MENTAL HEALTH-FOCUSED REVISION
MENTAL HEALTH-FOCUSED REVISION
FILLING IN THE BLANK
1. The
branch of psychiatry that deals with the assessment and treatment of mentally
disordered offenders and includes those
areas where psychiatry interacts with the law is called FORENSIC PSYCHIATRY
2. The
use of coping strategies, ways or methods that protect the individual from harm
in response to stress situations or stressors is called STRESS MANAGEMENT
3. The
means of reaching the goal of good mental health through actions that are taken to foster, protect and improving mental health is MENTAL HEALTH PROMOTION
4. The
type of personality disorder which Is characterised by a pervasive pattern of
grandiosity, attention seekers and always asks for favours is called NARCISSISTIC
PERSONALITY DISORDER
5. The reduction of the number existing of mental illnesses through screening, early
diagnosis, prompt treatment and education of signs and symptoms is known as
SECONDARY PREVENTION
6. A condition in which hallucinations and delusions are prominent and the
personality is relatively well precerved is called PARNOID
7. A thought disorder in which there is general lack of
additional, unprompted content is called
ALOGIA/POVERTY OF SPEECH
8. The inability to interpret sensations and hence to
recognize things typically as a result of brain damage is called AGNOSIA
9. The condition in which there is impairment of
consciousness accompanied by abnormal perception and mood changes is called DELIRIUM
10. CATATONIA
is a condition in which there is presence of motor abnormalities
such as posturing.
11. Chronic heavy drnkers exhibit a cluster of common
symptoms that form a syndrome known as KORSAKOFF SYNDROME
12. Attention- Deficit hypersensitivity is a chronic
psychiatric condition manifested by the following three (3) characteristics;
Attention difficulty, Impulsiveness and HYPERACTIVENESS.
13. Treatment of withdrawal symptoms is also called DETOXIFICATION
14. A pervasive and sustained emotion that colours the
person’s perception of the world is called MOOD
15. A patient who is unresponsive, akinetic, mute and
fully conscious is said to be in a STATE OF STUPOR
16. The term used to refer to behavior where there is
“acting out” of problems and loss of or poor control of impulses is called IMPULSE
CONTROL DISORDER
17. The term used for sexual excitation which arises
from inanimate objects such as material or colour is called FETISHISM
18. A disorder in which there is insufficient quality
and quantity of sleep is called INSOMNIA
19. The total scorederived several standardised tests designed to assess
human intelligence is called INTELLIGENT QUONTIENT
20. The unlawful and malicious destroying and damaging
of property by setting fire is called ARSON
21. Adding a rewarding stimulus as a consequence of a
behaviour , thus increasing the probaility that it will occur again is referred
to as POSTIVE REINFORCEMENT
22. The structural way of observing and describing a
patient’s current state of mind is referred to as MENTAL STATE EXAMINATION
23. ASSERTIVENESS
is to exercise one’s rights, opinion and feeling
without denying the rights of ohers.
24. Patients are unable to recall long periods of their
lives and sometime deny any knowledge of their previous life or personality
identity is called DISSOCIATIVE AMNESIA/DISSOCIATIVE FUGUE
25. The type of depression whee the cause is considered
to be coming from outside is called EXOGENOUS DEPRESSION
26. The act or an instance of taking one’s own life
voluntarily and intentionally common in depression is called SUICIDE
27. The type of phobia in which there is persistent fear
of heights which leads to embarssment and avoidance of such situations is
called ACROPHOBIA
28. The term that describes symptoms of a large group of
illnesses that cause a progressive decline in a person’s functioning such as
loss of memory, intellect, rationality and social skills is called COGNITIVE
DISORDERS
29. The term used to describe an individual’s reaction
to any change that requires an adjustment or response is called STRESS
30. The knowledge and skills people need to have to
leave in the community is called SOCIAL SKILLS
31. The persistent failure to meet a child’s basic
physical and/or psychological needs, likely to
result in the serious impairment of the child’s health or development is
called CHILD ABUSE
32. When staff in a home or other institutions sacrifice
needs , wishes and lifestyle of a disabled child in favour of the institution’s
regime is known as INSTITUTIONAL ABUSE
33. The process of enabling a mentallt ill peron to
return to the highest possible level of functioning is PSYCHIATRIC
REHABILITATION
34. The various types of support a person gets from
friends, family and medical or mental health professionals, that keeps one
mentally strong in difficult times is called EMOTIONAL SUPPORT
35. The
inability of the female to express sexual satisfaction is referred to as SEXUAL AROUSAL DISORDER
36. The
recurrent and persistent pain during coitus in either the man or the women is
called DYSPAREUNIA
37. An
involuntary constriction of the outer one third of the vagina that prevents
penetration, insertion and coitus is called VAGINISMUS
38. The
attraction for sexual relation with persons of the same sex is HOMOSEXUALITY
39. Sexual
gratification by genital exposure in public is referred to as EXHIBITIONISM
40. The
sexual encounter resulting from union of close relatives is INCEST
41. Excessive
sexual drive or desire in females is known as NYMPHOMANIA
42. Excessive
sexual drive or desire in males is called SATYRIASIS
43. Sexual
gratification which is achieved by telephoning someone and making rude/vulgar
remarks or remaining silent on the line is called TELEPHONE SCATOLOGIA
44. The
branch of psychiatry that deals with the assessment and treatment of mentally
disordered offenders and includes those areas where psychiatry interacts with
the law is called FORENSIC PSYCHIATRY
45. The
means of reaching thegoal of good mental healththrough actions that are taken
for the purpose of fostering, protecting and improving mental health is MENTAL HEALTH PROMOTION
46. A
person is not criminally responsible for an act or omission if at the time of
doing the act or making the omission he is, through any disease affecting his
mind,incapable of understanding what he is doing, or of knowing that he ought
not to do the act or make the omission is called INSANITY
47. When
a person getting psychiatric treatment commits a serious offence while they are
not documented legally that they are suffering from mental disorders, such a
person is liable to prosecution until proven mentally ill by a qualified and
registered psychiatrist is called PRESUMPTION OF SANITY
48. The
stages of alcohol intoxications are Euphoria, Excitement, Confusion, Stupor ,
Coma and DEATH
49. The
three levels of intervention incommunity mental health are Primary
Prevention,Secondary Prevention and
TERTIARY PREVENTION
50. Adding
a rewarding stimulus as a consenquence of a behaviour , thus increasing the
probability will occur again is referred to as POSITIVE REINFORCEMENT
51. Any
act deliberately undertaken by a patient who mimics the act of suicide but does
not result in a fatal outcome is called SUICIDAL
ATTEMPT
52. The
children with Attention Deficit Hyperactivity Disorder exhibit a triad of
symptoms which include Impulsivity, Hyperactivity and INATTENTION
53. A
persistent irrational fear of an activity, object or situation is called A PHOBIA
54. The
type of delusion in which there is exaggerated belief of one’s own power and
importance is called GRANDIOSE DELUSION
55. The
pathological inability to recall events that occurred prior to the onset of the
illness is called ANTEROGRADE AMNESIA
56. The
type of mania in which the patient is unresponsive ,immobile, mute and fully
conscious is called CATATONIA RETARDED
TYPE
57. The
sexual dysfunction in which there is a strong negative feeling or anxiety
associated with prospect of sexual activity with subsequent avoidance is called
SEXUAL AVERSION DISORDER
58. A
disorder in which there is insufficient quality and quantity of sleep is called
INSOMNIA
59. PARANOID PERSONALITY DISORDER is a type of disorde in which the patient
suspects others as exploiting, harming or deceiving him or her,
60. The
deprivation of neccesities or failure of a parent or persons legally
responsible for the child’s welfare to provide for the child’s basic needs and
adquate level of care is called CHILD
ABUSE
61. Production
of false stories to fill in memory gaps is known as CONFABULATION
62. The
sexual arousal and satisfaction by wearing the clothes appropriate to the
opposite sex is called TRANSVESTIC
FETISH
63. New
words created by the patient for psychological reasons are called NEOLOGISMS
64. According
to Abraham Maslow, a persoidn who has reached their full potential is perceived
to be SELF-ACTUALIZED
65. A
recurrent and intrusive thought, feeling or idea is called OBSESSION
66. A
consequence that causes undesirable behaviour to occur with less frequency is
called PUNISHMENT
67. An
individual believes that he/she posses recognized talent or in sight such as
that of religious leader and seek for position of power is said to have GRANDIOSE DELUSIONS
68. A
state of wellbeing characterised by the absence of mental or behavior disorder
whereby the person has made satisfactory adjustment as an individual and to the
community, in relation to emotional, personal, social and spiritual aspects of
their life MENTAL HEALTH
69. FLIGHT OF IDEAS refers
talking of many things within a short period or tendency of talking fron one
idea to another due to pressure of ideas or speech.
