INTRODUCTION

Mental health is an integral and essential component of health. It is the

foundation for individual well being and the effective functioning in a community.
Mental health is also related to promotion of mental well-being prevention of
mental disorders and treatment, rehabilitation of people affected by mental
disorders.

It is a state of balance between the individual and the surrounding world, a state of
harmony between oneself and others, a co-existence between the realities of the
self and that of other people and the environment.

DEFINITION

1. It defines that mental health as, "An adjustment of human beings to the
world and to each other with a maximum of effectiveness and happiness."

-Karl Menninger (1947)

2. It defines mental health as a state of well-being in which an individual

realizes his or her own abilities, can cope with the normal stresses of life,
can work productively and is able to make a contribution to his or her
community.

- The World Health Organization(WHO)

3. The American Psychiatric Association (APA 1980) defines mental health as,
"Simultaneous success at working, loving and creating with the capacity for
mature and flexible resolution of conflicts between instincts, conscience,
important other people and reality."
CLASSIFICATION OF MENTAL DISORDERS

The classification of mental disorders is also known as psychiatric taxonomy. It

represents a key aspect of psychiatry and other mental health professions and is an
important issue for people who may be diagnosed. There are currently two widely
established systems for classifying mental disorders:

1. Chapter V of the tenth International Classification of Diseases (ICD-10)

produced by the World Health Organization (WHO);
2. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
produced by the American Psychiatric Association (APA).
3. Indian classification of disease.

Purposes of classification of mental classification:

The purposes of classification of mental classification of mental disorders always

involve in the broadcast sense communication, control and comprehension.

I. Communication:

A classification enables users to communicate with each other about the disorders
with which they deal. This involves using names of categories as standard
shorthand ways of summarizing certain agreed on important features of categories
that would otherwise require use of a larger number of terms

II. Control:

Ideally involves the ability either to prevent their occurrence or modify their
courses with treatment. For that reason, control is the most important purpose of a
classification of mental disorders

III. Comprehension:

Comprehension implies understanding the causes of mental disorders and the

processes involved in their development and maintenance. Frequently, a mental
disorder can be treated effectively without understanding either its cause or its
pathological process, comprehension is not an end in itself but is desired because it
usually leads to better control of the disorder.
INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES

History of official classification:

1840: The official system for tabulation mental disorder in US with one category -
idiotic and insane together.

1880: 7 categories (Mania, Malancholia, Monomania, Paresis, Dementia,

Dipsomania, Epilepsy).

1889: A system adopted by American Psychiatric Association called as Standard

classified nomenclature of diseases.

1935: Classification was only for chronic patients proved inadequate for use with
World War II Psychiatric causatives, acute disturbances, psychosomatic,
personality disorders.

1948: WHO Revised

International list of causes of Death (1900) it was revised every 1/20 year 6
revision renamed as manual of the International Classification of Diseases,
injuries, causes of death, which contained for the first time a classification of
mental disorder entitled "mental, psychoneurotic and personality disorder" with 10
categories psychosis, 9 categories of psycho neurosis, 7 categories of disorder of
character, behaviour of Intelligence

ICD-10 1992 International statistical classifications of diseases & related health

problems - earlier called as International classification of diseases - injuries and
causes of death - 10 Revision, 1992.

WHO's classification for all diseases and related health problems.

Chapter 'F' - Classifies psychiatric disorders as mental and behavioural disorders.

Codes them on an alphanumeric system from F00 to F99

ICD 10 - is now available in several versions, some

Important versions are

1. Clinical descriptions & Diagnostic Guidance (CDDG),

2. Diagnostic criteria for research (DCR)

3. Multi - axial classification version,

4. Primary care version.

List of categories

F00-F09

Organic, including symptomatic, mental disorders

F00 Dementia in Alzheimer's disease

F00.0Dementia in Alzheimer's disease with early onset

F00.1Dementia in Alzheimer's disease with late onset

F00.2Dementia in Alzheimer's disease, atypical or mixed type

F00.9Dementia in Alzheimer's disease, unspecified

F01Vascular dementia

F01.0Vascular dementia of acute onset

F01.1Multi-infarct dementia

F01.2Subcortical vascular dementia

F01.3Mixed cortical and subcortical vascular dementia

F01.8Other vascular dementia

F01.9Vascular dementia, unspecified

F02Dementia in other diseases classified elsewhere

F02.0Dementia in Pick's disease

F02.1Dementia in Creutzfeldt-Jakob disease

F02.2Dementia in Huntington's disease

F02.3Dementia in Parkinson's disease

F02.4Dementia in human immunodeficiency virus [HIV] disease

F02.8Dementia in other specified diseases classified elsewhere

F03Unspecified dementia

A fifth character may be added to specify dementia in F00-F03, as follows:

.x0 without additional symptoms

.x1 other symptoms, predominantly delusional

.x2 other symptoms, predominantly hallucinatory

.x3 other symptoms, predominantly depressive

.x4 other mixed symptoms

F04Organic amnesic syndrome, not induced by alcohol and other substances

F05Delirium, not induced by alcohol and other psychoactive substances

F05.0Delirium, not superimposed on dementia, so described

F05.1Delirium, superimposed on dementia

F05.8Other delirium

F05.9Delirium, unspecified

F06Other mental disorders due to brain damage and dysfunction and to

physical disease

F06.0Organic hallucinosis

F06.1Organic catatonic disorder

F06.2Organic delusional [schizophrenia-like] disorder

F06.3Organic mood [affective] disorders

.30 Organic manic disorder

.31 Organic bipolar affective disorders

.32 Organic depressive disorders

.33 Organic mixed affective disorder

F06.4Organic anxiety disorder

F06.5Organic dissociative disorder

F06.6Organic emotionally labile [asthenic] disorder

F06.7Mild cognitive disorder

F06.8Other specified mental disorders due to brain damage and dysfunction and to
physical disease

F06.9Unspecified mental disorder due to brain damage and dysfunction and to

physical disease

F07Personality and behavioural disorder due to brain disease, damage and

dysfunction

F07.0Organic personality disorder

F07.1Postencephalitic syndrome

F07.2Postconcussional syndrome

F07.8Other organic personality and behavioural disorder due to brain disease,

damage and dysfunction

F09Unspecified organic or symptomatic mental disorder

F10--F19 Mental and behavioural disorders due to psychoactive substance

use

F10.-Mental and behavioural disorders due to use of alcohol

F11.-Mental and behavioural disorders due to use of opioids

F12.-Mental and behavioural disorders due to use of cannabinoids

F13.-Mental and behavioural disorders due to use of sedatives or hypnotics

F14.-Mental and behavioural disorders due to use of cocaine

F15.-Mental and behavioural disorders due to use of other stimulants,

including caffeine

F16.-Mental and behavioural disorders due to use of hallucinoeens

F17.-Mental and behavioural disorders due to use of tobacco

F18.-Mental and behavioural disorders due to use of volatile solvents

F19.-Mental and behavioural disorders due to multiple drug use and use of
other psychoactive substances

Four- and five-character categories may be used to specify the clinical conditions,
as follows:

F1x.0 Acute intoxication

.00 Uncomplicated

.01 With trauma or other bodily injury

.02 With other medical complications

.03 With delirium

.04 With perceptual distortions

.05 With coma

.06 With convulsions

.07 Pathological intoxication

F1x.1 Harmful use

F1x.2 Dependence syndrome

.20 Currently abstinent

.21 Currently abstinent, but in a protected environment

 .22 Currently on a clinically supervised maintenance or replacement regime
[controlled dependence]

.23 Currently abstinent, but receiving treatment with aversive or blocking drugs

.24 Currently using the substance [active dependence]

