1. Principles and Concepts of
Mental Health Nursing
Mr. Johny Kutty Joseph
Assistant Professor
SMVDCoN
2. Signs and Symptoms of
Mental Illness
âą Alterations of Personality & Behaviour
ï± A confirmed atheist turns into religious
ï± Social and outgoing person turns to
isolation.
âą Alterations of Biological Functions
ï± Sleep: its pattern, quality, and duration
ï±Appetite: pica, bulimia, anorexia
ï±Sexual desire: libido, erectile dysfunction,
ejaculation disturbances.
3. Signs and Symptoms of
Mental Illness
âą Disorders of Consciousness
ï± Clouding of Consciousness: diminution of
alertness. Organic and functional psychosis.
ï± Drowsiness: slipping into sleep though awake.
ï± Coma: unconscious and non responsive
ï± Qualitative changes: confusion, disorientation,
stereotypism etc.
ï± Fugue and dissociation: temporary alteration of
consciousness and identity.
ï± Stupor: conscious but unresponsive to
environment.
4. Signs and Symptoms of
Mental Illness
âą Disorders of Attention and Concentration
ï± Distraction.
ï± Decreased span of attention.
ï± Narrowing of attention.
ï± seen in anxiety, mania, depression,
schizophrenia, substance abuse etc.
5. Signs and Symptoms of
Mental Illness
âą Disorders of Orientation
ï± Time, Place, Person.
ï± Disorientation to own identity.
âą Volitional Disturbances: It is the willful initiation
and control of oneâs behaviour.
ï± Seen organic and functional disorders
ï± Immobility
ï± Mutism
ï± Stupor
ï± decreased drives (sleep, appetite, thirst etc.)
6. Signs and Symptoms of
Mental Illness
âą Disorders of Motor Activity
ï± Increased Activity Level: Hyperactivity may be goal
oriented or not. (mania)
ï± Impulsivity, Restlessness, Agitation & Excitement
ï±Decreased activity: Depression, slow and lack of
initiation of activities (akinesia) mutism, stupor etc.
ï±Qualitative disturbances of movement: sudden
involuntary twitching of movement, facial expression
like blinking, sniffing, throat clearing. Tics and
mannerisms, tremors odd acts such as scratching of
head, nose pulling, ear pulling. Negativism.
7. Signs and Symptoms of
Mental Illness
âą Disturbance in Posture and Expression
ï± Voluntary assumption of inappropriate and
bizarre positions.
ï± Waxy flexibility.
ï± Maintaining Psychological Pillow (head raised)
ï± Extremely cheerful, Odd Facial expressions or
grimacing.
8. Signs and Symptoms of
Mental Illness
âą Disturbance in Motor Speech
ï± Echolalia and Palialia
âą Disorders of perception
âą Disorders of Mood
âą Disorders of Memory
ï± Amnesia: partial or total failure to recall past.
Seen in trauma, infection etc. Due to defective
registration of information under influence of
drug or alcohol.
10. Signs and Symptoms of
Mental Illness
âą Disorders of Thought
âą Disorders of Intelligence: Mental Retardation,
Intellectual deterioration occurs in dementia
and other organic conditions.
âą Disorders of Insight and Judgment:
âą 1: Personal judgment,
âą 2: social judgment, and
âą 3: test judgment.
11. Signs and Symptoms of
Mental Illness
âą Insight is level of self awareness of his
disability and the need for help.
âą 1: complete denial of illness
âą 2: Slight awareness of being sick
âą 3: Awareness of being sick attributed to
external or physical factor
âą 4: Awareness of being sick due to something
unknown to self.
âą 5: Intellectual insight
âą 6: True emotional insight
12. Classification of Mental Illness
âą Classification is a process by which complex
phenomena are organized into categories,
classes or ranks so as bring together those
things that most resemble each other & to
separate those that differ.
âą At present there are two major classification in
psychiatry, namely ICD 10 (1992) & DSM V
(2013).