70. A
false sense of familiarity with unfamiliar circumstances or senses is called JAMAIS VU
71. NIHILISM is
a feeling of nothingness or false belief
of nothingness.
72. The
inability to experience pleasure in previously pleasurable activities is called
ANHEDONIA
73. The
type of personality disorder which is characterised by constant disregard and
violation of the rights of others and lack of concern for the feelings of
others is called ANTISOCIAL PERSONALITY DISORDER
74. The
type of phobia in which there is persistent abnormal fear of being helpless in
a situation from which escape maybe difficult or embarassing which leads to
avoidance of such situations is called AGORAPHOBIA
75. The type of depresion where the cause is considered
to becoming from outside is called EXOGENOUS DEPRESSION
76. Looking inward to understand oneself and objectively
without bias eamine one’s beliefs, values, attitudes, motivations, strengths
and limitations is called SELF-AWARENESS
77. A situation where, the person experiences thoughts
imposed by some external force is referred to as PASSIVITY FEELINGS
78. A non-specific response of the body to any demand
made upon it is known as STRESS
79. The type of admission where the employers writes a
letter to the hospital requesting the medical officers to examine the patient
and determine whether that person can continue working or be retired on medical
grounds is called UNDER MEDICAL BOARD
80. ASSERTIVENESS
is the ability to communicate your needs, feelings,
opinions and beliefs in an open and honest manner without violating or injuring
the rights of others.
81. The skill used bt the nurse to determine the basic
message in a patient’s statement, and then restating the sentence in similar
words used by the patient is called PARAPHRASING
82. NEUROSIS
refers to a category of mental disorders in which
the symptoms are distressing to the person,reality testing is intact and
behaviour does not violent gross social norms.
83. A pattern of passive dependent behaviour observed among psychiiatric inpatients, which is characterised by hospital attachment and resistance to discharge is called INSTITUTIONALISM
TOP PSYCHIATRY
Multiple Choice Questions and Answers
PSYCHIATRY
Multiple Choice Questions with Answers:-
1. Delusions in clear consciousness
are seen in:
a) Dementia
b) Delirium
c) Schizophrenia
d) Neurosis
Ans: c
2. Impaired consciousness, visual
hallucination, hyperactivity and fragmentary delusions are
a) Delirium
b) Dementia
c) Paranoid psychosis
d) Schizophrenia
Ans: a
3. Dementia is seen in all except
a) Schizophrenia
b) Head injury
c) Huntington’s chorea
d) Cannabis
Ans: c
4. Common cause of mood congruent
delusions is:
a) Schizophrenia
b) Paraphrenia
c) Paranoia
d) Depression
Ans: d
5. IQ is
a) Mental age/chronological x 100
b)CA/MAxlOO
c)MA+CA/MAxlOO
d)MA+CA/CAxlOO
Ans: a
6. Which is not a feature of Hyperkinetic
child
a) Low IQ
b) Low attention span
c) Right to left dissociation
d) Amphetamine is drug of choice
Ans: c
7. Who introduced cocaine in psychiatry?
a) Freud
b) Jung
c) Miller
d) Stanley
Ans: a
8. Which of the following is a
mature defense mechanism
a) Projection
b) Reaction formation
c) Anticipation
d) Denial
Ans: a
9. Most common cause of mood
congruent delusion is:
a) Schizophrenia
b) Mania
c)OCN
d) Dementia
Ans: b
10. The most common post-partum
psychosis is
a) Mania
b) Depression
c) Dementia
d) Schizophrenia
Ans: b
11. Not a proper match
a) Auditory hallucination – Alcoholism
b) Thought broadcasting-schizophrenia
c) Delusion of infidelity – obsessive compulsive neurosis
d) Delusion of grandeur – mania
Ans: c
12.Suicidal tendencies are least
common with
a) Alone
b) Depression
c) Old age
d) Married person
Ans:d
13.Psycho analysis was introduced by
a) Freud
b) Schielder
c) Dale & Denicker
d) Eugen Bluer
Ans:a
14.’Reinforcement’ is used in:
a) Psychoanalysis
b) Hypnoanalysis
c) Abreaction
d) Conditioned learning
Ans:d
15.Dissociation is seen in all
except
a) Somnambulism
b) Fugue
c) Multiple personality
d) None
Ans:a
16.Thematic perception test is named
after
a) Freud
b) Simon paul
c) Douglas
d) Wechslers
Ans:d
17.That part of mind which is
working on reality principle is:
a) Id
b) Ego
c) Super ego
d) Ego-ideal
Ans:b
18.All are features of type A
behavior, proposed by Friedman and Rosenman except:
a) Time urgency and impatience
b) Hard driving career orientation
c) Ambitiousness
d) Poor job involvement
Ans:d
19.Vasanthi 45 years, was brought to
casualty with abnormal movements which included persistent deviation of neck to
right side one day before she was prescribed Haloperidol 5 mgs three times
daily from the psychiatry OPD. She also had an altercation with her husband
recently. Which of the following is the most likely cause for her Symptoms.
a) Acute drug dystonia
b) Conversion reaction
c) Acute psychosis
d) Cerebrovascular accident
Ans:a
20.The commonest cause of mental
retardation is:
a) Alkaptonuria
b) Kluver-Bucy syndrome
c) Korsakoffs syndrome
d) Birth asphyxia
Ans:d
21.A Tibetian living in high
altitude is now at sea level. His wife died 2 weeks back. He says he has seen
his wife twice during this period and she asked him to join her at heaven. The
diagnosis is
a) Normal grief reaction
b) Brief reactive psychosis
c) Bereavement reaction
d) Schizophrenia
Ans:b
22.The best account for diagnosis of
psychoneurosis is derived from:
a) Verbal accounts
b) Visceral reactions
c) Motor behavior
d) Reaction to environment
Ans:a
23.Ego’s defense mechanism “Undoing”
is typically seen in:
a) Depression
b) Schizophrenia
c) Obsessive-compulsive neurosis
d) Hysteria
Ans:c
24.Kalloo, a 24 year old occasional
alcoholic has got a change in his behavior. He has become suspicious that
people are trying to conspire against him though his father states that there
is no reason for his fears. He is getting hallucinations of voices commenting
on his actions. What is the most probable diagnosis
a) Delirium tremens
b) Alcohol induced psychosis
c) Schizophrenia
d) Delusional disorder
Ans:c
25.The eight-stage classification of
human life is proposed by
a) Sigmund Freud
b) Pavel
c) Strauss
d) Erikson
Ans:d
26.An alcoholic woman was brought to
the casualty following a suicide attempt by taking several tablets of diazepam.