.25 Continuous use

.26 Episodic use [dipsomania]

F1x.3 Withdrawal state

.30 Uncomplicated

.31 With convulsions

F1x.4 Withdrawal state with delirium

.40 Without convulsions

.41 With convulsions

F1x.5 Psychotic disorder

.50 Schizophrenia-like

.51 Predominantly delusional

.52 Predominantly hallucinatory

.53 Predominantly polymorphic

.54 Predominantly depressive symptoms

.55 Predominantly manic symptoms

.56 Mixed

F1x.6 Amnesic syndrome

F1x.7 Residual and late-onset psychotic disorder

.70 Flashbacks
.71 Personality or behaviour disorder

.72 Residual affective disorder

.73 Dementia

.74 Other persisting cognitive impairment

.75 Late-onset psychotic disorder

F1x.8 Other mental and behavioural disorders

F1x.9 Unspecified mental and behavioural disorder

F20-F29 Schizophrenia, schizotypal and delusional disorders

F20 Schizophrenia

F20.0 Paranoid schizophrenia

F20.1 Hebephrenic schizophrenia

F20.2 Catatonic schizophrenia

F20.3 Undifferentiated schizophrenia

F20.4 Post-schizophrenic depression

F20.5 Residual schizophrenia

F20.6 Simple schizophrenia

F20.8 Other schizophrenia

F20.9 Schizophrenia, unspecified

A fifth character may be used to classify course:

.x0 Continuous

.x1 Episodic with progressive deficit

.x2 Episodic with stable deficit

.x3 Episodic remittent

.x4 Incomplete remission

.x5 Complete remission

.x6 Other

.x9 Course uncertain, period of observation too short

F21 Schizotypal disorder

F22 Persistent delusional disorders

F22.0 Delusional disorder

F22.8 Other persistent delusional disorders

F22.9 Persistent delusional disorder, unspecified

F23 Acute and transient psychotic disorders

F23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia

F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia

F23.2 Acute schizophrenia-like psychotic disorder

F23.3 Other acute predominantly delusional psychotic disorders

F23.8 Other acute and transient psychotic disorders

F23.9 Acute and transient psychotic disorders unspecified

A fifth character may be used to identify the presence or absence of associated

acute stress:

.x0 Without associated acute stress

.x1 With associated acute stress

F24 Induced delusional disorder

F25 Schizoaffective disorders

F25.0 Schizoaffective disorder, manic type

F25.1 Schizoaffective disorder, depressive type

F25.2 Schizoaffective disorder, mixed type

F25.8 Other schizoaffective disorders

F25.9 Schizoaffective disorder, unspecified

F28 Other nonorganic psychotic disorders

F29 Unspecified nonorganic psychosis

F30-F39 Mood [affective] disorders

F30 Manic episode

F30.0 Hypomania

F30.1 Mania without psychotic symptoms

F30.2 Mania with psychotic symptoms

F30.8 Other manic episodes

F30.9 Manic episode, unspecified

F31 Bipolar affective disorder

F31.0 Bipolar affective disorder, current episode hypomanic

F31.1 Bipolar affective disorder, current episode manic without psychotic

symptoms

F31.2 Bipolar affective disorder, current episode manic with psychotic symptoms

F31.3Bipolar affective disorder, current episode mild or moderate depression

.30 Without somatic syndrome

.31 With somatic syndrome

F31.4 Bipolar affective disorder, current episode severe depression without

psychotic symptoms
 F31.5 Bipolar affective disorder, current episode severe depression with psychotic
symptoms

F31.6 Bipolar affective disorder, current episode mixed

F31.7 Bipolar affective disorder, currently in remission

F31.8 Other bipolar affective disorders

F31.9 Bipolar affective disorder, unspecified

F32 Depressive episode

F32.0 Mild depressive episode

.00 Without somatic syndrome

.01 With somatic syndrome

F32.1 Moderate depressive episode

.10 Without somatic syndrome

.11 With somatic syndrome

F32.2 Severe depressive episode without psychotic symptoms

F32.3 Severe depressive episode with psychotic symptoms

F32.8 Other depressive episodes

F32.9 Depressive episode, unspecified

F33 Recurrent depressive disorder

F33.0 Recurrent depressive disorder, current episode mild

.00 Without somatic syndrome

.01 With somatic syndrome

F33.1 Recurrent depressive disorder, current episode moderate

.10 Without somatic syndrome

.11 With somatic syndrome

F33.2 Recurrent depressive disorder, current episode severe without psychotic

symptoms

F33.3 Recurrent depressive disorder, current episode severe with psychotic

symptoms

F33.4 Recurrent depressive disorder, currently in remission

F33.8 Other recurrent depressive disorders

F33.9 Recurrent depressive disorder, unspecified

F34 Persistent mood [affective] disorders

F34.0 Cyclothymia

F34.1 Dysthymia

F34.8 Other persistent mood [affective] disorders

F34.9 Persistent mood [affective] disorder, unspecified

F38 Other mood [affective] disorders

F38.0 Other single mood [affective] disorders

.00 Mixed affective episode

F38.1 Other recurrent mood [affective] disorders

.10 Recurrent brief depressive disorder

F38.8 Other specified mood [affective] disorders

F39 Unspecified mood [affective] disorder

F40-F48 Neurotic, stress-related and somatoform disorders

F40 Phobic anxiety disorders

F40.0 Agoraphobia
.00 Without panic disorder

.01 With panic disorder

F40.1 Social phobias

F40.2 Specific (isolated) phobias

F40.8 Other phobic anxiety disorders

F40.9 Phobic anxiety disorder, unspecified

F41 Other anxiety disorders

F41.0 Panic disorder [episodic paroxysmal anxiety]

F41.1 Generalized anxiety disorder

F41.2 Mixed anxiety and depressive disorder

F41.3 Other mixed anxiety disorders

F41.8 Other specified anxiety disorders

F41.9 Anxiety disorder, unspecified

F42 Obsessive - compulsive disorder

F42.0 Predominantly obsessional thoughts or ruminations

F42.1 Predominantly compulsive acts [obsessional rituals]