âą It helps in making generally acceptable
diagnosis, communication of professionals,
generalization in treatment and a framework for
research.
13. ICD 10 (International Statistical
Classification of Disease & Related
Health Problems)- 1992
âą This is WHOâs classification for all diseases
& related health problems. âą
âą The chapter âFâ classifies psychiatric
disorder as mental & behavioral disorders &
codes them on an alphanumeric system from
F00 to F99.
âą The Main Categories in ICD 10:-
14. ICD 10 - 1992
âą F00 â F09 Organic, Including Symptomatic,
Mental disorders
âą F00 â Dementia in Alzheimerâs disease
âą F01 â Vascular dementia
âą F04 â Organic amnestic syndrome
âą F05 â Delirium
âą F06 â Other mental disorders due to brain
damage & dysfunction & to physical disease
âą F07 â Personality & behavioral disorders due
to brain disease, damage & dysfunction
15. ICD 10 - 1992
âą F10 â F19 Mental & behavioral Disorders due to
Psychoactive Substance use
âą F10 â Mental & behavioral disorders due to use of
alcohol
âą F11 - Mental & behavioral disorders due to use of
opioids
âą F12 â Mental & behavioral disorders due to use of
cannabinoids
âą F13 â Mental & behavioral disorders due to use of
sedatives & hypnotics
âą F14 â Mental & behavioral disorders due to use of
cocaine
âą F16 â Mental & behavioral disorders due to use of
hallucinogens (Eg. LSD/Lysergic Acid)
24. ICD 10 - 1992
âą F80 â F89 Disorders of psychological
development
âą F80 â Specific developmental disorders of
speech & language
âą F81 â Specific developmental disorders of
scholastic skills
âą F82 â Specific developmental disorders of
motor function
âą F83 â Mixed specific developmental disorders
âą F84 â Pervasive developmental disorders
25. ICD 10 - 1992
âą F90 â F98 Behavioral & emotional Disorders with
onset usually occurring in childhood &
adolescence
âą F90 â Hyperkinetic disorders
âą F91 â Conduct disorders
âą F93 â Emotional disorders with onset specific to
childhood
âą F94 â Disorders of social functioning with onset
specific to childhood & adolescence
âą F95 â Tic Disorders
âą F98 â Other behavioral & emotional disorders
with onset usually occurring in childhood &
adolescence
27. DSM â V (2013)
âą DSM V (Diagnostic & Statistical Manual) â 2013.
âą This is the classification of mental disorders by
the American Psychiatric Association (APA).
âą The pattern adopted by DSM V is of Multi-axial
systems.
âą A multi-axial system that evaluates patients
along several versatile contains Five axes.
28. DSM â V (2013)
âą The Five Axes of DSM V Are:-
âą Axis I : Clinical psychiatric diagnosis
âą Axis II : Personality disorder & mental
retardation
âą Axis III ; General medical conditions
âą Axis IV : Psychosocial & environmental
problems
âą Axis V : Global assessment of functioning in
current & past one year.
29. DSM â V (2013)
âą The diagnostic criteria and codes in DSM 5 are
âą 1.2.1: Neurodevelopmental disorders
âą 1.2.2: Schizophrenia spectrum and other
psychotic disorders.
âą 1.2.3: Bipolar and related disorders.
âą 1.2.4: Depressive disorders
âą 1.2.5: Anxiety disorders
âą 1.2.6: OCD
âą 1.2.7: Trauma and stress related disorders
âą 1.2.8: Dissociative disorders
âą 1.2.9: Somatic symptoms and related disorders.
30. DSM â V (2013)
âą 1.2.10: Feeding and eating disorders
âą 1.2.11: sleep wake disorders
âą 1.2.12: sexual dysfunction.
âą 1.2.13: gender dysphoria /identity
âą 1.2.14: disruptive, impulse control and conduct
disorders.
âą 1.2.15: substance related and addictive
disorders.