There is history of previous attempts of suicide by wrist slashing, etc. The
type of personality dis order in this woman is
a) Histrionic personality
b)Dependent personality
c) Narcissistic personality
d) Border line personality
Ans:d
27.Patient presents with altered
behavior, delusions & hallucination suggest
a) Psychotic disorder
b) Confirms schizophrenia
c) Korsakoff’s psychosis
d) Obsessive-compulsive neurosis
Ans:a
28.All are affective disorder except
a) Depression
b) Obsessive compulsive neurosis
c) Reaction formation
d) Adjustment reaction
Ans:b
29.Commonest psychiatric illness in
India is:
a) Schizophrenia
b) Endogenous depression
c) Neurotic depression
d) Anxiety neurosis
Ans:c
30.One of the important defence
mechanisms is:
a) Alienation
b) Confabulation
c) Repression
d) Suppression
Ans:c
31.A middle-aged patient was brought
to the hospital in stuporous conditions with loss of power in all four limbs.
Waxy flexibility of muscle tone in the limbs was detected. The most likely
diagnosis is:
a) Hysterical stupor
b) Organic stupor
c) Catatonic stupor
d) Depressive stupor
Ans:d
32. Oedipus complex (given by
Sigmund Freud) is seen in:
a) Boys of 1 -3 years of age
b) Girls of 1 -3 years of age
c) Boys of 3-5 years of age
d) Girls of 3-5 years of age
Ans:c
33. The term “Ambivalence” was
coined by:
a) Hippocrates
b) Eugen Bleuler
c) Kraeplin
d) Sigmund Freud
Ans:b
34.Which of the following is a
dissociative phenomenon
a) Fugue
b)Amnesia
c) Deafness
d) Lack of insight
Ans:a
35.Which is most specific of
psychosis
a) Pressure of speech
b) Neologism
c) Incoherence
d) Preservation
Ans:b
36.Lesion in autistic disorder is in
a) Corpus collosum
b) Frontal lobe
c) Temporal lobe
d) Cerebellum
Ans:c
37.Basanti age 27 years, female
thinks her nose is ugly, her idea is fixed not shared by anyone else. Whenever
she goes out of home, she hides her face with a cloth. She visits to surgeon.
Next step would be
a) Investigate and then operate
b) Refer to psychiatrist
c) Reassure the patient
d) Immediate operation
Ans:b
38.Irresistible urge to move about
and increased motor activity is
a) Rabbits syndrome
b) Malignant neuroleptic syndrome
c) Akathasia
d) Tardive dyskinesia
Ans:c
39.Which is in first rank symptom
described by Scheidner?
a) Echolalia
b)Thought insertion
c) Autism
d) Suicidal tendency
Ans:b
40.The characteristic symptom of
Hyperkinetic syndrome is
a) Reduced attention span
b) Mental retardation
c) Extreme shyness
d) Truancy
Ans:a
41.Disturbances of affect include
all except
a) Panic
b) Apathy
c) Phobia
d) Obsession
Ans:d
Ans:b
43.A
false belief unexplained by reality, shared by a number of people is:
a) Superstition
b) Illusion
c) Delusion
d) Obsession
Ans:a
44which of the following is a center
for recent memory:
a) Parietal cortex
b) Temporal lobe
c) Hippocampus
d) Thalamus and sub thalamus
Ans:c
45.Sleep deprivation leads to:
a) Psychotic behavior
b) Decreased mental alertness
c) Emotional disturbances
d) Anxiety neurosis
Ans:b
46.A person who is a chronic
alcoholic is brought to the casualty. When asked he says that he is drinking
because of the quarrels with his wife. The defence mechanism is
a) Denial
b) Rationalization
c) Sublimation
d) Projection
Ans:b
47.Fugue state may be seen in:
a) Schizophrenia
b) Hysteria
c) Epilepsy
d) All of the above
Ans:d
48.Mature defence mechanism is seen
in
a) Altruism
b) Repression
c) Regression
d) None
Ans:a
49.The following are psychotic
disorders except
a) Schizophrenia
b) Mania
c) Psychotic depression
d) Hysteria
Ans:d
50.A person quarrels and hits his
neighbor. The next day starts feeling that he is being followed by police and
that they may arrest him. He also feels that his neighbors are controlling him
by radio waves. Diagnosis is
a)Delusion of persecution
b) Schizophrenia
c) Passivity
d) Thought insertion
Ans:b
51.Mental retardation implies
a) Depression of brain
b) Intellectual deficiency
c) Suspicious behavior
d) Emotional disorder
Ans:b
52.Major psychosis is
a) Neurosis
b) Dementia
c) Reactive depression
d) Endogenous depression
Ans:d
53.All are true about hyper kinetic
child except
a) Poor impulse control
b) Increase in the anger outburst
c) Right to left disorientation
d) Decrease in attention span
Ans:c
54.A person missing from home, found
wandering purposefully, well groomed, has some degree of amnesia
a) Dissociative fugue
b) Dissociative amnesia
c) Schizophrenia
d) Dementia
Ans:a
55.Delirium and schizophrenia differ
from each other by:
a) Change in mood
b) Complete consciousness
c) Tangential thinking
d) All
Ans:b
56.Concept of super ego was given
by:
a)EricFromm
b) Sigmund Freud
c) Eric Erikson
d) Carl Jung
Ans:b
57.The following are psychosomatic
disorders except
a) Hypertension
b) Pepticulcer
c) Cirrhosis of liver
d) Asthma
Ans:c
58.Confabulation means
a) Conversation with imaginary person
b) Misinterpretation of stimulus
c) Perception in the absence of stimuli
d) Making stories to fill up gaps in memory loss
Ans:d
59.Which category is most prone for
suicide
a) Adolescent girl
b) Old man
c) Unemployed youth
d) Married woman
Ans:a
60.One of the following is used to
test
a) Eyesenck personality
b) Ink blot test
c)Sentence completion
d) Binet Stanford test
Ans:d
61. Fugue’ state occurs in
a) Head injury
b) Depression
c) Hysteria
d) Mania
Ans:c
62.AH the following are defense
mechanisms of ego except
a) Projection
b)Conversion
c) Reaction formation
d) Transference
Ans:d
63.Characteristic feature of
psychosis is
a) Mood disturbance
b) Suicidal tendency
c) Autistic tendency
d) Acceptance of other persons delusion
Ans:d
64.The commonest mental illnesses in
children are:
a) Mental retardation
b) Infantileautism
c) Enuresis
d) Neuroses
Ans:d
65.Oedipus complex has been
described by:
a) Plato
b) Socrates
c) Freud
d) Huxley
Ans:c
66.Preoccupation with body diseases
is seen in
a) Obsession
b) Somatisation
c) Hypochondriasis
d) Conversion disorder
Ans:c
67.The most common psychiatric
disorder is
a) Depression
b) Dementia
c) Schizophrenia
d) Paranoia
Ans:a
68.Mental retardation implies
a) Depression of brain
b) Intellectual deficiency
c) Suspicious behavior
d) Emotional disorder
Ans:b
69.The classic psychosomatic illness
include all of the following except
a) Essential hypertension
b) Rheumatoid arthritis
c) Hyperventilation
d) Bronchial asthma
Ans:b
70.22 year old Babu had a fight with
his neighbor’s son. Next day, while going to the bus stop, he felt that 2
uniformed policemen were following him. On reaching home he was frightened and
he felt that the neighbors were using radio waves to control his mind. What is
his symptom
a) Delusion of persecution
b) Passivity
c) Auditory hallucination
d) Thought insertion
Ans:c
71.Delusion is
a) A feeling of loss of sensation
b) Not able to get proper answer
c) A false belief
d) An uncomfortable sensation
Ans:c
72.Which does not cause dementia?