F42.2 Mixed obsessional thoughts and acts

F42.8 Other obsessive - compulsive disorders

F42.9 Obsessive - compulsive disorder, unspecified

F43 Reaction to severe stress, and adjustment disorders

F43.0 Acute stress reaction

F43.1 Post-traumatic stress disorder

F43.2 Adjustment disorders

.20 Brief depressive reaction

.21 Prolonged depressive reaction

.22 Mixed anxiety and depressive reaction

.23 With predominant disturbance of other emotions

.24 With predominant disturbance of conduct

.25 With mixed disturbance of emotions and conduct

.28 With other specified predominant symptoms

F43.8 Other reactions to severe stress

F43.9 Reaction to severe stress, unspecified

F44 Dissociative [conversion] disorders

F44.0 Dissociative amnesia

F44.1 Dissociative fugue

F44.2 Dissociative stupor

F44.3 Trance and possession disorders

F44.4 Dissociative motor disorders

F44.5 Dissociative convulsions

F44.6 Dissociative anaesthesia and sensory loss

F44.7 Mixed dissociative [conversion] disorders

F44.8 Other dissociative [conversion] disorders

.80 Ganser's syndrome

.81 Multiple personality disorder

.82 Transient dissociative [conversion] disorders occurring in childhood and

adolescence
.88 Other specified dissociative [conversion] disorders

F44.9 Dissociative [conversion] disorder, unspecified

F45 Somatoform disorders

F45.0 Somatization disorder

F45.1 Undifferentiated somatoform disorder

F45.2 Hypochondriacal disorder

F45.3 Somatoform autonomic dysfunction

.30 Heart and cardiovascular system

.31 Upper gastrointestinal tract

.32 Lower gastrointestinal tract

.33 Respiratory system

.34 Genitourinary system

.38 Other organ or system

F45.4 Persistent somatoform pain disorder

F45.8 Other somatoform disorders

F45.9 Somatoform disorder, unspecified

F48 Other neurotic disorders

F48.0 Neurasthenia

F48.1 Depersonalization - derealization syndrome

F48.8 Other specified neurotic disorders

F48.9 Neurotic disorder, unspecified

F50-F59Behavioural syndromes associated with physiological disturbances

and physical factors
F50 Eating disorders

F50.0 Anorexia nervosa

F50.1 Atypical anorexia nervosa

F50.2 Bulimia nervosa

F50.3 Atypical bulimia nervosa

F50.4 Overeating associated with other psychological disturbances

F50.5 Vomiting associated with other psychological disturbances

F50.8 Other eating disorders

F50.9 Eating disorder, unspecified

F51 Nonorganic sleep disorders

F51.0 Nonorganic insomnia

F51.1 Nonorganic hypersomnia

F51.2 Nonorganic disorder of the sleep-wake schedule

F51.3 Sleepwalking [somnambulism]

F51.4 Sleep terrors [night terrors]

F51.5 Nightmares

F51.8 Other nonorganic sleep disorders

F51.9 Nonorganic sleep disorder, unspecified

F52 Sexual dysfunction, not caused by organic disorder or disease

F52.0 Lack or loss of sexual desire

F52.1 Sexual aversion and lack of sexual enjoyment

.10 Sexual aversion

.11 Lack of sexual enjoyment

F52.2 Failure of genital response

F52.3 Orgasmic dysfunction

F52.4 Premature ejaculation

F52.5 Nonorganic vaginismus

F52.6 Nonorganic dyspareunia

F52.7 Excessive sexual drive

F52.8 Other sexual dysfunction, not caused by organic disorders or disease

F52.9 Unspecified sexual dysfunction, not caused by organic disorder or disease

F53Mental and behavioural disorders associated with the puerperium, not

elsewhere classified

F53.0 Mild mental and behavioural disorders associated with the puerperium, not
elsewhere classified

F53.1 Severe mental and behavioural disorders associated with the puerperium, not
elsewhere classified

F53.8 Other mental and behavioural disorders associated with the puerperium, not
elsewhere classified

F53.9 Puerperal mental disorder, unspecified

F54Psychological and behavioural factors associated with disorders or

diseases classified elsewhere

F55 Abuse of non-dependence-producing substances

F55.0 Antidepressants

F55.1 Laxatives

F55.2 Analgesics

F55.3 Antacids
F55.4 Vitamins

F55.5 Steroids or hormones

F55.6 Specific herbal or folk remedies

F55.8 Other substances that do not produce dependence

F55.9 Unspecified

F59Unspecified behavioural syndromes associated with physiological disturbances

and physical factors

F60-F69 Disorders of adult personality and behaviour

F60 Specific personality disorders

F60.0 Paranoid personality disorder

F60.1 Schizoid personality disorder

F60.2 Dissocial personality disorder

F60.3 Emotionally unstable personality disorder

.30 Impulsive type

.31 Borderline type

F60.4 Histrionic personality disorder

F60.5 Anankastic personality disorder

F60.6 Anxious [avoidant] personality disorder

F60.7 Dependent personality disorder

F60.8 Other specific personality disorders

F60.9 Personality disorder, unspecified

F61 Mixed and other personality disorders

F61.0 Mixed personality disorders

F61.1 Troublesome personality changes

F62 Enduring personality changes, not attributable to brain damage and

disease

F62.0 Enduring personality change after catastrophic experience

F62.1 Enduring personality change after psychiatric illness

F62.8 Other enduring personality changes

F62.9 Enduring personality change, unspecified

F63 Habit and impulse disorders

F63.0 Pathological gambling

F63.1 Pathological fire-setting [pyromania]

F63.2 Pathological stealing [kleptomania]

F63.3 Trichotillomania

F63.8 Other habit and impulse disorders

F63.9 Habit and impulse disorder, unspecified

F64 Gender identity disorders

F64.0 Transsexualism

F64.1 Dual-role transvestism

F64.2 Gender identity disorder of childhood

F64.8 Other gender identity disorders

F64.9 Gender identity disorder, unspecified

F65 Disorders of sexual preference

F65.0 Fetishism

F65.1 Fetishistic transvestism

F65.2 Exhibitionism

F65.3 Voyeurism

F65.4 Paedophilia

F65.5 Sadomasochism

F65.6 Multiple disorders of sexual preference

F65.8 Other disorders of sexual preference

F65.9 Disorder of sexual preference, unspecified

F66 Psychological and behavioural disorders associated with sexual

development and orientation

F66.0 Sexual maturation disorder

F66.1 Egodystonic sexual orientation

F66.2 Sexual relationship disorder

F66.8 Other psychosexual development disorders

F66.9 Psychosexual development disorder, unspecified

A fifth character may be used to indicate association with:

.x0 Heterosexuality

.x1 Homosexuality

.x2 Bisexuality

.x8 Other, including prepubertal

F68 Other disorders of adult personality and behaviour

F68.0 Elaboration of physical symptoms for psychological reasons

F68.1 Intentional production or feigning of symptoms or disabilities, either

physical or psychological [factitious disorder]
F68.8 Other specified disorders of adult personality and behaviour

F69 Unspecified disorder of adult personality and behaviour

F70-F79 Mental retardation

F70 Mild mental retardation

F71 Moderate mental retardation

F72 Severe mental retardation

F73 Profound mental retardation

F78 Other mental retardation

F79 Unspecified mental retardation

A fourth character may be used to specify the extent of associated behavioural

impairment:

F7x.0 No, or minimal, impairment of behaviour

F7x.1 Significant impairment of behaviour requiring attention or treatment

F7x.8 Other impairments of behaviour

F7x.9 Without mention of impairment of behaviour

F80-F89 Disorders of psychological development

F80 Specific developmental disorders of speech and language

F80.0 Specific speech articulation disorder

F80.1 Expressive language disorder

F80.2 Receptive language disorder

F80.3 Acquired aphasia with epilepsy [Landau-Kleffner syndrome]

F80.8 Other developmental disorders of speech and language

F80.9 Developmental disorder of speech and language, unspecified

F81 Specific developmental disorders of scholastic skills

F81.0 Specific reading disorder

F81.1 Specific spelling disorder

F81.2 Specific disorder of arithmetical skills

F81.3 Mixed disorder of scholastic skills

F81.8 Other developmental disorders of scholastic skills

F81.9 Developmental disorder of scholastic skills, unspecified

F82 Specific developmental disorder of motor function

F83 Mixed specific developmental disorders

F84 Pervasive developmental disorders

F84.0 Childhood autism

F84.1 Atypical autism

F84.2 Rett's syndrome

F84.3 Other childhood disintegrative disorder

F84.4Overactive disorder associated with mental retardation and stereotyped

movements

F84.5 Asperger's syndrome

F84.8 Other pervasive developmental disorders

F84.9 Pervasive developmental disorder, unspecified

F88 Other disorders of psychological development

F89 Unspecified disorder of psychological development

F90-F98 Behavioural and emotional disorders with onset usually occurring in

childhood and adolescence
F90 Hyperkinetic disorders

F90.0 Disturbance of activity and attention

F90.1 Hyperkinetic conduct disorder

F90.8 Other hyperkinetic disorders

F90.9 Hyperkinetic disorder, unspecified

F91 Conduct disorders

F91.0 Conduct disorder confined to the family context

F91.1 Unsocialized conduct disorder

F91.2 Socialized conduct disorder

F91.3 Oppositional defiant disorder

F91.8 Other conduct disorders

F91.9 Conduct disorder, unspecified

F92 Mixed disorders of conduct and emotions

F92.0 Depressive conduct disorder

F92.8 Other mixed disorders of conduct and emotions

F92.9 Mixed disorder of conduct and emotions, unspecified

F93 Emotional disorders with onset specific to childhood

F93.0 Separation anxiety disorder of childhood

F93.1 Phobic anxiety disorder of childhood

F93.2 Social anxiety disorder of childhood

F93.3 Sibling rivalry disorder

F93.8 Other childhood emotional disorders

F93.9 Childhood emotional disorder, unspecified

F94 Disorders of social functioning with onset specific to childhood and
adolescence

