of Community mental health in India 360
Organization of Mental Health Services in India 363; Some of the Innovative
Programs in Mental Health 364; The Chandigarh Experiment 365
National Mental Health Program 365
Objectives 365; Targets of National Mental Health Program 366
District Mental Health Program (dmhp) 368
Nurse’s Role 369
Institutionalization vs deinstitutionalization 370
Three Essential Components of a Sound Deinstitutionalization Process 370;
Institutionalization 371
Models of Preventive Psychiatry: Levels of Prevention—role of a nurse 371
Primary Prevention 372; Secondary Prevention 373; Tertiary Prevention 374
Psychiatric Rehabilitation 375
Definition 375; Need for rehabilitation of mentally ill patients 375; Principles of
Rehabilitation 375; Psychiatric Rehabilitation Approaches 375; Rehabilitation Team
376; Steps in Psychiatric Rehabilitation 376; Role of a Nurse in Psychiatric
Rehabilitation 376; Vocational Rehabilitation 377; Rehabilitation Services in India
378
Mental Health Services Available at the Primary, Secondary and Tertiary Level 379
At Primary Level 379; Secondary level 379; Tertiary level 379; Mental Health
Services Available for Psychiatric Patients 380
Mental Health Agencies: Government and Voluntary, National and International 382
Mental Health Agencies—Government at National Level 382; Mental Health
Agencies— International 382; Mental Health Agencies—Voluntary/Non-Governmental Organizations 384
Contents xxvii
Community Mental Health— Psychiatric Nursing 386
Goals of Community Mental Health Nursing 386; Community Mental Health Nursing
Process 387; Tips for Working in the Community 388
Misconceptions about Mental Illness 389
General Attitude Towards the Mentally Ill 390
Mental Health Nursing Issues for Special Population 390
Children 390
Adolescents 391
Mental Health Problems among Adolescents 391
Women 392
Premenstrual Syndrome 392; Psychiatric Disorders Associated with Childbirth 393;
Baby blues (Postnatal Blues, Transitory Mood Disorders) 394; Postpartum depression
394; Postpartum psychosis 394; Menopausal Syndrome 395
Elders 395
Nursing Management 396
Victims of Violence and Abuse 396
Child Abuse 396; Domestic Violence 397; Sexual Assault and Rape 397; Elderly
Abuse 398
Handicapped 398
HIV/AIDS 398
Psychosocial aspects of HIV/AIDS 398; Nursing Management 400
Appendices 405
Glossary 465
Further Reading 475
Index 477