a) Multiple infarction
b) Huntington’s chorea
c) Alzheimer’s disease
d) Schizophrenia
Ans:d
73.Illusion with loss of
consciousness is seen in
a) MDP
b) Delirium
c) Schizophrenia
d) Anxiety Neurosis
Ans:b
74.Dementia is produced by
deficiency of vitamin:
a) A
b) D
c) Pyridoxine
d) Niacin
Ans:d
75.Persistent belief in something
which is not a fact is
a) Illusion
b) Hallucination
c) Delusion
d) Delirium
Ans:c
76.All are features of Dementia except
a) Impaired memory
b) Loss of judgment
c) Impaired consciousness
d) Loss of learned function
Ans:c
77.The most common cause of organic
amnestic syndrome is:
a) Alzheimer’s disease
b) Concussion
c) Hypoxia
d) Vitamin deficiency
Ans:b
78.Biochemical etiology of
Alzheimer’s disease relates it to:
a) Acetylcholine
b)GABA
c) Serotonin
d) Dopamine
Ans:a
79.Dementia is seen in all except:
a) Head injury
b) Alzheimer’s
c) chizophrenia
d) Huntington’s chorea
Ans:c
80.Dissociation is seen in
a) Schizophrenia
b) Mania
c) Hysterical conversion
d) Organic brain syndrome
Ans:c
81.22 year old Mahesh had fight with his neighbor’s son. Next day, while going to the bus stop, he felt that 2 uniformed policeman were following him. On reaching home in the evening,he was frightened. He felt that the neighbors were using radio waves to control his mind.What is his symptom?
a) Passivity
b) Delusion of persecution
c) Auditory hallucination
d) Thought insertion
Ans:b
82.Sub cortical dementia is
a) Memory
b) Dyslexia
c) Tactile Agnosia
d) Receptive Aphasia
Ans:c
83.A 68 year old man complaining of
hearing voices from the upper floor using abusive language believes that
somebody is trying to take away his property. He also does unusual things as
wearing his vest over his shirt. He could be suffering from
a) Schizophrenia
b) Dementia
c) Delusion
d) Hysteria
Ans:c
84.Tick the proper answer among the
answer provided. Hallucination is a
a) Thinking disorder
b) Disorder of perception
c) Disorder of motor behavior
d) Disorder of consciousness
Ans:a
85.Reversible cause of dementia
a) Post encephalitis
b) Multi infarct
c) Hydrocephalus
d) Senile dementia
Ans:a
86.Following are predispositions to
Alzheimer’s disease except
a) Down’s syndrome
b) Head trauma
c) Smoking
d) Low education group
Ans:c
87.In the absence of auditory
hallucination, visual or tactile hallucinations are in favour of one
the following conditions
a) Conversion disorder
b) Panic disorder
c) Manic disorder
d) Organic brain syndrome
Ans:d
88.Delusions are found in all of the
following disorders except
a) Schizophrenia
b) Psychotic depression
c) Mania
d) Personality disorder
Ans:d
89.False perception without any
external stimulus is
a) Hallucination
b) Delusion
c) Illusion
d) Mania
Ans: a
90. Delusion is not seen in
a) Depression
b) Anxiety
c) Schizophrenia
d) Mania
Ans:b
91. Delusion of infidelity on part
of the sexual partner is known as:
a) De Clerambault’s syndrome
b) Couvade syndrome
c) Othello syndrome
d) Ekbim’s syndrome
Ans:c
92. Subcortical dementia is seen in
all except
a) Parkinsonism
b) Alzheimer’s disease
c) Wilson’s disease
d) Huntington’s Chorea
Ans:b
1. Mental
disorders are defined by
a) Confirmation
of how the individual acts
b)
Behavior
and what the individual thinks
c) How
the person feels, acts and perceives things
d) Talking
a lot
2. The
term Psych from psychiatry in greed means:-
a) Disease
b) Confusion
c)
Mental
processes
d) Healing
3. Psychiatry
nursing is a speciality concerned with
a) People’s
health
b) Application
of health principles in nursing care
c)
Application
of psychiatric principles in nursing care
d) Patients
with mental problems
4. A
mental disorder manifested with severe impaired thinking, emotions and behavior
is called
a)
Schizophrenia
b) Hallucinations
c) Mania
d) Hypomania
5. The
biggest mental health hospital, Chainama Hills was opened in
a)
1962
b) 1960
c) 1964
d) 1965
6. Training
of enrolled psychiatric nurse at Chainama Hills Hospital started in
a)
1967
b) 1966
c) 1968
d) 1980
7. Psychiatric
patients at times believe that there thoughts are known by other people. This
is called
a)
Thought
broadcasting
b) Thought
insertion
c) Hallucinations
d) Thought
withdraw
8. A
mental disorder characterized by persecutory delusions and inflicting harm is
known as
a) Simple
schizophrenia
b)
Paranoid
schizophrerenia
c) Catatonic
schizophrenia
d) Hebephrenia
schizophrenia
9. A
mood disorder is also referred to as
a)
affective
disorder
b) Irritable
disorder
c) Cognitive
disorder
d) Mania
10. The
following are causes of mood disorders
EXCEPT
a) Hereditary
factors
b)
Emotional
stability
c) Stressful
life events
d) Illnesses
11. The
following are examples of obsessive behavior except
a) Fear
of losing things
b) Fear
of contamination
c) Fear
of losing a spouse
d)
Severe
anxiety
12. Panic
disorder is common in
a)
Women
b) Children
c) Men
d) Females
and men
13. Cognitive
behavioral therapy is indicated in
a) anxiety
disorder
b) Panic
disorder
c)
Compulsive
disorder
d) Mood
disorder
14. Anxiety
which results from traumatic experience is called
a) Stress
disorder
b) Pre
stress disorder
c)
Post
traumatic disorder
d) Traumatic
disorder
15. Persistent
and emotional fear of any specific object or situation is called
a) Stress
b)
Phobia
c) Phobic
stress
d) Emotional
upset
16. Fear
of a situation in which an individual may be exposed to scrutiny by others is
known as
a) Agoraphobia
b)
Social
phobia
c) Photophobia
d) Phobia
17. The
common type of phobia among women is
a) Social
phobia
b) Specific
phobia
c) Photophobia
d)
Agoraphobia
18. Which
of the following is not commonly associated with a psychiatric disorder
a) Anxiety
b) Personality
changes
c) Agitation
d)
Good
memory
19. A
relationship in which the client is helped to make a decision is called
a) Teaching
b) Communication
c)
Counselling
d) Friendship
20. Treatment of a mental patient through psychological
method is also known as
a)
Psychotherapy
b) Phototherapy
c) Chemotherapy
d) Pharmacotherapy
21. The
acronym that best demonstrates and summarizes behavior during counselling
sessions is known as…………
a. Counselling
therapy
b. Behavior
modification
c.
Soler
d. Counselling
skills
22. The
inability to recognize objects and people is known as…..
a. Alogia
b. Apraxia
c.
Agnosia
d. Aphasia
23. The
most common cause of dementia is
a. HIV/AIDS
b. Cerebral
vascular accident
c. Stroke
d.
Alzheimer’s
disease
24. The
type of Schizophrenia where a person has symptoms of both Schizophrenia and a
major mood disorder such as depression is called:-
a) Paranoid
Schizophrenia
b) Catatonic
Schizophrenia
c)
Schizoaffective
disorder
d) Simple
Schizophrenia
25. Anxiety
is caused by….
a. Objective
threat
b.
Subjective
perceived threat
c. Hostility
turned to self
d. Masked
depression
26. Which
drug is mostlyq indicated in anxiety
a. Modicate
b. Lithium
c. Prozac
d.
Valium
27. Fragmented
thinking means……………….
a) Beating
about the bush
b)
Having
disjointed ideas
c) Ideas
coming into your mind frequently
d) Repeating
what the interviewer says
28. The
only institution in Zambia ,which is used to confine people who have committed
homicide or grievous bodily harm to
others, as a result of being insane is;.
a) Chainama
North
b) Chainama
west
c) Chainama
South
d)
Chainama
East
29. Which
one of the following drugs is a tricyclic anti-depressant
a. Iripiprazole
b.
Imipramine
c. Trifluoperazine
d. Diazepam
30. ……..
is an anti-psychotic drug belonging to the family of typical antipsychotics
a. Sertraline
b.