F94.0 Elective mutism

F94.1 Reactive attachment disorder of childhood

F94.2 Disinhibited attachment disorder of childhood

F94.8 Other childhood disorders of social functioning

F94.9 Childhood disorder of social functioning, unspecified

F95 Tic disorders

F95.0 Transient tic disorder

F95.1 Chronic motor or vocal tic disorder

F95.2 Combined vocal and multiple motor tic disorder [de la Tourette's
syndrome]

F95.8 Other tic disorders

F95.9 Tic disorder, unspecified

F98 Other behavioural and emotional disorders with onset usually occurring
in childhood and adolescence

F98.0 Nonorganic enuresis

F98.1 Nonorganic encopresis

F98.2 Feeding disorder of infancy and childhood

F98.3 Pica of infancy and childhood

F98.4 Stereotyped movement disorders

F98.5 Stuttering [stammering]

F98.6 Cluttering
 F98.8Other specified behavioural and emotional disorders with onset usually
occurring in childhood and adolescence

F98.9Unspecified behavioural and emotional disorders with onset usually

occurring in childhood and adolescence

F99 Unspecified mental disorder

F99 Mental disorder, not otherwise specified

DSM (Diagnostic & statistical manual of mental disorders)

DSM I: In 1951, U.S with representation of American

Psychiatric Association developed an alternative to mental disorder section of

ICD-6 which was published in 1952. It replaced the outdated mental disorders
section of ANA and first time provided a glossary of definition of categories

DSM II: In 1965, by American Psychiatric Association It encouraged multiple

diagnosis by clinician unlike DSM-1 and the word "Reaction was eliminated.

DSM-Ill: In 1974 - 1980 was published using poly diagnostic criteria and multi
axial system i.e.

Axis I - Mental disorder and additional codes.

Axis II - Personality disorder and specific development of disorder

Axis III - Physical disorder

Axis IV - Severity of psychosocial stressors (7 point rating scale)

Axis V - Highest level of adaptive functioning past year.

DSM - IV (Diagnostic & statistical manual of mental disorders - IV Edition,

1994).

The fourth edition of DSM of mental disorder published in 1994 is latest and most
up to date classification of mental disorder. It correlated with 10 edition of WHO's
ICD

APA's Classification of mental disorders

It has mainly 5 Axes.

Axis I: Clinical psychiatric Axis

Axis II: Personality disorders mental retardation

Axis III: General medical conditions.

Axis IV: Psychological and environmental problems.

Axis V: Global assessment of functioning – Past one year.

Basic Features of DSM-IV:

DSM IV attempts the describe what manifestation of mental disorder are:

 Specific diagnostic criteria are provided for each mental disorder

 Describes each disorders in terms of associated features, specific age, culture
and gender and prevalence
 Provides explicit rule when information is insufficient by category NOIS.

DSM-IV TR (Diagnostic and Statistical Manual Textbook Review)

 The diagnosis of mental disorder is based on the classification system of the

4 edition of DSM of mental disorder try the American psychiatric
association, 1994
 This manual provides a helpful guide to the clinical practice that is practical
for clinical, research educational purposes.
 It contains subtype and other specified to describe further the characteristics
of the diagnosis as exhibited in a given individual.
 Even though it provide criteria for diagnosing mental disorder. There are no
absolute boundaries separating one disorder from another and similar
disorder may have different manifestation at different point in time
 It is of multiaxial system.

AXIS-I: CLINICAL DISORDER AND OTHER CONDITION THAT MAY

BE A FOCUS OF CLINICAL ATTENTION

1. Disorder usually first diagnosed during infancy childhood, adolescence.

 Mental retardation
 Learning disorder
 Motor skill disorder
 Feeding and eating disorder in infancy and early childhood
 Communication disorder
 Pervasive developmental disorder
 Attention deficit and disruptive behavior disorder
 Other disorder of infancy, childhood or adolescence.
  Tic disorder
 Elimination disorder.
2. Delirium, dementia, amnesia, and other cognitive disorder
3. Mental disorder due to general medical
4. Substance related disorder
5. Schizophrenia and related disorder
6. Mood disorder
7. Anxiety ( panic, phobia, OCD, stress)
8. Somatoform (somatoform conversion)
9. Factitious disorder
10. Dissociative disorder
11.Sexual and gender identity disorder
12.Eating disorder
13. Sleep disorder
14.Impulse control disorder
15.Adjustment disorder
16. Other condition that may not be a focus of clinical attention

AXIS – II PERSONALITY DISORDER AND MENTAL RETARDATION

Personality disorder

a) paranoid
b) schizotypal
c) borderline
d) schizoid
e) antisocial
f) historic
g) narcissistic
h) dependent
i) Personal disorder.

Mental Retardation

AXIS-III GENERAL MEDICAL CONDITION

o Infection parasitic disease

 o Neoplasm
o Endocrine, nutrition, metabolic disease and immune disorder
o Disorder of blood and blood forming organ
o Disorder of nervous and sense organ
o Disorder of circulatory, respiratory, digestive, gastro intestinal
o Complication of childbirth, pregnancy, peuperium.
o Disorder of skin and subcutaneous tissues
o Disorder of musculoskeletal and connective tissues
o Congenital abnormality

AXIS - IV PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS

 Problem with primary support group

 Problem related to the social environment.
 Educational problem.
 Occupations.
 Housing
 Economic
 Problem with access to health care system/ services
 Problem related to interaction and the legal.
 Other psychosocial to environmental problem.

AXIS-V GLOBAL ASSESSSMENT OF FUNCTIONS

Psychological/social to occupational functions on a hypothetical counts number of

mental (i) illness.

SCORES

91- 100 -superior functions/no symptoms.

81-90 -absent or minimal symptoms, good functioning in all areas

71- 80 - if systems present, they are transient and expectable reactions to

psychosocial stressors - no more than slight impairment meaningful interpersonal
relationship.

61-70 - some mild symptoms/ difficulty but generally functions well has some
51 - 60 moderate symptoms/difficulty.

41 - 50 serious symptoms / difficulty

31-40 major impairment in several areas-work/ school/functions......

