Textbook of Mental Health and Psychiatric Nursing: Principles and Practice

1. Introduction

• Mental Health
  • Perspectives of Mental Health and Mental Health Nursing
  • Evolution of Mental Health Services, Treatments and Nursing Practices
• The World Psychiatric Association
• The Indian Psychiatric Society
• The International Society of Psychiatric Nurses
• The Indian Society of Psychiatric Nurses
• Mental Health Team
• Nature and Scope of Mental Health Nursing
  • Role and Functions of a Mental Health Nurse in Various Settings
  • Factors Affecting the Level of Nursing Practice
• Concepts of Normal and Abnormal Behaviour
• Characteristics of a Mentally Healthy Person
• Signs of Mental Illness
• Continuum of Mental Health and Mental Illness

2. Principles and Concepts of Mental Health Nursing

• Definition of Mental Health Nursing
• Classification of Mental Disorders
• Terminologies
• Review of Personality Development
  • Factors Affecting Personality Development
  • Theories of Personality Development
• Defence Mechanisms
• Maladaptive Behaviour of Individuals and Groups
  • Stress, Crisis and Disaster(s)
  • Maladaptive Behaviour of Groups
• Stress and Disaster
• Aetiology of Mental Disorders: Biopsychosocial Factors
• Psychopathology of Mental Disorders
  • Signs of Psychopathology
  • Diagnostic Systems
  • Identifying Psychopathology
• Review of the Structure and Function of Brain, Limbic System, and Abnormal Neurotransmission
  • Central Nervous System
  • The Peripheral Nervous System
• Principles of Mental Health Nursing
  • The Patient is Accepted as She or He is
  • Introspection by the Nurse
  • Consistency in Care
  • Genuine Reassurance
  • Attempt Therapeutic Changes Through Emotional Experiences and Not by Rationalization
  • Nursing Procedures May Be Modified Without Altering the Basic Principles
  • Therapeutic Nurse–Patient Relationship
  • Avoid Unnecessary Stimulation of Anxiety in the Patient
  • Treat the Patient as a Person and Not as an ‘Illness’ or ‘Symptom’
  • Objectivity Enhances Understanding of Patient Behaviour
  • Offer Information in a Patient-Friendly Manner
  • Avoid any Form of Punishment
• Ethics and Responsibilities
• Conceptual Models and the Role of Nurse
  • Interpersonal Model in Nursing
  • Medical Model
• Some Important Nursing Theories
  • Martha E. Rogers’s Science of Unitary Human Beings
  • Dorothea E. Orem’s Self-care Deficit Theory
  • Sister Callista Roy’s Adaptation Model of Nursing
• Practice Standards for Psychiatric-Mental Health
• Nursing, Indian Nursing Council (2019)

[A] Standards of Practice
[B] Standards of Education
[C] Standards of Administration
[D] Standards of Evidence-Based Practice and Research
[E] Other Standards of Professional Performance
3. Mental Health Assessment

• The Initial Interview
  • Contents of the Interview
  • Guidelines for Interviewing
  • Interview Skills
  • Some Do’s and Don’ts While Conducting Interview
• History Taking
• Mental Status Examination
• Mini-Mental Status Examination
• Neurological Examination
• Importance of Blood Chemistry, EEG, CT, MRI in Mental Disorders and the Nurse’s Role

4. Therapeutic Communication and Nurse-Patient Relationship

• Introduction
  • Definition of Therapeutic Communication
• Characteristics of Therapeutic Communication
• Techniques of Therapeutic Communication
• Types of Relationships
• Elements of Nurse-Patient Contract
• Review of Technique of IPR-Johari Window
• Goals, Phases, Tasks, Therapeutic Techniques
  • Goals
  • Phases
  • Tasks and Therapeutic Techniques
• Therapeutic Impasse and Its Intervention
  • Pre-Interaction Phase
  • Orientation Phase
  • Working Phase
• Conclusion