Trifluoperazine
c. Imipramine
d. Iripiprazole
31. Which
one of these best describes self-awareness skills
a. It
is about teaching the patient step by step way of changing bad behavior and
learn good behaviour.
b.
It’s
about inspecting oneself inwardly
c. Its
about training patient to express themselves in an appropriate way
d. Its
about helping patient change abnormal behavior
32. An
affective disorder which presents with elation of mood and increased
psychomotor activities is called………………
a. MDD
b. Neurosis
c.
Mania
d. Hysteria
33. Thought
broadcasting is described as……..
a. Thoughts
made aware to oneself
b. Belief
that thoughts are being taken away from oneself.
c.
A
belief that ones thoughts are being shared by others
d. Misinterpretation
of external stimuli
34. A
form of hostile aggression that does damage to another's peer relationships, as
in social exclusion or rumor spreading
a. Hostile
aggression
b.
Relational
aggression
c. Instrumental
aggression
d. Fear
induced aggression
35. ........are
internal debates in which arguments for and against even the simplest every day actions are reviewed endlessly.
a. Obsessional phobias
b.
Obsessional doubts
c. Obsessional
rumination
d.
Obsessional rituals
36. Echopraxia is defined as…..
a. Purposeless
imitation of others
b. Absence of emotional expression in person
c. Difficulties in finding the right word
d. False perception or response to stimulus
37. The outward expression of the immediate experience
of emotions at a given time is called..
a. Mood
b. Illusion
c. Behaviour
d. Affect
38. ……
is the knowledge and skills people need to have to live in the community.
a. Assertive
skills
b. Counselling
skill
c. Reacreation
skills
d.
Social
skill
39. Examples of social skills include all of the
following except:
a. Holding
conversations
b. Establishing
and maintaining friendships
c. Dating
d.
Deviance
40. Grooming
is an example of……..
a. Assertive
skills
b. Behavioural
modification skills
c.
Social
skills
d. Counselling
skills
41. Numerous
activities and skills that are a part of leading a happy and successful life
are collectively known as…..
a. Behavioural
modification skills
b.
Social
skills
c. Counselling
skills
d. Stress
management skills
42. Different
ways of changing abnormal behavior include:
a. Classical
conditioning
b. Operant
conditioning
c. Modelling
d.
All
of the above
43. The several types of admissions
in psychiatry include all of the following except:
a.
Voluntary
b.
Emergency
c.
Involuntary
d. Elective
44. Discharge
planning involves working through phases, and in the ………..the admitting nurse and
multi-disciplinary team hold a meeting with the client and relatives in which they together begin to plan for the patient’s eventual discharge upon
recovery.
a. Working
phase
b. Termination
phase
c.
Introduction
phase
d. Termination
phase
45. During
the …………….. the community mental health team may be called upon to make a home
visit to assess the home environment before a patient goes there.
a. Norming
phase
b.
Working
phase
c. Termination
phase
d. Introduction
phase
46. The
……… is a transition phase in which the patient passes from a mental hospital to
the community and in which the patient is discharged.
a.
Working phase
b.
Termination
phase
c. Introduction
phase
d. Norming
phase
47. Brian a psychiatric patient was heard
formulating a sentence as follows “Braid, raid and aid.” Which disordered
speech pattern is this?
a. Word
salad
b. Neologism
c.
Clang
association
d. Echolalia
48. Mary from a female ward was fond of coining
the phrase “Bing boom, big bang, a ragged rascal who bought a bang gang round
the rocks.” Which disordered speech pattern is this?
a.
Word
salads
b. Neologism
c. Clang
association
d. Echolalia
49. Actions that result from ideas that come into one’s
mind frequently are known as………….
a. Obsessive
rituals
b.
Compulsions
c. Waxy
flexibility
d. Habits
50. …………
is the interaction between people and their environment based on stimuli and
responses.
a. Counselling
b. Socialization
c.
Communication
d. association
ESSAY QUESTIONS REVIEW
QUESTION 1 A
You are the in-charge for E ward and you observe patients are fond of
sleeping, doing nothing and seem to lack interest in their surroundings, they
lack initiative and appear to be powerless in decision making about issues that
concern their lives.
A) Define
institutionalization 5%
B) Discuss the
causes of institutionalization 25%
C) As an
in-charge of E ward, what measures should put in place to address this
problem 20%
QUESTION 1B
Edina Moyo, is a schizophrenic patient admitted in chainama hospital for
the past 8 years. She is observed to have developed the symptoms of being
institutionalized.
A) Define
institutionalization 5%
B) Explain five
(5) features of institutionalization on the patient and how you would
manage them 25%
C) Explain five
(5) measures you would take to prevent developing symptoms of
institutionalization 20%
D) Describe ten
(10) points you would include in the rehabilitation programme for Edina Moyo
who is institutionalized 50%
QUESTION 2
The current ministry of Health Policy focuses on public Health with emphasis
on health promotion and disease prevention. You happen to implement the above
policy in your community
A) Explain the three (3) levels of prevention in
relation to mental illness to the student nurses 30%
B) You are
trying to find out the prevalence of mental illness in the community, discuss
four (4) data collection techniques 40%
C) Explain the
importance of follow up visits/home visits in relation to psychiatric patients 30%
QUESTION 3
You are a mental health nurse working at one of the Rural Health Centres
in the country. The local volunteers engaged to support people with mental
illness within the catchment area informs you that the greatest challenge faced
by individuals with mental illness in the community is stigma.
A) Define the
two (2) forms of stigma likely to be experience by people suffering from mental
illness 10%
B) State five
(5) factors that contribute to stigma against clients with mental illness 20%
C) Explain five
(5) effects stigma may have on the recovery process from mental illness 20%
D) Describe the
program that you may develop within your catchment area aimed at reducing
stigma against people with mental illness
50%
QUESTION 4
Mr Mbuzi phiri male aged 36 years married with 4 children is admitted to
Chainama Hills Hospital with history of
alcohol abuse. The wife said her husband sometimes experiences tremor. He has
been suspended at work for absenteeism. The wife explains that he has impaired
thinking and hallucinations as well. On examination a provisional diagnosis of
alcoholism was made.
A) State six (6)
social effects of alcohol abuse 20%
B) Discuss how
alcohol abuse can be prevented 30%
C) Describe in
details the management of Mr. Mbuzi 50%
QUESTION 5
Mrs Nyambe went through various stages of the grieving process after
losing her husband 6 months ago and made several attempt to take her life. She
is admitted to the acute ward following suicidal attempts
A) I. Explain
three (3) significant loses that may lead to grieving 15%
ii. State five (5) stages of grieving 15%
B) Explain three
(3) types of suicide 15%
C) What are some
of the circumstances that may complicate grieving 35%
D) Outline the
management of a client who has three previous attempts of suicide while on the ward 20%
QUESTION 6
Mr. Mulenga, a 36 year old man is due to undergo Electro-convulsive
therapy (ECT). ECT remains controversial for many Psychiatric Practitioners.
One of the important ethical aspects of ECT is whether the therapeutic benefits
out-weigh the risk. Given that there is no conclusive evidence to identify ECT
as the treatment of choice in major depression, each case needs individual
assessment.
A) Discuss the preparation
of Mr. Mulenga before he undergoes ECT 25%
B) Lithium carbonate is
usually given to patients with psychiatric depression
(i) List five (5) side
effects of the drug 10%
(ii) Outline the specific
nursing care for the management of the side effects identified in (i) 25%
C) State five (5) side
effects of ECT 15%
D) Explain five (5) roles of
the community psychiatric nurse towards
Mr. Mulenga upon his discharge 25%
QUESTION 7
Lukundo is an epileptic patient; married with 3 children has been
brought to the ward following a grandmal seizure two days ago. The patient had
generalized movement of the body and confusion ensued thereafter. Since then
the patient just stares blankly in the environment, withdrawn and has
hallucinations and illusion. Patient is also neglecting himself and not eating.