21- 30 behaviours is conderably influced by delusion or hallucination or serious

impairment in communication/adjustment

11-20 some danger of hurting self or other or occasionally fails to maintain

personal hygiene and gross impairment of communication

1-10 persistent danger of hurting self or others,

Indian Classification

In India, Neki (1963), Wig and Singer (1967), Vahia (1961) and (1971) have
attempted some modifications of ICDS to suit Indian conditions. They are as
follows

A. Psychosis

1. Functional
 Schizophrenia
 Simple Schizophrenia
 Hebephrenic schizophrenia
 Paranoid schizophrenia
2. Affective
 Mania
 Depression
3. Organic
 Acute
 Chronic

B. Neurosis

1. Anxiety neurosis
2. Depressive neurosis
 3. Hysterical neurosis
4. Obsessive compulsive neurosis
5. Phobic neurosis

C. Special disorders

o Childhood disorders
 Conduct disorders
 Emotional disorders
o Personality disorders
 Sociopath
 Psychopath
o Substance abuse
 Alcohol abuse
 Drug abuse
o Psycho physiological disorders
 Asthma
 Psoriasis

D. Mental retardation

 Mild
 Moderate
 Severe
 Profound

STANDARDS AND PRINCIPLES OF PSYCHIATRIC NURSING

Standards of Psychiatric Care

Standards of care pertain to professional nursing activities that are

demonstrated by the nurse through the nursing process. These involve assessment,
diagnosis, outcome identification, planning, implementation and evaluation. The
nursing process is the foundation of clinical decision making and encompassing all
significant action taken by nurses in providing psychiatric- mental health care to all
clients
Standard I Assessment

The psychiatric mental health nurse collects client health data

Standard II Diagnosis

The psychiatric - mental health nurse analyses the assessment data in

determining diagnoses

Standard III Outcome identification

The psychiatric mental health nurse identifies outcomes individualized to the

client

Standard IV Planning

The psychiatric- mental health nurse develops a plan of care that prescribes
interventions to attain expected outcomes

Standard V Implementation

The psychiatric- mental health nurse implements the interventions identified in

the plan of care

Standard V-A Counselling

The psychiatric mental health nurse uses counselling interventions to assist

clients improving or regaining their previous coping abilities, fostering mental
health, and preventing mental illness and disabilities

Standard V-B Milieu therapy

The psychiatric mental health nurse provides, structures. and maintains a

therapeutic environment in collaboration with the client and other health care
providers

Standard V-C Self-care activities

The psychiatric mental health nurse structures interventions around the client's
activities of daily living to foster self care and mental and physical wellbeing
Standard V-D Psychobiologic interventions

The psychiatric mental health nurse uses knowledge of psychobiologic

interventions and applies clinical skills to restore client's health and prevent further
disability

Standard V- E Health teaching

Through health teaching she, assist client in achieving satisfying, productive

and healthy patterns of Wing

Standard V- F Case management

She provide case management to coordinate comprehensive health services

and ensure continuity of care

Standard V-G Health promotion and maintenance

She employs strategies and interventions to promote and maintain mental

health and ensure continuity of care.

Advanced practice interventions V- H to V- J

The following interventions (V-H to V-J) may be performed only by the

certified nursing specialist in psychiatric- mental health

Standard V- H Psychotherapy

The certified nurse in psychiatric mental health nursing uses individual, group
and family psychotherapy, and other therapeutic treatments to assist clients in
fostering mental health, and improving or regaining previous health status and
functional abilities

Standard V- I prescription of pharmacological agents

The certified specialist uses prescription of pharmacological agents in

accordance with the state nursing practice act, to treat symptoms of psychiatric
illness and improve functional health status

Standard V-J Consultation

 The certified specialist provides consultation to health care providers and
others to influence the plan of care for clients and to enhance the abilities of others
to provide psychiatric and mental health care and affect change in system.

Standard VI Evaluation

She evaluates the client's progress in attaining expected outcomes

STANDARDS OF PROFESSIONAL PERFORMANCE:

It describes a competent level of behaviour in the professional role, including

activities related to quality of care, performance appraisal, education, collegiality,
ethics collaboration, research, and resource utilization. All the psychiatric mental
health nurses are expected to engage in professional role activities appropriate to
their education, position and practice setting

The nurses should be self directed and purposeful in seeking necessary knowledge
and skills to enhance career goals. Other activities such as membership in
professional organization, certification in speciality or advanced practice
continuing education and further academic education are desirable methods of
enhancing the psychiatric mental health nurse professionalism.

Standard I Quality of care

The psychiatric mental health nurse systematically evaluates the quality of

care and effectiveness of psychiatric mental health nursing practice

Standard II Performance appraisal

The psychiatric mental health nurse evaluates his or her own psychiatric mental
health nursing practice in relation to professional practice standards and relevant
statutes and regulations.

Standard III Education

The psychiatric mental health nurse acquires and maintains current knowledge in
nursing practice.

Standard VI Collaboration
The psychiatric mental health nursing collaborates with the client, significant
others and health care providers in providing care

Standard VII Research

The psychiatric mental health nurse contributes to nursing and mental health
through the use of research

Standard IV Collegiality

The psychiatric mental health nurse contributes to the professional development of

peers, colleagues and others.

Principles of Psychiatric Nursing

Psychiatric mental health nursing is to provide highly individualized

comprehensive care. There are certain principles that apply to the care of all who
show behaviour disorder irrespective of the mental illness that they are suffering
from and or promotion of mental health. Prevention of mental illness and treatment
and rehabilitation of respective clients.

These principles are based on the concept that each individual has an intrinsic
worth and dignity and he has potentiality to grow

1. Accept the patient exactly as he is

Acceptance conveys the feeling of being loved and cared Acceptance provides the
patient with an experience, which is emotionally neutral, where he finds unlearning
of his sick behaviour is less threatening before he can relearn the art of living with
himself and with others

Acceptance does not mean complete permissiveness, but setting of positive

behaviour to convey to him the respect as an individual human being. Acceptance
is expressed in the following

 Be Non-Judgemental and Non-Punitive

We don't judge patient's behaviour as right or wrong, good or bad. Patient is

not punished for his undesired behaviour. All direct and indirect methods of
punishing must be avoided.
Chaining, restraining, putting him in a separate room are some of the direct
punishments. Ignoring his presence or withdrawing his importance are few ways of
giving indirect punishment

 Show Interest in the Patient as a Person

This can be demonstrated by:
 Studying patient's behaviour pattern.
 Making the patient aware in a subtle manner that you are interested in
him.
 Seeking out a patient.
 Using time spent with him on those things he is interested in
 Being aware of his likes and dislikes.
 Explain when his demands cannot be met
 Dealing with his comments, complaints and expression of approval
realistically.
 Accepting his fears as real to him.
 Avoiding subjects on which he feels sensitive.
 Listening to him.
 Recognize and Reflect on feelings which patient may express

The nurse acts as a sounding board for patient's strong or negative feeling.
The nurse develops skill in identifying the feelings actually expressed For
example, when a patient says I would like to break someone's neck, we understand
that he is angry at somebody and is expressing the anger I am a dead person feeling
of worthlessness, etc.) When patient talks, it is not the content that is important to
note, but the feeling behind the conversation is more important. That has to be
recognized and reflected.

 Talk with a Purpose

Nurse's conversation with a patient must revolve around his needs, wants and
interests. Nurse's responses must guide her/his patient. Indirect approaches like
reflection, open-end question, focusing on a point presenting reality is more
effective when the problems are not obvious. Avoid evaluative, hostile, probing
 responses and use the understanding responses, which may help the patient to
explore his feelings

 Listen

Listening is an active process. Two ears are required for what the patient says
verbally and the third ear is required for what patient is otherwise nanverbally
saying Encourage patient to talk through brief non-directive comments showing
interest in what patient is saying.

1. Use self-understanding as a therapeutic tool

Self-understanding leads to understanding of others. Knowing how one ought to

feel or act is not important but to understand why one behaves the way she does is
vital. Patient's behaviour can produce lot of anxiety or fear in the nurse, and she
ought to understand why she is anxious or frightened.

We can understand ourselves better by

a) Exchanging personal experience freely and frankly with our colleagues or by

b) Discussing our personal reaction with an experienced person, or by
c) (c) Participating in-group conference regarding our patient care, or by
d) Introspecting on why we feel or act the way we do.