5. Treatment Modalities and Therapies in Mental Disorders

• Physical Therapies
  • Psychopharmacology
  • Electroconvulsive Therapy
• Psychological Therapies
  • Psychotherapy
• Behaviour Therapy
• Cognitive Behaviour Therapy
• Psychosocial Therapies
  • Milieu Therapy
  • Family Therapy
  • Recreational Therapy
  • Art Therapy
  • Occupational Therapy
• Alternative & Complementary Therapies
  • Yoga
  • Meditation
  • Relaxation

6. Nursing Management of Persons With Schizophrenia and Other Psychotic Disorders

• What Is Schizophrenia?
  • History
  • Prevalence and Incidence
  • Types of Schizophrenia
  • Aetiology
  • Pathophysiology
  • Psychodynamics
  • Diagnostic Criteria (ICD-11) and Clinical Manifestations
  • Diagnostic Guidelines (ICD-11)
  • Treatment Modalities
  • Nursing Management
  • Geriatric Considerations/Considerations for Special Populations
  • Follow-up, Home Care and Rehabilitation
  • Education of the Person with Schizophrenia and Family Members
  • Family Emotional Climate
  • Home Care and Rehabilitation of PwS
  • What After Me Issues

7. Nursing Management of Persons With Mood Disorders

• What Are Mood Disorders? (ICD-11)
• Prevalence and Incidence
• Characteristics of the Four Primary Types of Mood Episodes (ICD-11)
• Classification of Mood Disorders (ICD)
• Episode of Mania
  • Aetiology
• Clinical Manifestations
• Diagnostic Criteria
• Treatment Modalities
• Nursing Management of the Person With Mania
• Hypomania
• Episode of Depression
  • Aetiology
• Clinical Manifestations
• Diagnostic Criteria
• Treatment Modalities
• Nursing Management of the Person With Depression
  • Nursing Assessment
• Geriatric Considerations/Considerations for Special Populations
• Follow-up, Home Care and Rehabilitation

8. Nursing Management of Persons With Neurotic, Stress-Related and Somatization Disorders

• Classification – ICD-11

1. Anxiety & Fear-Related Disorders (ICD-11)

• Prevalence and Incidence
• Various Anxiety Disorders (ICD-11 Code for Anxiety
• and Fear-Related Disorders: 6B00 to 6B0Z)
• Aetiology
• Psychodynamics
• Assessment
• Clinical Manifestations
• Treatment
• Nursing Management

B. Obsessive–Compulsive and Related Disorders and Nursing Management

• Prevalence and Incidence
• Aetiology
• Psychodynamics
• Assessment
• Clinical Manifestations
• Treatment
• Nursing Management

C. Stress-Related Disorders and Nurse’s Role

• Prevalence and Incidence
• Aetiology
• Psychodynamics
• Assessment
• Clinical Manifestations
• Treatment
• Nursing Management,

D. Adjustment Disorder and Nurse’s Role
E. Dissociative Disorders and Nursing Management

• Dissociative Amnesia
• Dissociative Fugue
• Dissociative Identity Disorder
• Depersonalization/Derealization

F. Disorders of Bodily Distress or Bodily

• Experience
• Prevalence and Incidence
• Aetiology
• Assessment
• Treatment
• Nursing Management

• Geriatric Considerations
• Special Considerations for Women
• Special Considerations for Children and Adolescents
• Follow-Up, Home Care and Rehabilitation
• COVID-19 Pandemic Implications

9. Nursing Management of Persons With Substance Use Disorders (SUDs)

• Prevalence and Incidence
• Common Terms Related to Substance Abuse
• Psychodynamics/Aetiology of Dependence
• Classification of Disorders
• Diagnostic Criteria (Refer ICD-11 Guidelines)
• Commonly Used Psychotropic Substances
• Dual Diagnosis
• Assessment
• Transcultural Considerations
• Screening Tools
• Diagnostic Tests
• Treatment
• Alcohol Withdrawal Delirium (Delirium Tremens)
  • Signs and Symptoms
  • Diagnosis
  • Management
• Relapse Prevention Strategies
• Nursing Management
  • Special Considerations for Women
  • Special Considerations for Older Persons
  • Special Considerations for Children and Youth
  • Follow-up, Home Care and Rehabilitation
• Impact of COVID-19 Pandemic