A) Define epilepsy 5%
B) Discuss five (5) points
why epilepsy is a mental condition 15%
C) Discuss the management
of Lukundo according to the presenting symptoms
40%
D) You are required to draw
a rehabilitation plan for Lukundo, identify five (5) community based structures
that you would work with and explain their roles 40%
QUESTION 8
The issue of Child Abuse has raised concern among the Government and
Stake Holders.
A) Define the term “Child
Abuse” 5%
B) Outline five (5) factors
that contribute to Child Abuse 25%
C) Discuss five (5) effects
of abuse on a Child 25%
D) Outline the role of the community Mental Health Nurse in preventing and dealing with abuse. 45%
QUESTION 9
Mutinta, a young female adolescent is brought to the psychiatric
hospital amidst talking and shouting on top of her voice non-stop. The mother
had accompanied her saying this was of sudden onset. The daughter cannot sleep
claims she is the newly crown queen of England, and feels she has some special
powers to save the world. The staff on the ward decides to manage this client
accordingly.
A) Define Mania 5%
B) State five (5) causes of
mania 15%
C) State five (5) clinical
manifestation of mania 15%
D) Discuss the management of
mutinta 50%
E) State five (5) points
you would include in your information education and communication to both mutinta
and the relatives on discharge 15%
QUESTION
10
Aggression is one of the common sign that are exhibited by mentally ill
patients
A) Define aggression 5%
B) Explain five (5) risk
factors of aggression 20%
C) Discuss the nursing
intervention during an episode of aggression
50%
D) Discuss how you would
prevent episode of aggression in the ward
25%
ANSWERS
Question 2
A)
I.
Primary prevention. This is defined as
reducing the incidence of mental illness/ disorders within the population. It
mainly targets individuals and the environment and emphasis is twofold:
Assisting individuals to increase the abilities to cope with stress within the
environment. Targeting and diminishing harmful forces (stressors within the
environment).Nursing in primary intervention is fused on targeting groups at
risk and the provision of education programs such as teaching physical and
psychosocial effects of alcohol and drugs to primary and secondary school
children. Teaching techniques of stress management to virtually anyone when
desires to learn. Teaching the concepts of mental illness within the community.
II.
Secondary prevention: This is accompanied through early
identification of problems and prompts initiation of treatment. Nursing in
secondary prevention focuses on recognition of symptoms and provision of
referrals for treatment for example ongoing assessment of individuals of high
risk of mental illness. This is done through home visit, day care, community
health centers or any setting where screening of high risk individuals might
occur. Provision of care for individuals
in whom illness symptoms have been assessed and the type of care is done
through counselling, medication, admission, health education as well as support
III.
Tertiary prevention. This is defined as reducing
the residual defects that are associated with severe or chronic mental illness.
This is accomplished in two ways: Prevention of complication of illness.
Promoting rehabilitation that is directed towards achievements of each
individual’s maximum level of functioning. Nursing in tertiary prevention
focuses on helping the clients to earn or re-learn socially appropriate
behaviors so that they can achieve a satisfying role within the community. E.g.
Monitoring effectiveness of after care services through home visits or follow
up appointments in community mental health centers .Referring clients for
various after care services e.g. supports groups, day treatments programs,
psychosocial rehabilitation programs etc. Teaching the clients the daily living
skills and encouraging independence to his or her maximum ability.
(B ) Use of Available Information
Depending on the type of
information that is needed, a researcher can use the already available
information. For example, if the researcher needs information on the prevalence
of disease from a particular geographical area during a certain period of time,
he can simply request for the hospital and health centre record books and
retrieve the information. Or if the information is readily available from
Management Health Information System, the researcher can simply request for a
print out. Another example is the birth registration records kept by the
registration office. In order to retrieve the information in its original
state, the researcher may need to design a checklist or a compilation sheet or
form.
Observing
When using this technique, the researcher need to systematically select, watch and record the behaviors and characteristics of the people, objects or situations. Observation of human behavior can be done in two ways: Participant observation: This is when the observer takes part in the situation he or she observes. Non-participant observation: This is when the observer watches the situation, openly or concealed, but does not participate. Observations are important because they give additional, more accurate information on behavior of people than interviews or questionnaires. Observations can be used to check on information collected especially on sensitive topics such as alcohol or drug use, or stigmatization of epilepsy, or AIDS patients. Or they may be a primary source of information. Information can be obtained using tools such as scale, thermometer, eyes, tape measures, microscopes etc. Information obtained through observations can be recorded using either a checklist, or compilation sheets. Checklist and data compilation sheets are also called data collection tools.
Interviewing
An interview is a data-collection technique that involves the researcher asking questions to the respondents while the respondent provides answers. Interviewing should be carried out in a conversation manner.
The
answer - question session during interviews can be recorded either by writing
down the responses or using a tape recorder. Interviews can be conducted with
varying degrees of flexibility such as high and low degrees. The degrees of
flexibility are outlined below:
High degree of flexibility: These use loosely structured methods of asking
questions. There are no restrictions as to what or how the respondent should
answer. Data collection tools such as unstructured questionnaires or interview
schedules can be used. The interviewer is allowed to ask additional questions
to clarify issues. Loosely structured methods are used when there is little
knowledge of the problem or situation for example in exploratory studies or in
case studies.
Low grade flexibility: This method uses
questionnaires that have a fixed list of questions with fixed or
pre-categorized answers. The methods are used when the researcher has less
knowledge about the expected answers and when the number of participants to be
interviewed is large.
Administering written
questionnaires
A written
questionnaire is a data collection tool that the respondent has to answer by
writing in the questionnaire according to the instructions given. A written
questionnaire is also called a self-administered questionnaire. Questionnaire can
be sent by mail. Clear instructions should be given to respondent on how to
answer and where to post the filled in questionnaire. Respondents can be
gathered in one area at the same time. Oral or written instructions are given
to them and respondents fill in the questionnaire. The questionnaires are then
collected from the respondents. The questionnaires can also be delivered to the
respondents by hand and then collected later on. It involves close and open
ended questions. Open-ended type of
questions allows the respondent to express themselves freely. The kind of data
collected from open-ended type of questions is called qualitative data. Open-ended
questions allow flexibility in the sense that the respondents are not
restricted or the degree of restriction is minimal. Closed-ended questions do
not allow the respondent or the interviewer to express themselves or seek
clarification respectively. They are used to collect quantitative data. Both
types of questions can be used in a questionnaire. Use of both flexible
(qualitative methods) and non - flexible (quantitative methods) is helpful in
that they complement each other.
(C) Purpose of home visit
- Home visit is done in order to
assess the patient’s response to treatment
- In order to assess the level of
drug compliance in cases of defaulters.
- In order to assess the home
environment if there are any triggering factors such as family support, stigma
and discrimination. The structure of the house can also show the economic
status of the patient e.g poverty.
- Assessment of family dynamics
- Assessment of social support system
available
- Assessment of coping strategies
- Physical assessment such as nutrition
Q. 4. ANSWERS
SIX (6) SOCIAL EFFECTS OF ALCOHOL
1. Disruption
of marriages; alcohol can lead to disruption of marriages in that people who
take alcohol tend to have impaired judgment which can lead to violence in homes
causing disruption of a marriage.
2. Unemployment.
Alcohol leads to poor work performance and absenteeism which leads to loss of
jobs.
3. Poverty;
this can occur due to employment loss and because alcoholics tend to use most
of their finances on alcoholism leading to poverty.
4. Road
traffic accidents; alcohol leads to impaired judgment which can lead to road
traffic accidents.
5. Serious
illnesses; alcohol deteriorates the health status e.g. it causes hypertension,
liver cirrhosis, peripheral neuropathy
6. Increased
reckless behaviors; alcohol increases
the libido of someone causing them to be involved in reckless behaviors such as
having sex with different ladies which also leads to the development of
sexually transmitted diseases.