2. Use consistent behavior to increase patient's emotional security

Consistency in our approach is needed to develop a feeling in-patient that we can

depend on the people working in the ward. Our consistency must reflect in our
attitudes, ward routine and defining the limitation placed on the patient.
Consistency could be demonstrated by:

a) Patient to be constantly and continuously exposed to an atmosphere of quiet

acceptance, Consistency to be maintained from nurse to nurse and shift to
shift which must be planned properly
b) Permissiveness to be limited, e.g. with homicidal, Suicidal, hyperactive and
suspicious patients.
c) Patient is allowed to feel as he does but limitations are put on his behaviour
 d) Limit and its reinforcement requires great deal of tact and understanding
and should be done in quiet and matter of fact way.
e) Attempt to win patient's liking (favoritism) is most disastrous for the patient

3. Give reassurance to patients in subtle and acceptable manner.

Reassurance is building patient's confidence or restoring his confidence. To give

reassurance, we need to understand the meaning of experience to the patient. We
need to analyze the situation as to how it appears to the patient.

While giving reassurance, we must avoid saying to the patient, statements like you
will get well, your fears are you are a nice person's nothing to worry and ground
false promises making Reassurance can be given in the following manner

a) Be truly interested in patient's problem,

b) Pay attention to the matters that are important to then patient-matter however
insignificant it may be.
c) Allow be as sick as he needs to be. him to
d) Be aware and accept how the patient really feels.
e) Do things the patient without asking anything of the patient in return such
as improved behaviour or show of appreciation
f) Sit beside patient even when he does not want to talk Accepting patient's
silence and the physical presence of nurse can be very reassuring to the
patient
g) Listen to personal problem without showing surprise or disapproval.
h) Agree that patient has a problem and think along with him to solve them
i) Provide patient with acceptable outlets of anxiety

4. Change patient's behaviour through emotional experience and not by

rational interpretation

Major focus in psychiatry is on feeling aspect and not on intellectual aspect.

Telling and advising patients is not effective in changing behaviour. Role-play,
socio-drama and transactional analysis are few ways of creating emotional
experience in a patient about his own behaviour. When an alcoholic patient is told
that his drunkard behaviour is more hurting to his wife, to his children and takes
away his time and money, he does not agree to our interpretation. But the same is
acted out by giving him a role of wife or child or an alcoholic, he gains more
understanding about this troublesome behaviour.

Corrective emotional experience can bring behaviour change. Help the patient feel
emotionally secured to enable him to develop and use understanding of his own
behaviour. Understanding cannot be forced, as insight and understanding of one's
own behaviour is painful. Interpretation is only done when patient is ready for it.
i.e. secure enough to tolerate it and able to apply it to alter his behaviour. Attitudes
are also not identified for the patient When he is ready to tolerate he will identify
them by himself.

5. Avoid unnecessary increase in patient's anxiety

Anxiety is a feeling of fear for an unknown object or event. It is also a feeling of

apprehension. It is also a threat to biological integrity or self-system (ego) of the
person. Psychiatric patients already have some amount of anxiety owing to their
illness, social disapproval and seclusion from the family. Psychiatric nurses must
not further increase anxiety of the patients by:

a) Contradicting his psychotic ideas

b) Demanding the patients to complete the set tasks. which he cannot obviously
meet
c) Making him to face repeated failure
d) Using big sentences, professional terms while talking to him
e) Careless conversation within patient's hearing about his personal life
f) Calling attention to patient's defects
g) Being insincere
h) Giving no orientation about the wards, about his co patients about ward
staff, policies, routines and procedures
i) Threats, passing sharp commands and showing indifference
j) Asking questions about family, work, friends, and home which is not good
for the first phase of patient nurse relationship
k) Showing nurses own anxiety
 6. Demonstrate objective observation to understand and interpret the
meaning of patient's behaviour

We need to observe what a patient says or does. Those observations need to

be analyzed by us to draw motivation or purpose behind his talk or action.

We improve our skills of observation by continuously predicting a patient's

behaviour

While working with a patient, learn his basic problems and: then guess what he
will do, if your predication is right, ask yourself why? If the predication is wrong,
ask yourself why? Keep asking yourself what is the goal of the patient and why did
he behave the way he did. While examining yourself, be objective

Objectivity is an ability to evaluate exactly what patient wants to say and not mix
up your own feelings, opinion or judgement.

Objectivity is not coldness, indifference and absence of feeling but is an ability not
to let your own judgment get confused with emotional warmth. To be objective,
you keep indulging in introspection; make sure that your own emotional needs
don't take precedence over patient's needs. Maintain an objectives attitude and live
balanced life.

The indications of lack of objectivity in nurse's observations are:

a) Nurse is critical of the patient

b) Defending or justifying herself
c) Demanding that the patient should treat her in a certain way
d) Evaluating the patient's behaviour right or wrong

7. Maintain realistic nurse-patient relationships

Realistic or professional relationship focuses upon the personal and emotional

needs of the patients and not on nurse's needs. Such a relationship is
therapeutically oriented and planned, and is always based on patient's needs.
Nurse's goal is not shared by the patient neither does she seek patient's approval.
Nurse keeps analyzing the interaction between herself and the patient to prepare
herself to guide the patient towards matured behaviour. Nurse differentiates
between patient's demands and actual needs.

Nurse-patient relationship is an interpersonal process, It is for the purpose of

bringing adaptiveness, integration and more maturity in patients

8. Avoid physical and verbal force as much as possible

Any kinds of force applied on patient results in psychological trauma, unless it is a

patient who needs and welcome punishment. For example, a depressed patient
welcomes the punishment or scolding as he is basically suffering from guilt of
having done a mistake. Restraining the violent patient in the cot is an example of
physical force. If at all this needs to be used the following points to be kept in
mind.

a) Carry out the procedure quickly, firmly, and efficiently with adequate help.
b) Do not show your anger or annoyance while tying him.
c) Tell him the reason for tying him and also that he will be allowed to mix
with other when he has gained control of himself.
d) Attend to his needs as usual and never let the patient feel that he is being
punished.
e) After he has become controllable approachable, never remind him again
about the incidence.

9. Provide nursing care to the patient as a person and not on control of

symptoms of the disease that he has

Every behaviour is caused understand the meaning behind the behaviour. The
symptoms in him are the reflections of his problems. Two patients showing the
same symptoms may be expressing two different needs. For example, two patients
with headache may have different meaning of the symptom to them. One may have
headache because of sleeplessness and the other may have because of
hypoglycemia. Analysis and study of symptoms are necessary to reveal their
meaning and their significance to the patient. In a psychiatric ward, for example,
two patients feel hostile towards the nurse and both express it verbally One patient
having spoken may get over whelmed by feeling of guilt and panic. The other may
show a rather satisfied relief having spoken. The first patient may nee help in
refraining from verbal expression and help him to channelize hostility in indirect
way until she can tolerate his frank expression of hostility. The other patient may
be encouraged to explore verbally, and eventually hostility of both should be
understood.

10. Explain routines and procedures at patient’s level of understanding

Every patient has a right to know what is being done and why it is being done to
him. Every procedure should be explained at his level of understanding depending
on the limitation placed on him by his symptoms. Explaining to the patient reduces
anxiety. They character of explanation depends on the patient's span of attention,
level of anxiety level of ability to decide, etc, But the explanation should never be
withheld, thinking that psychiatric patients are not having contact with reality or
have no ability to understand.