10. Nursing Management of Persons With Personality and Sexual Disorders

• Personality Disorder
  • Definition (ICD-11)
  • Prevalence
  • Classification of Disorders
  • Aetiology
  • Psychodynamic Theory/Pathology
  • Diagnostic Guidelines (ICD-11)
  • Treatment Modalities
  • Nursing Management
  • Geriatric Considerations/Considerations for Special Populations
  • Follow-Up, Home Care and Rehabilitation
• Sexual Disorders
  • Classification (ICD-11)
  • Treatment Modalities
  • Nursing Management
  • Assessment of Specific Conditions
  • Geriatric Considerations/Considerations for Special Populations
  • Follow-Up, Home Care and Rehabilitation

11. Nursing Management of Behavioural and Emotional Disorders in Childhood and Adolescence

• Phases of Development
• Challenges in Identifying Problems in Children
• Classification of Disorders (ICD-11)

A. Neurodevelopmental Disorders
Classification of Neurodevelopmental Disorders (ICD-11)
B. Secondary Parented Categories in

• Neurodevelopmental Disorders
  • Primary Tics and Tic Disorders (8A05, ICD -11)
  • Tourette Syndrome (8A05.00, ICD-11)

• Anxiety and Fear-Related Disorders
  • Classification of Anxiety and Fear-Related Disorders (ICD-11)
  • Panic Disorder (6B01, ICD-11)

D. Eating and Feeding Disorders
I. Eating Disorders

1. Nursing Diagnosis

• • Nursing Interventions

2. Nursing Diagnosis

• • Nursing Interventions

3. Nursing Diagnosis

• • Nursing Interventions

4. Nursing Diagnosis

• • Nursing Interventions

Evaluation of Nursing Care

• • Geriatric Considerations

II. Feeding Disorders
E. Elimination Disorders

• • Classification of Elimination Disorders (ICD-11)

F. Disruptive Behaviour Disorders and Dissocial Disorders Oppositional Defiant Disorder (ODD) (6C90, ICD-11)

• • Classification of Disruptive Behaviour and Dissocial Disorders
  • II. Conduct-Dissocial Disorder (CDD) (6C91, ICD-11)
  • G. Altered Pattern of Family Relationships in Childhood (QE92, ICD-11)
  • Management
  • Follow-up, Home Care and Rehabilitation
  • COVID-19 Pandemic and Children

12. Psychiatric Emergencies and Crisis Intervention

• Introduction
• Classification
  • ICD-11 Criteria
• Dementia

• Prevalence and Incidence
• Aetiology
• Pathophysiology
• Stages of Dementia
• Early Symptoms
• Clinical Features
• Differential Diagnosis
• Diagnostic Formulations
• Treatment Modalities
• Nursing Management
• Nursing Care Plan for Patients With Dementia
• Follow-up, Home Care and Rehabilitation
• COVID-19 Pandemic-Related Challenges

• Vascular Dementia

• Prevalence
• Risk Factors
• Clinical Features
• Investigations
• Treatment
• Nursing Care

• Delirium

• Prevalence and Incidence
• Risk Factors
• Aetiology
• Clinical Features
• Diagnostic Formulation
• Differential Diagnosis
• Course and Prognosis
• Treatment
• Nursing Care Plan for a Patient With Delirium

• Organic Amnestic Syndrome

• Aetiology
• Clinical Features
• Treatment
• Mental Disorders Because of Brain Damage and Because of Other Causes
• Personality and Behavioural Disorders Because of Brain Damage
• Geriatric Conditions
• Follow-up, Home Care and Rehabilitation

13. Psychiatric Emergencies and Crisis Intervention

• Common Types of Psychiatric Emergencies
• Suicide

• Epidemiology
• Facts and Myths About Suicide
• Risk Factors for Suicide
• Protective Factors
• Mode of Committing Suicide
• Warning Signs or Cues
• Role of Nurses
• Suicide in the Psychiatry Wards
• Interventions after a Successful Suicide
• Gatekeeper Training
• Legal Implications

• Aggression/Violent Behaviour

• Conditions Associated with Aggression and Violence
• Common Causes of Aggression
• Aetiology
• Clinical Features or Cues
• Assessment
• Nursing Diagnosis
• Goals
• Nursing Interventions
• Evaluation