PREVENTION
OF ALCOHOL ABUSE
1. Sensitization
of the community on the dangers of alcohol abuse. This can be done through the
media, music, drama e.t.c.
2. Organizing
school health services in the community; this involves screening of pupils for
substance abuse and educating them on the dangers of substance abuse.
3. Recreational
activities. The community should identify community based programs to occupy
the youths and unemployed in order to reduce idleness, hence reducing substance
abuse.
4. Reporting
people selling illegal substances to relevant authorities.
5. Conducting
counselling sessions; when patients are cancelled about the dangers of
substance abuse, it helps them to understand the effects of substance abuse
which helps to prevent substance abuse.
6. Conducting
group therapies within the hospital; this therapy helps the clients to
understand more about substance abuse, its effects and how it can be avoided,
hence it helps clients prevent substance abuse
MANAGEMENT
OF MR NJOBVU WITH ALCOHOL ABUSE
Management of alcohol
abuse generally involves immediate intervention, nursing management,
pharmacological management, counselling and managing the side effects of drugs
IMMEDIATE
MANAGEMENT
Since the patient is
presenting with alcohol withdrawal symptoms, therefore the immediate
intervention will involve calming the patient by administering benzodiazepines
such as diazepam 10mg iv. If the patient is a danger to self, others or
property, will make sure the patient is observed throughout his stay at OPD.
Removing any dangerous objects which the patient can use to harm against self
or others, will help ensuring safety for the patient and others. A full
diazepam detox regime will be prescribed by the clinician. The initial dose of
this treatment regime can either be commenced from the filter clinic or on the
ward depending on the severity of the condition. Patient shall require to take
treatment for five (5) days and the route of administration will depend on the
patient’s condition.
TREATMENT REGIME GUIDELINE FOR
DIAZEPAM IV (MODERATE – SEVERE
CONDITION)
Day 1……10mg QID
Day 2……10mg TDS
Day 3……10mg BD
Day 4……5mg BD
Day 5……5mg OD
NURSING
MANAGEMENT
PATIENTS
SAFETY AND ENVIRONMENT
Patient’s safety in the
environment is the nursing priority when nursing a patient with alcohol abuse.
The environment should be free from any dangerous objects that the patient can
use to harm himself as the patient is prone to falls. The patient should be
searched in his pockets for dangerous items that he can use to injure
himself. Since, Mr. Mbuzi is
experiencing withdrawal symptoms is likely to be anxious, therefore I will
orient the patient on the ward environment and I will make sure that the
environment is quiet, adequate lighting system
with low stimulation as such environment is favored for alcohol abusers.
In addition, monitor the risk of falls and ensure enough night light to reduce
perceptual errors which may exacerbate the anxiety levels and psychotic
phenomenon.
Detoxification of
alcohol is the initial treatment for alcohol abusers who experience alcohol
withdrawal symptoms. I will do a full detoxification to Mr. Mbuzi using
diazepam for five days as prescribed as it helps to alleviate withdrawal
symptoms and separate the patient from alcohol related social and environment
stimuli that may increases the risks of relapse.
THERAPEUTIC COMMUNICATION
Communicate to the
patient and the family about the nature of severity and duration of the
symptoms and the role of medication during the treatment of Mr Mbuzi.
Explaining all appropriate intervations to relatives and Mr Mbuzi clearly and
in the friendly manner to alley anxiety.
OBSERVATIONS
AND PHYSICAL EXAMINATION
Since Mr Mbuzi is
experiencing alcohol withdrawal symptoms, he is likely to have unstable vital
signs, therefore I will ensure that the blood pressure, temperature, pulse and
respiration are checked regularly to notice any deviation from the normal.
Physical examination should also be conducted to rule out certain medical
disorders that can occur comorbid with alcoholism which can exacerbate
withdrawal symptoms and complicate treatment. I will also observe if the
patient is responding well to treatment and monitor the patients eating
patterns.
NUTRITION
Most of the alcoholics
exhibit vitamin deficiencies, presumably due to poor diet habits as well as from
alcohol induced changes in the digestive tract that impairs the absorption of
nutrients into the blood stream. I will give folic acid to Mr Mbuzi for two
weeks as it helps in the synthesis of the cells genetic material and maturation
of certain blood cells. I will also administer thiamine 100 mg / day orally for
5 days (or longer if required) as it
helps in the metabolism of sugars for
energy and it prevent the development of
thiamine-deficiency syndromes such as Wernicke’s encephalopathy.
HYDRATION
AND COLLECTION OF ELECTROLYTE IMBALANCE
Mr NJOBVU is at risk of being dehydrated
as he might start sweating and fever due to hyperactivity of autonomic nervous
system induced by alcohol, I will ensure that he takes enough fluids as they
are essential for the performance of the physiological processes and to
maintain the function of the vital organs such as the heart and the kidney. I
will also collect electrolyte imbalances by administering magnesium, phosphate
and sodium as they help in the metabolism in order to prevent life threatening
metabolic disorders. Magnesium
supplements also helps to reduce the occurrence of seizures.
MEDICATION
INFORMATION, EDUCATION AND COMMUNICATION
Ø As
the patient stabilizes, I will explain about the importance of staying away
from alcohol as this will help on a good prognosis and prevent relapse cases.
Ø Patient’s
family shall be counseled on Mr Mbuzi’s condition. This will ensure the family
to take appropriate care and support necessarily
Ø Mr
Mbuzi will be canceled on the dangers of alcohol abuse and the social and
health effects that alcohol can cause.
Ø The
patient will be advised to be staying away from the influence of alcohol
especially his old associates in order to prevent alcohol relapse cases.
Ø Prior
to discharge, Mr. mbuzi will advised to undergo rehabilitation. This will help
him cope with his new life style. Rehabilitation will involve skills such as
problem solving skills, anger management skills, etc.
Ø
ANSWER
QUESTION 3
3 A) Self-stigma is where the client is self-stigmatised due to mental illness from the public. The other form of stigma is Public stigma is where the public stigmatises people with mental illness. They are considered to be of no value to the society.
B)
ü One of the factors that contribute to stigma against people with mental illness is the lack of knowledge about cause of mental illness. They believe that mental illness is caused by supernatural powers or evil spirits hence this makes them stigmatise people with mental illness.
ü The other factor that contribute to stigma is the side effects of medication that they are given to treat their condition, people usually experiences severe side effects that are unusual know that they are suffering from mental disorder hence they stop medication.
ü Course and duration of mental illness condition is also the cause of stigma for they believe that mental illness cannot be healed hence when one suffer from a mental disorder he is considered to be a permanent patient.
ü Relapse are at fault of causing stigma among people with mental illness when these patient are not compliant to medication regimen, they tend to relapse hence causing stigma.
ü The myth that people have towards mental illness.
C)
ü Stigma has a greater effects on the recovery process of mental illness in that people are reluctant to seek medical help at early stage of the illness and this makes it difficult for the illness to be completely treated because it has already progressed.
ü People stopped going to psychiatric hospitals to collect medication and this has really reduced the rate of people attending psychiatric clinics and hospital hence increase in the number of relapse.
ü Patients because of stigma they loss employment as they are considered to be non-functional once they suffer from mental illness.
ü Poor funding by the government
D)
The programmes that can be developed in the community to reduce stigma include the following:
- Sensitizing the community on the causes of mental illness
- Use of mass media will reduce stigma
- Educating the community on substances like alcohol and others as they are at high risk of causing mental illness
- Provide employment to the people who have recovered from mental disorder
- Offer housing to people with mental illness, because patients with no accommodation move anyhow
- Social network between the mentally ill patients and the general public
- Implement and advocating for mental health act to be enacted in parliament
QUESTION 6
ELECTROCONVULSIVE
THERAPY (ECT)
Electroconvulsive
therapy is the artificial induction of a grandma seizure through the
application of electrical current to the brain. The stimulus is applied through
electrodes that are placed either bilaterally in the front-temporal region, or
unilaterally on the non-dominant side
Parameters of
electrical current applied
Standard dose according to American psychiatric Association, 1978
- Voltage- 70-120 volts
- Duration- 0.7-1.5seconds
Types of ECT
Direct ECT- in this, ECT is given in the absence of anesthesia and
muscular relaxation. This is not a commonly used method now.