11. Many procedures are modified but basic principles remain unaltered

In psychiatric nursing field, many methods are adapted to the protective needs of
the patients but the nursing principles and scientific principles remain the same.
For example, giving enema, doing surgical dressing, catheterization and giving
medication, the principles behind each remain the same, but the same, but the
procedure of each treatment may be different.

The Nursing principles to be kept in mind are:

a) Safety
b) Comfort
c) Individuality and privacy
d) Maintaining therapeutic effectiveness, very fine workmanship while doing
procedure and
e) Economy of time, energy and material
CHALLENGES AND SCOPE OF PSYCHIATRIC NURSING

The American Nurses Association defines psychiatric nursing as a specialized area

of nursing practice, employing the wide range of explanatory theories of human
behaviour as its science and purposeful use of self as its art and diagnosis and
treatment of human responses to actual or potential health problems

Nature of Mental Health Nursing

Hildegard Peplau, called as the mother of psychiatrie nursing, identified the art of
psychiatric nursing as the role of counsellor or psychotherapist Therapeutic Nurse
patient relationship forms the core part of this

The practice of mental health nursing is based on certain philosophical beliefs.

1. The individual has intrinsic worth and dignity and is worthy of respect
2. The goal of all individuals is growth, health, autonomy and self-actualization
3. Every Individual has the potential to change
4. Each person functions as a holistic being that acts on interact with, and react
to the Environment as a whole person.
5. All people have common basic needs such as physical requirements, safety,
loving, belonging, esteem and self actualization.
6. All behaviour of the individual is meaningful.
7. Individuals vary in their coping capacities.
8. All people have a right to equal opportunity for adequate health care
9. Each Individual has the right to participate in decision making regarding
his/her health
10. The goal of nursing care is to promote wellness,
11. An interpersonal relationship can produce change and growth.
SCOPE OF MENTAL HEALTH NURSING

Mental health nursing practice occurs within a social and environmental context.
Hence the "Nurse- patient relationship is nothing but "nurse-patient partnership"
that expands the dimensions of the professional mental health nursing role. This
includes

1. Clinical competence

2 Patient-family advocacy

3. Fiscal responsibility

4. Interdisciplinary collaboration

5. Social accountability and

6. Legal-ethical parameters

MULTIDISCIPLINARY TEAM I INTERDISCIPLINARY TEAM

Teamwork is paramount for the success of any group. Teamwork means the
combined. co-ordinated and dedicated effort of each and every member of the team
towards achievement of the vested interest, target or goal of the team as an entity

Teamwork becomes more significant in a mental health setting where the

contribution of the entire member is extremely vital for the assessment, diagnosis,
treatment and rehabilitation of mentally ill patient.

This multidisciplinary team can also function as an interdisciplinary team in that,

the total care of the patient requires not only the total input of each member of the
team but also the inter-disciplinary coordinated efforts. Egg one can compare this
concept to an orchestra led by music director. Each member of the orchestra has to
give his input and simultaneously there should be coordination with other members
as directed by the music director, so that the final effect is splendid.

Functioning as an effective team member requires the development and practice of

several core skill areas,
  Interpersonal skills, such as tolerance, patience and understanding
 Humanity, such as warmth, acceptance, empathy non-judgemental attitude.
 Knowledge base about mental disorder, symptoms and behaviours.
 Communication skills.
 Teamwork skills such as collaborating, sharing and integrating

Members of the Mental Health Team

1. Psychiatrist

2. Psychiatric nurse clinical specialist

3. Registered nurse working in a psychiatric unit/hospital

4. Clinical psychologist

5. Psychiatric social worker

6. Psychiatric Para-professionals

7. Psychiatric Aids-ECT technician

8. Occupational therapist

9. Recreational therapist

10. Diversional/play therapist 11. Creative art therapist

12. Clergymen

1. Psychiatric nurse clinical specialist.

The psychiatric nurse clinical specialist should have a master's degree in nursing,
preferably with post graduate research work. She participates actively in primary,
secondary and tertiary prevention of mental disorder and provides individual,
group and family psychotherapy in a hospital and community settings. She also
takes up the responsibilities of teaching administration and research, besides
publishing work in mental health settings, She takes up the role of a leader and can
practice independently Other functions include:
  Administering and monitoring medications
 Assisting in numerous psychiatric and physical training,
 Participating in interdisciplinary team meetings
 Takes responsibility for patient's records
 Interacts with patients significant others

2. Registered nurse in psychiatric unit

The registered nurse undergoes a general nursing and midwifery programme or

B.sc nursing / post-basic B.Sc nursing programme with added qualification such as
diploma in psychiatric nursing, diploma in nursing administration etc. This nurse is
skilled in caring the mentally ill. Gives holistic care by assessing the patients
mental social, physical, psychological and spiritual needs, making a nursing
diagnosis, formulating, evaluating and rendering the appropriate nursing care.
She /he updates knowledge via continuing education, in-service education,
workshops and courses conducted by open universities. The nurse is also an
essential team member in evaluating the effectiveness of medical treatment,
particularly medications

3. Psychiatrist

The psychiatrist is a doctor with post graduation in psychiatry with 2-3 years of
residence training, 2 years of clinical practice and completion of an examination.
He/she is accountable for diagnosis, treatment and prevention of mental disorders,
prescribes medicines and somatic therapy and functions as the leader of the mental
health team. Other important functions are:

 Admitting the patient into acute care setting.

 Prescribing and monitoring psychopharmacologic agents
 Administering ECT.
 Conducting individual and family therapy
 Participating in interdisciplinary team meetings

4. Clinical psychologist.

The clinical psychologist holds a doctoral degree in clinical psychology and is

registered with the clinical psychologist's association. He/she conducts
psychological, diagnostic tests, interprets and evaluates the findings of these tests
and implements a program of behavioural modification and participates in research
activities He offers direct services such as individual, family and marital status

5. The psychiatric social worker.

The psychiatric social worker is a graduate in social work and a post graduate in
psychiatric social work He /ahe assesses the individual, family and community
support system, helps in discharge planning, counselling for job placement. He she
is skilled in interview techniques and group dynamics. The social workers may
practice therapy and often have the primary responsibility for working with the
families, community support and referral. He conducts group therapy sessions,

6. Psychiatric para-workers.

a) Psychiatric nursing Aids

b) ECT technicians
c) Auxiliary personal
d) Occupational therapist.
e) Recreational therapist
f) Diversional play therapist.
g) Creative art therapist.
h) Clergymen.

ROLE OF PSYCHIATRIC NURSE. EXPANDED AND EXTENDED ROLE

Introduction

Psychiatric mental health nurses work in a variety of hospital and community

settings. During recent years in the development of health services in the world,
much emphasis has been placed on the expanding role" of the nurse Psychiatric
nursing is a speciality area within the discipline of nursing. Traditionally, the role
of the nurses was to provide care and comforts as they carried out specific nursing
function, but changes in nursing of the day have expanded the role to include
increased emphasis on health promotion and lines-prevention, as well as concern
for the client as whole.
Tremendous changes have happened in all specialities of nursing including
psychiatric nursing. The role shift of psychiatric nursing and mental health care are
be influenced by factors like economics, financing of health care, information
technology, managed behavioural health care, the psychobiologic shift,
accountability in practice, and mental health research.