• Stupor

• Signs and Symptoms

• Delirium Tremens

• Clinical Signs and Symptoms
• Assessment
• Management

• Drug-Induced Extrapyramidal Symptoms

• Neuroleptic Malignant Syndrome
• Lithium Toxicity

• Disaster Management and Role of the Psychiatric Nurse

• Assessment,
• Nursing Diagnosis
• Nursing Interventions
• Evaluation
• Disaster Nursing Academic Programmes

• Crisis Intervention

• Concept and Meaning
• Definition
• Phases in the Development of a Crisis
• Balancing Factors
• Types of Crises
• Crisis Intervention
• Geriatric and Special Population Considerations
• COVID-19 Pandemic Considerations

• Stress Adaptation Model and Stress Management

• Interventions
• Sources of Stress
• Early Theories of Stress
• Effects of Stress
• Hypothalamic–Pituitary–Adrenal Axis and Stress
• Stress Adaptation Model
• Coping
• Stress Management

• Grief

• Types of Loss
• Grief, Mourning and Bereavement
• Unresolved or Dysfunctional Grief and Disenfranchised Grief
• Theories of Grief
• Duration of the Grief Process
• Pathological Grief Responses
• How to Differentiate Grief from Clinical Depression?
• Nursing Management

• Counselling

• Definition of Counselling
• Principles of Counselling
• Common Counselling Approaches
• Counselling Techniques
• Special Considerations

14. Legal Issues in Mental Health Nursing

• Mental Health Legislation in India

• History of Legislation Related to Persons with Mental Illness in India

• Repeal of Mental Health Act, 1987, and Saving of MHCA, 2017

• Revisions Made in the Mental Health Act, 1987

• Responsibilities of Nurses During Admission and Discharge (Gandhi et al., 2019)

• Admission Procedure

• Responsibilities of Nurses During Admission and Discharge of Prison Ward Patients (Gandhi et al., 2019)

• Prison Ward Admission Procedure
• Prison Ward Discharge Procedure

• Role and Responsibilities of Nurses in Implementing the Mental Health Care Act, 2017

• Challenges in Implementation

• Rights of Persons With Mental Illness
• Nurses’ Role in Implementing the RPWD Act, 2016
• Guidelines for Assessment of Persons With Disabilities (Divyangjan), (www.disabilityaffairs.gov.in)
• Legal Issues in Psychiatric Nursing
• Types of Laws
• Legal Issues in Nursing
• Nursing Records and Their Legal Implications
• Legal Safeguards in Nursing Practice
• Responsibilities of Nurse Administrator
• Common Causes for Lawsuits Against the Psychiatric Nurse
• Civil Rights and Due Process
• Legal Competence
• Rights Regarding Restraint and Seclusion
• Child and Elder Abuse Reporting
• Tort Law Applied to Psychiatric Settings
• Nursing Malpractice
• Determination of Standard of Care
• Steps to Avoid Nursing Liability
• Legal Support
• Narcotic Drugs and Psychotropic Substances Act, 1985
• Protection of Children From Sexual Offence Act, 2012

• Nurses’ Role

• Forensic Psychiatry

• Scope of Forensic Psychiatry

• Involvement of PwMI in Legal Issues
• Testamentary and Contractual Capacity and
• Competence
• Criminal Law
• Forensic Psychiatric Nursing

15. Community Mental Health Nursing

• Development of Community Mental Health Services Globally
• Development of Community Mental Health Services in India
• Community Mental Health Services at NIMHANS, Bengaluru
• National Mental Health Policy, Viz. National Health Policy

• National Health Policy
• National Mental Health Policy (2014)

• National Mental Health Programme

• Objectives of NMHP
• Aims of NMHP
• Targets of NMHP
• Activities Planned to Implement NMHP in the Seventh
• Five-Year Plan
• Limitations of NMHP

• District Mental Health Programme Inception

• Objectives of DMHP
• Components of DMHP
• Activities of DMHP
• Role and Responsibilities of Nurses
• Principles of Community Mental Health Nursing
• Goals of Community Mental Health Nursing

