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Chapter: 12th Nursing : Chapter 10 : Mental Health Nursing

Mental Disorders

Mental illness is maladjustment in living. It produces disharmony in the person’s ability to meet the human needs.

Mental Disorders

Mental illness is maladjustment in living. It produces disharmony in the person’s ability to meet the human needs. In general, the physical health of an individual is given greater importance and mental health aspect is often neglected.

World wide Prevalence Rates of Mental Disorders are

Classification Of Mental Disorders

Classification of mental disorders is also known as psychiatric “nosology” or “taxonomy”.

Classification of Mental Disorders Under (International Classification of Diseases) ICD-10

·  Organic including symptomatic mental disorders

·  Mental and behaviour disorders due to psychoactive substance use

·  Schizophrenia, schizotypal and Delusional disorders

·  Mood (Affective) Disorders

·  Neurotic, Stress related and Somatoform disorders

·  Behavioural syndromes associated with physiological disturbances and physical factors

·  Disorders of adult personality and behaviour

·  Mental retardation

·  Disorders of psychological development

·  Behavioural and emotional disorders with onset occurring in childhood and adolescence

·  Unspecified mental disorders

Indian Classification of Mental Disorders

It is a modification of ICD-8 to suit Indian conditions. It is broadly grouped as follows

·  Psychosis

o      Functional

o      Affective

o      Organic

·  Neurosis

·  Special disorders

o      Childhood disorders

o      Conduct disorders

o      Substance abuse

o      Psycho physiological disorder

o      Mental retardation

Signs and Symptoms of Mental Illness

·  Alterations in personality and behaviour

·  Alterations in biological functions (sleep, appetite, sexual desire)

·  Disorders of consciousness (conscious, unconscious, coma, drowsy, and stupor)

·  Disorders in orientation (time, place and person)

·  Disorders of attention and concentration

·  Disorders of thought

·  Disorders of motor activity (increased, decreased, stereotype, violence, echolalia, echo praxia, waxy flexibility, restlessness and excitement)

·  Disturbances in speech (word salad, circumstantiality, mutism and neologism)

·  Disturbances in perception (hallucination, delusion and illusion)

·  Disturbances in emotions (elevation, panic, agitation, hostile, depressed and anxiety)

Management of mental disorders

·  Antidepressants

·  Antipsychotics

·  Mood stabilizing drugs

·  Anxiolytics, hypnotics and sedatives

·  Anti parkinsonian drugs

·  Psychoanalytic therapy

·  Supportive psychotherapy

·  Benzodiazepines

·  Psychotherapy

·  Behaviour therapy

·  Cognitive therapy

·  Group therapy

·  Play therapy

·  Interpersonal psychotherapy

·  Stress reducing techniques – Music , Dance, Yoga, Medication and breathing exercises


1. Schizophrenia


The term schizophrenia was coined in 1908 by the Swiss psychiatrist Eugen Bleuler. The word was derived from Schizo (split) and phren (mind).


Schizophrenia a psychotic condition characterized by a disturbance in thinking, emotions, volitions and clear consciousness which usually leads to social withdrawal.

Causes: The exact cause is not known

·  Genetic causes and hereditary

·  Bio chemical – abnormalities in dopamine, epinephrine, serotonin.

·  Psychological factors – impaired ego, crisis situation

·  Family factors – parent – child relationship, family dysfunction

·  Social causes – social crisis,

·  Endocrine and metabolic causes.

Types of Schizophrenia

·  Paranoid Schizophrenia -

·  Hebephrenic Schizophrenia

·  Catatonic Schizophrenia

·  Undifferentiated Schizophrenia

·  Post schizophrenic depression

·  Residual Schizophrenia

·  Simple Schizophrenia

·  Schizo typal disorder

Symptoms of Schizophrenia

Types of Hallucinations


·  History collection

·  Substance history

·  CT, MRI and brain studies

·  Blood investigations

·  Mental status examination

Management of Schizophrenia

Nursing Management

·  Nursing assessment

·  Health education


2. Paranoid


Paranoid is a thought process that causes an irrational suspicion (doubtfulness) or mistrust of others.


Genetics, stress, brain chemistry and also drug abuse.


·  A consistent stress or anxiety beliefs about others

·  A mistrust of others

·  Feeling disbelieved /misunderstood

·  Isolation


History collection, physical examination and mental status examination.


·  Accept their vulnerability

·  Develop trust in others

·  Encourage to express emotions in positive manner.

·  Psychotherapy


3. Depression

Depression (The Common Cold of Psychiatric Disorders)


“An alteration in mood that is expressed by feelings of sadness, despair, and pessimism. There is a loss of interest in usual activities, and somatic symptoms may be evident. Changes in appetite and sleep pattern are common”.