âą 1.2.16: Neuro cognitive disorders
âą 1.2.17: paraphilic disorders
âą 1.2.18: personality disorders.
31. Indian Classification 1971
It is modification to ICD 8 by Indian Psychiatrists.
âą A: Psychosis
ï¶Functional (Schizophrenia / simple /
hebephrenic / catatonic / paranoid)
ï¶Affective: (mania and depression)
ï¶Organic: (Acute and Chronic)
âą B: Neurosis
ï¶ Anxiety Neurosis
ï¶ Depressive neurosis
ï¶ Hysterical neurosis
ï¶ OCD
ï¶Phobic Neurosis
32. Indian Classification 1971
âą C: Special disorders
ï¶ Childhood disorders
ï¶Personality disorders
ï¶Substance abuse
ï¶Mental retardation
33. Factors influencing Personality
âą Biological Factors
ï¶ Heredity: gene and its traits
ï¶Endocrine glands: thyroid gland can cause
mania / depression. Parathyroid glands monitor
calcium that cause nervous excitability.
ï¶Physique: size, strength, physical appearance
and dominance or inferiority.
ï¶Nervous System: rate of transmission and level
of neurotransmitters.
34. Factors influencing Personality
âą Environmental Factors.
ï¶ Family (family reactions, parents, morality,
social norms, tolerant fathers increase
emotional stability and self confidence,
overprotective mothers, submissive mothers,
Birth order etc.)
ï¶ School (friendships, type of curriculum,
facilities)
ï¶Teacher (reactions, personality and
relationship)
ï¶Peer Group (development of self concept,
sharing, cooperation, sexuality, intimacy etc.)
35. Factors influencing Personality
âą Environmental Factors.
ï¶ Sibling relationship (number of children,
developing cooperation / sharing/
aggressiveness traits, jealousy, rivalry,
unhealthy comparisons by parents, )
ï¶Mass Media (attitudes, values, beliefs, role
models, addictive programmes)
ï¶Culture ( moral values, beliefs, religion,
geographical / dietary / hormonal influence on
personality.)
36. Theories of Personality Development
âą Psycho Analytic Theory
ï¶ Oral, Anal, Phallic, Latent, Genital
âą Psycho social development theory
ï¶ trust vs mistrust, autonomy vs shame,
initiative vs guilt, industry vs inferiority, identity
vs role confusion, intimacy vs isolation,
generativity vs stagnation, ego integrity vs
despair.
37. Theories of Personality Development
âą Theory of Cognitive development
ï¶ Sensori-motor (0-2), pre-opeartaional (2-6),
concrete operational (6-12), formal operational (12-
15).
âą Theory of Moral Development
ï¶Level 1 4-10 years (Pre - conventional / self
centered orientation, egocentric judgment,
punishment and obedience etc)
ï¶Level 2 10-13 years ( Conventional Level:
interpersonal orientation, law / order orientation )
ï¶Level 3 (13 +) (Post conventional level) (social
contract legalistic orientation, universal ethical
orientation)
38. Theories of Personality Development
âą Humanistic Theories;
âą Carl Rogersonâs theory: The organism is the individualâs
entire frame of reference. It represents the totality of
experiences ie. conscious and unconscious. The self is the
accepted awareness part of experience
ï¶Maslowâs hierarchy of needs.
ï¶Behavioral Theories: (classic conditioning and
operant conditioning)
ï¶Revise defense mechanisms.
39. Etiology of Mental Illness
âą Predisposing Factors: The factors that determine
an individualâs susceptibility to mental illness.
âą Genetic make-up
âą Physical damage to CNS
âą Adverse psychosocial influence.
âą Precipitating Factors: these are events that occur
shortly before the onset of a disorder an dappear
to have induced it.
âą Physical stress
âą Psychosocial stress
âą Perpetuating Factors: responsible for aggravating
or prolonging the diseases.