• Institutionalization Versus De-Institutionalization

• Institutionalization
• De-institutionalization

• Model of Preventive Psychiatry: Levels of Prevention and Role of Nurse

• Primary Prevention
• Secondary Prevention in Psychiatry
• Tertiary Prevention in Psychiatry

• Psychiatric Rehabilitation and Role of Nurses

• History
• Aim
• Principles of Psychiatric Rehabilitation
• Need for Rehabilitation
• Psychiatric Disorders Requiring Rehabilitation
• Settings in Which Psychiatric Rehabilitation Is
• Possible
• Psychiatric Rehabilitation Team
• Current Approaches in Psychiatric Rehabilitation
• Psychiatric Rehabilitation Services
• Role of Nurses in Psychiatric Rehabilitation

• Rehabilitation Services in India
• Current Scenario
• Welfare Benefits for Persons With Mental Illness

• Legal Protection
• Central and State Benefits

• COVID-19 Pandemic and Psychiatric Rehabilitation
• PRS at NIMHANS During the Pandemic
• Mental Health Services Available at the Primary, Secondary and Tertiary Levels

• Primary Level
• Secondary and Tertiary Levels

• Mental Health Agencies: Government and Voluntary, National and International

• Mental Health Agencies – Government at National
• Level
• International Mental Health Agencies
• Mental Health Nongovernmental Organizations
• (MHNGOs) in India
• Mental Health Professional Associations
• Mental Health Journals in India

• Community Mental Health Nursing
• Mental Health Nursing Issues for Special Populations

• Children
• Adolescents
• Women
• Perinatal Mental Health Issues (See Table 15.3, ICD-
• 11 Code for Mental and Behavioural Problems in
• Puerperium)
• Older Persons

• Victims of Violence and Abuse

• Domestic Violence, Sexual Assault and Rape
• Domestic Violence
• Sexual Assault and Rape
• Child Abuse
• Elder Abuse
• Persons with Physical Disability
• People with HIV/AIDS

APPENDIXES

I. Appendix A
A1: History Taking Format
A2: Physical Examination Format
A3: Neurological Examination Format
A4: Mental Status Examination
A5: Mental Status Examination of Non-Cooperative or
Stuporose Patients (KIRBY,1921)
A6: Mini-Mental Status Examination (MMSE)
A7: Process Recording
A8: Process Recording Sample
A9: Nursing Care Plan for Mr Z With Psychosis NOS
A10: Case Study on Mr V With Recurrent Depressive Disorder
A11: Case Presentation
A12: Assisting for Electroconvulsive Therapy
A13: Assisting for Psychometric Assessment Format
A14: Assisting for Psychotherapy Format
A15: Assisting for Behaviour Therapy Format
A16: Format to Assess Activities of Daily Living (ADL)
and Intervene
A17: Health Education Format
A18: Group Therapy Format
A19: Family Therapy Assignment Format
A20: Assisting/Conducting Leisure /Recreation Therapy
Format
A21: Perinatal History Collection Format
A22: Geriatric History Collection Format
A23: Format for History Collection from a Person
Abusing Alcohol
A24: Format for Case Work of a Child With IDD
A25: Occupational Therapy Format
A26: Observation Report of OPD
A27: Play Therapy
A28: Format for Assignments in the Community Mental
Health Setting
A29: Drug Book Format
A30: NANDA Nursing Diagnosis

II. Appendix B
B1: Problem-Based Learning /Teaching Using Concept
Maps
Sample Concept Maps
B2: Expressed Emotions and Illness Relapse
B3: Concept Map to Understand Illness Relapse
B4: Holistic Health
Concept Maps with Case Vignette
B5: Schizophrenia
B6: Mania With Psychosis
B7: Depression
B8: Anxiety Disorder
B9: Alcohol-Dependence Syndrome (ADS)
B10: Objective Structured Clinical Examination
B11: Question Bank of Multiple-Choice Questions
B12: Sample Question Papers

III. Appendix C
Abbreviations
IV. Appendix D
Glossary
V. Appendix E
Drug Guide
Index