Development of Psychiatric Nursing roles

"A role is a set of expected and actual behaviours associated with a position in a
social structure" -Hardy & Hardy (1988). A role is the sum total of expected
behaviours the behaviours expected from a person who occupies a particular
position and status in a social pattern". The role of psychiatric nurse expanded after
World War II. The discovery of psychiatric nursing theory and practice by
Hildegard Peplau gave impetus to the advanced practice in psychiatric nursing,
Many of the by other new professionals, like to Sing roles are taken up activity
therapist. But new roles are emerging for psychiatric nursing. Some of the new
roles for psychiatric nurses in US are entrepreneur, manager, clinician, educator
and researcher. Depending on the state laws, nurses are practicing psychotherapy
and prescribing medicines to uncomplicated patients in US

Traditional roles of nursing

 Contemporary nursing requires that the nurse possess knowledge and skills
in different areas.
 Caregiver, Communicator, Educator / teacher, Manager, Advocate, Leader,
Counsellor, Researcher, Career Development

Expanded and extended role of nurse

Expanded role of nurse is the one that the nurse assumes by virtue of education
and experiences. It goes beyond the traditional nursing roles with additional
responsibilities Clinician, Nurse researcher, Nurse Administrator/ Manger, Nurse
Educator, Advanced Practice Nurse (APN), Nurse practitioner, Clinical Nurse
Specialist (CNS), School health nurse, Critical care nurse, Family nurse
practitioner, Trauma nurse specialist.
The concept of extended roles means to reach out. The role of the nurse needs
change along with that of other health professional which means that the
knowledge and skills of nurse needs to be broadened. Extended nursing facilities
are that agency which provides variety of services for the patient of all age groups
which may be a part of hospital or institution or a separate institution may
proprietary or non-proprietary Nurse Entrepreneurs. Nurse anaesthetist, Nurse
Informatics, Palliative care nurse/ Hospice care nurse, Nurse Oncologist, Nurse
Prescriber, infection control nurse, Nurse endoscopist

Expanded Roles of Psychiatric Nurse

As when working with the clients in any other nursing settings, the psychiatric
nurse uses various roles to provide needed care to the client.

1. Teacher: During the working phase of nurse-patient relationship, the nurse may
teach the client new methods of coping and solving problems. To be a good
teacher, the nurse must feel confident about the knowledge he or she has and must
know the limitations of that knowledge base. The nurse should be aware of the
resources available which can help to provide needed information to the client.

2. Caregiver: The primary care giving role in mental health settings is the
implementation of the therapeutic relationship to build trust, explore feelings,
assist the client in problem solving and helps the client meet psychosocial needs. A
psychiatric nurse provides nursing care to individuals, families and groups to
enable them to function to an optimal level of psychological wellness,

3. Advocate: In the advocate role, the nurse informs the client and then supports
him or her in whatever decision he or she makes. In psychiatric mental health
nursing, advocacy is a bit different from medical surgical settings because of the
nature of the client's illness. For ex: the nurse cannot support the client's decision
to hurt himself or herself or any other person. Advocacy is the process of acting on
the client's behalf when he or she cannot do so. This includes ensuring privacy and
dignity, promoting informed consent, preventing unnecessary examination and
procedures. For ex; if the physician begins to examine the a client without closing
the curtains and the necessary steps in and properly drapes the patient and closes
the curtains, the nurse has just acted as a the client's advocate.
4. Parent surrogate: when a client exhibits child like behaviour or when a nurse is
required to provide personal care such as feeding or bathing, the nurse may be
tempted to assume the parental role as evidenced in choice of words and non-
verbal communication. The nurse must ensure the relationship remains therapeutic
and does not become social or intimate.

5. Liaison role: Nurses will be connecting links, bridges the gap between clients
and family members, with family and health care professionals, between
community welfare agencies or resources and families, and thus acts as a
supporting system for clients and their families

6. Counsellor role: counsels the family members and help them In meeting the
client’s needs at home and reduces the social stigma associated with it. Mobilizes
the community agencies and its resources for welfare of mentally ill and provision
of needed services

7. Coordinator role: psychiatric care is based on multidisciplinary team approach

and the nurse has to coordinate between team members, case findings, screening,
follow-up, continuity of services and referral etc.

8. Domiciliary care: community mental health nurses visits the house and assess
the health status, coping strategies utilized by the family members, psychological
functioning of the individuals, etc and plans, implements necessary care at their
doorsteps.

9. Researcher role: a psychiatric nurse utilizes the therapeutic principles and

research to understand and interpret the client's emotions, thoughts and behaviour.
Plans and conducts research activities, minor projects, submits its report to
concerned authorities, publishes various articles, based on their observations and
results plan.
 JOURNAL ABSTRACT

The Nature of Psychiatric Classification: Issues Beyond ICD-10 and DSM-IV

- Assen Jablensky

Abstract

Objective:

The aim of this paper is to provide an overview of the methodological

underpinnings of current classification systems in psychiatry, their impact on
clinical and social practices, and likely scenarios for future development, as an
introduction to a series of related articles in this issue.

Method:

The method involved a selective literature review. Results: The role and
significance of psychiatric classifications is placed in a broader social and cultural
context; the ‘goodness of fit’ between ICD-10 and DSMIV on one hand, and
clinical reality on the other hand, is examined; the nature of psy chiatric
classification, compared to biological classifications, is discussed; and questions
related to the impact of advances in neuroscience and genetics on psychiatric
classification are raised for further discussion.

Conclusions:

The introduction of explicit diagnostic criteria and rule-based classification, a

major step for psychiatry, took place concurrently with the ascent to dominance of
a biomedical paradigm and the synergistic effects of social and economic forces.
This creates certain risks of conceptual closure of clinical psychiatry if
phenomenology, intersubjectivity and the inherent historicism of key concepts
about mental illness are ignored in practice, education and research.
 THEORY APPLICATION

GENERAL SYSTEM THEORY

General system theory was proposed in the 1940’s by the biologist Ludwig von
Bertalanffy and furthered by Ross Ashby (1964). The system theory focuses on the
organization as a whole its interaction with the environment and its need to
achieveequilibrium.

Input: it refers to demographic variables such as age, sex, educational status,

occupation.

Through put: it refers to intervention which we given

Output: output is any information that leaves the system and enters the
environment through system boundary.
SUMMARY:

As I am summaries my topic of introduction to mental health nursing. In that we

discussed about the definition of mental health classification of mental illness. In
that International classification of disease(ICD) and Diagnostic statistical manual
classification of mental disease (DSM-IV) and Indian classification. Hope you all
understand my topic.

CONCLUSION:

I’ll conclude my topic that all classification is characterized by every years of

updating disease. The international classification of disease is a globally used
diagnostic tool for epidemiology, health management and clinical purpose. In
current we are using ICD-10 classification. In India Indian classification are also
used to diagnosis the disease.
BIBLIOGRAPHY

1. Elakkuvana Bhaskara Raj,(2014), DEBR’S Mental Health (Psychiatric)

Nursing,1st edition,Bangalore, EMMESS Medical publication , page no:2-
37.
2. R. Sreevani (2010), “A GUIODE TO MENTAL HEALTH AND PSYCHIATRIC
NURSING”,3rd edition, Bangalore, Jaypee publications, page no:1-36
3. Dr.K.Lalitha (2007), “MENTAL HEALTH AND PSYCHIATRIC NURSING ON
INDIAN PERSPECTIVE”.1st edition, Bangalore, VMG Book House, page no:3-1
4. BimlaKapoor(2002), “TEXTBOOK PSYCHIATRIC NURSING”,7thedition,Vol II,
Delhi, Kumar Publishing House, page no:45-60
5. Mary. C Townsend. Psychiatric Mental Health Nursing: concepts of care in
Evidence based practise. 8th edition. New delhi: Jaypee brothers Medical
publication;2014 page no: 28-47.

NET REFERENCE

1. http://www.slideshare.com\mentalhealthnursing

JOURNAL REFERENCE

1. https://doi.org/10.1046/j.1440-1614.1999.00535.x