- Mary C. Townsend


·  Due to loss of loved object

·  Repeated losses in the past

·  Negative expectations of environment, Negative expectations of the self

·  Negative expectations of the future

·  Stressful life events, Death, Marriage, Financial loss

Symptoms of Depression

·  Sadness

·  Sleep disturbances Insomnia -early morning or over sleeping

·  Hopelessness, Helplessness, Worthless ness, restless, irritable.

·  Guilt,

·  Anger

·  Fatigue

·  Thoughts of death

·  Spontaneous crying

·  Avoids interactions with family or friends.

Diagnostic Measure for Depression

·  History collection

·  Mental status examination

·  Depression assessment tools

Treatment for Depression

·  Medication - antidepressants

·  Electro Convulsive Therapy

·  Psychotherapy


4. Mania

Mania refers to a syndrome in which the central features are over activity, mood changes which may be towards elation or irritability and self-important ideas.

- Dr. R. Sreevani


5. Postpartum Psychosis

Postpartum psychosis (some times called puerperal psychosis) that occurs in women who have recently delivered a baby. The syndrome is often characterized by the mother’s depression, delusions, and thoughts of harming either herself or her baby.

- Sadock and Sadock


6. Neurotic (Stress related) Disorders

A. Phobia

Phobia is defined as unreasonable fear of a specific object, activity or situation.


B. Panic Attack

Intense feeling of fear or terror that occurs suddenly and intermediately without warning.

C. Anxiety

Anxiety is a feeling of uneasiness or tension that a person experience to an unknown object or situation.

D. Obsessive Compulsive Disorder

Obsessive Compulsive­ Disorder is a common chronic and long lasting disorder in which a person has uncontrollable recurrent thoughts and behaviour that he/she feels the urge to repeat over and over like frequent hand washing, checking the doors.

E. Conversion Disorder

Conversion disorder formerly known as HYSTERIA, which is a loss of or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained in terms of any known medical disorder or pathophysiological mechanism.

F. Psychosomatic Disorders

The term psychosomatic disorder is mainly used to mean a physical disease that is thought to be caused or made worse by mental factors. Eg. Chest pain may be caused by stress and not by physical disease.

The word psychosomatic is now replaced with psychophysiologic disorder. They are also called as stress related disorders. Most of the symptoms are treated in general hospital rather than in mental hospital.

G. Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder is a severe anxiety disorder that can develop after exposure to any event which results in psychological trauma.

H. Generalised Anxiety Disorder (GAD)

Generalised anxiety disorder is characterized by excessive anxiety and worry about every day life events with no obvious reasons for worry. It may be about money, health, family, work or school


7. Personality Disorders

(Refer Applied psychology Chapter/Section.)


8. Eating Disorders


An eating disorder is when you have an unhealthy attitude to food, which can take over your life and make you ill.

Types Of Eating Disorder

ANOREXIA NERVOSA: anorexia nervosa is an eating disorder in which people have an intense fear of gaining weight and can become dangerously ill.

BULIMIA NERVOSA: Bulimia nervosa is a psychological and severe life threatening eating disorder characterised by ingestion of an abnormally large amount of food in short time followed by attempt to avoid weight gain, they induce vomiting.

Usually found in school girls and college students.


·  Medications

·  Behaviour modification therapy

·  Psychotherapy


9. Sleep Disorders


Sleep disorders are changes in sleeping pattern or habit that can negatively affects health.

Types Of Sleep Disorders:

·  Insomnia: Disorder of initiation and maintenance of sleep

·  Hypersomnia: Excessive sleep pattern

Sleep Disorders

·  Sleep walking (somnambulism)

·  Bruxism (Tooth grinding)

·  Sleep talking (somniloqy)

·  Sleep enuresis (Bed wetting)

Night terrors


·  Treat the cause

·  Medications

·  Sleep hygiene

·  Relaxation techniques


10. Sexual Disorder


Any disorder that involving sexual functioning, desire or performance

Types Of Sexual Disorders:

1. Gender Identity Disorders

TRANSSEXUALISM: Sense of discomfort about one’s own sex. They want to change their sex permanently. (Male to female or female to male)

DUAL ROLE TRANSVESTISM: Wearing clothes of opposite sex to enjoy temporarily, but they do not want to change their sex

·  Psychological and behavioural problems related to sexual development and maturation

·  Homosexuality of females (Lesbians)

·  Homosexuality of males (Gay)

3. Paraphilias


·  Treat the underlying physical and psychological problems

·  Medications

·  Psychotherapy

Behaviour therapy


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12th Nursing : Chapter 10 : Mental Health Nursing : Mental Disorders |

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