Modified ECT: here ECT is modified by drug-induced muscular relaxation
and general anesthesia.
Indications
A) Major
depression, especially with suicidal risk
B) Severe catatonia
C) Severe
psychosis (F20 or mania)
D) Organic
mental disorders
Contraindications
(A) absolute:
Raised ICP (intracranial pressure)
(B) Relative
-cerebral aneurysm
-cerebral hemorrhage
-brain tumor
-acute myocardial infarction
-retinal detachment
SIDE
EFFECTS OF ECT
-Memory impairment
-Drowsiness, confusion and
restlessness-
-Poor concentration, anxiety
-Headache, weakness/fatigue,
backache, muscle aches
-Dryness of the mouth, palpitations,
nausea, vomiting
-Unsteady gait
-Tongue bite and incontinence
ROLE
OF THE NURSE
Pre-treatment
evaluation
- detailed medical and psychiatric
history, including history of allergies
- An informed consent should be
taken. Allay any unfounded fears and anxieties regarding the procedure.
- Patient should be on empty stomach
for 4-6hrs prior to ECT.
- Withhold night doses of drugs,
which increase seizure threshold like diazepam, barbiturates and
anticonvulsants.
-Withhold oral medications in the
morning
- Head shampooing in the morning
since oil cause impedance of passage of electricity to brain.
- Any jewellery, prosthesis,
dentures, contact lens, metallic objects and tight clothing should be removed
from the patients body.
- Empty bladder and bowel just before
ECT
- Administer of 0.6mg atropine IM
30minutes before ECT or IV just before ECT
Intra-procedure care
-Place the patient comfortably on the
ECT table in supine position
-Assist in administering the
anesthetic agent (thiopental sodium) and muscle relaxant –succinylcholine
-Since the muscle relaxant paralyzes
all muscles including respiratory muscles, patient airway should be ensured and
ventilator support should be started.
-Mouth gag should be inserted to
prevent possible tongue bite.
-The place (s) of electrode placement
should be cleaned with normal saline or 25% bicarbonate solution, or a
conducting gel applied
-Monitor voltage, intensity and
duration of electrical stimulus given
-100% oxygen should be administered
-Monitor vital signs during seizure ,
ECG, oxygen saturation EEG etc
-Record the findings and medicines
given in the patient chart.
Post-procedure care
-Monitor vital signs
-Continue oxygenation till
spontaneous respiration starts
-Assess for post-ictal confussion and
restlessness
-Take safety precautions to prevent
injury (side-lying position and suctioning to prevent aspiration of secretions,
use of side rails to prevent falls)
-If there is severe post-ictal
confussion and restlessness, IV diazepam may be administered
-Reorient the patient after recovery
and stay with the patient until fully oriented.
-Document any findings as relevant in
the patients record
QUESTION 7
- Def
-
Behavioral disturbances associated with the seizure:
-
Psychiatric and cognitive disorder associated with the
underlying cause
-
Pre-ictal: prodromal states and mood disturbances
-
Ictal: complex partial seizures cause affective
disturbances, hallucinations, experiential phenomena, automatisms, absence
seizure cause altered awareness
-
Post-ictal:
impaired consciousness, delirium, psychosis.
-
Inter-ictal disorder: cognitive changes, personality
changes, sexual behavior, depression and other emotional disorders, suicide and
deliberate self-harm, crime and other antisocial behavior
i) Behavioral and cognitive
disturbances associated with seizures
Increasing tension, irritability and
depression are sometimes apparent as prodromata for several days before a
seizure. Transient confusional states, hallucinations, affective disturbances,
automatisms and other abnormal behaviors may occur during seizures
(particularly complex partial seizures), and after seizures (usually those
involving generalized convulsions, and complex partial seizures)
ii) Psychiatric and cognitive
disorders associated with the underlying cause
The underlying cause of epilepsy may
contribute to intellectual impairment or personality problems, especially if
there is extensive brain damage. For example, epilepsy is more common in the
mentally retarded, than among people with normal intelligence.
iii) inter-ictal disorders
Personality disturbance: Epileptic
personality is said to be characterized by egocentricity, irritability,
religiosity and quarrelsomeness. When such personality changes occur, social
factors probably play an important role in etiology, such as the social
limitations imposed on them, their own embarrassment, and reactions of the
other people. Also, brain damage can contribute to the development of
personality disorder.
Iv) Inter-ictal psychosis
Some patients with temporal lobe
epilepsy may develop a psychosis that resembles schizophre
v) Depression and other emotion
disorders
Depression and certain other
emotional disorders are more common in people with epilepsy than in the general
population.
- I) Providing safe
environment
- Restrict environmental stimuli,
keep unit calm and well illuminated
- As the patient is responding to a
terrifying unrealistic world of hallucinatory and illusions, continuous
observation and care is needed to protect him from himself and others
ii) Alleviating patients fear and
anxiety
-
Remove any object in the room that seem to be a source
of misinterpreted perception
-
There should always be somebody at the patient’s
bedside reassuring and supporting; as much as possible have the same person all
the time by the patient’s bedside
iii) Meeting the physical needs of
the patient
-
Maintain intake and output chart
-
Hygienic needs should be taken care of
-
Monitor vital signs
-
Use appropriate nursing measures to reduce high fever,
if present
Iv) Facilitate orientation
-
Have a calendar in the room, repeatedly explain to the
patient where he is and what date, day and time it is
-
Introduce people with name even if the patient
misidentifies the people
D
I)
Teachers
·
Educator role- creating awareness in the community
about mental health and mental illness with special focus on vulnerable groups
·
Educate pupils about the condition thereby reducing
stigma
ii) Community mental health nurses
·
Clinician role- providing direct nursing care to the
patient in the community
·
Domiciliary care- services are provided to the client
by visiting their homes. Services like administering of medication, assessment
of the level of functioning and improvement of patients
·
Bridging the gap between the client and the hospital,
client and the employers and also by networking in the community for resource
development
·
Train- training of paraprofessionals, community
leaders, school teachers and other care giving professionals in the community
iii) Parents (community) .
·
Monitoring of side effects of drugs, knowing the
warning signs
·
Understand the condition and know how to manage
·
Management of resources, planning and coordination
(e.g review dates ,drugs )
iv) Counselors
·
Counseling of patients and family members at the
clients home setting
·
Educator role- creating awareness in the community
about mental health and mental illness with special focus on vulnerable groups
·
v) Social / psych social workers
·
Consultative role- this means giving advice to other
professionals in the community about the type and level of nursing care
required for a given client group
·
Educate patients and family members of the service
agencies available
·
Networking in the community for resource development
·
Follow-up care with special emphasis on medication
regimen, improvement made, side effects and patient’s occupational function.
·
Identification of patients in the community
QUESTION 10
A
B i)
C
Nursing intervention
·
Be aware of factors that increases the likelihood of
violent behavior or that signify a build-up of agitation
·
Talk with the client in a low, calm voice, use simple,
clear, direct speech; repeat if necessary
·
Approach the client in a calm, matter-of-fact manner
·
Always maintain control of yourself and the situation;
remain calm, if you do not feel competent in dealing with the situation, obtain
assistance as soon as possible.
·
Decrease environmental stimulation by turning stereo
or TV of or lowering the volume; lowering the lights; asking other clients,
visitors or others to leav the area.
·
Try to help the client express these feelings,
verbally or physically, in nondestructive ways (remain with the client and
listen, use communication technique
·
Do not use physical restraints or techniques without
sufficient reason
·
Be aware of PRN medication and procedures for
obtaining seclution or restraint orders
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