40. Etiology of Mental Illness
âą Perpetuating Factors:
âą Biological Factors
âą Physiological Factors
âą Psychological Factors
âą Social Factors.
41. Etiology of Mental Illness
âą Biological Factors
ï¶ Heredity: sibling studies have shown that
unfavorable heredity causes on third of the mental
problems.
ï¶ Biochemical Factors: disturbance in
neurotransmitters.
ï¶ Brain Damage: Infections (HIV, encephalitis),
Injury (RTA), Intoxication (alcohol, lead, poison),
Vascular (ICH, SAH, SDH, CVA etc), Functional
problems (change in RBS, hypoxia, anoxia fluid
imbalance), Tumors, Vitamin deficiency (Vitamin
B), degenerative disorders (dementia), Endocrine
disorders (hypothyroidism), Physical defects (any
chronic illness).
42. Etiology of Mental Illness
âą Physiological Factors
ï¶Critical periods of life such as puberty,
menstruation, pregnancy, delivery, peurperium and
climacteric.
ï¶ These periods are marked not only by endocrine
changes but also diminished psychological status
and adaptive capacity.
43. Etiology of Mental Illness
âą Psychological Factors
ï¶Unsocial and reserved people may develop
schizoid personality disorders.
ï¶ strained IPR at home, work, school, loss of
prestige, loss of job etc.
ï¶ Childhood insecurities due to faulty parenting,
over strictness, over leniency, over protection,
rejection, unhealthy comparisons, etc.
ï¶ social and recreational deprivations resulting
in boredom, isolation etc.
44. Etiology of Mental Illness
âą Psychological Factors
ï¶Marriage problems like forced bachelorhood,
disharmony due to childlessness, educational
and financial incompatibility.
ï¶Sexual difficulties such as unhealthy attitude,
guilt feelings of masturbation, pre and extra
marital relationship and worries.
ï¶ Stress, frustration etc.
45. Etiology of Mental Illness
âą Social Factors
ï¶Poverty
ï¶Unemployment
ï¶Injustice
ï¶Insecurities
ï¶Migration
ï¶Urbanization
ï¶Social problems such as Gambling, Alcoholism,
Prostitution, Broken homes, Divorce, religion,
traditions, political problems etc.
46. Psychopathology of mental illness
âą It is the scientific study of mental disorders,
including efforts to understand their genetic,
biological, psychological and social causes,
effective classification schemes, course across
all stages of development, manifestations and
treatment.
âą It was found by Karl Jaspers in 1913 and
termed as mental phenomena.
âą This tries to define the 4 Dâs of an abnormality
are: Deviance, Distress, Dysfunction and
Danger.
47. Psychopathology of mental illness
âą A. Deviance: the deviation of individual actions
or unacceptability of his behaviour.
âą B. Distress: feeling of deep trouble affected by
illness.
âą C. Dysfunction: a maladaptive behaviour that
impairs the individualâs ability to perform
normal daily functions.
âą D. Danger: dangerous and violent behaviour
directed to others.
48. Review Nervous System
âą CNS
ï¶ Forebrain: thalamus, hypothalamus, limbic
system and cerebrum. Thalamus and
hypothalamus control autonomous system,
sleep, emotions and motivation. Sensory and
motor processing centers are in forebrain.
Limbic system controls memory, smell,
pleasure, pain, aggression, affections, sexual
desire etc. Functional areas of cerebrum are
also important.
49. Review Nervous System
âą CNS
ï¶ Midbrain: relaying message sto hugher brain
centers. It has RAS center of consciousness.
ï¶ Hindbrain: it has medulla, pons and
cerebellum. It controls digestions, respiration,
impulse transmission, coordination of body
movement, and circulation.
ï¶Spinal Cord: Channel of communication. Reflex
centers
âą PNS; role of somatic and autonomic nervous
system.
50. Review Nervous System
âą Integrative functions of the Nervous System:
ï¶ the cerebral cortex integrates sensory input
and motor output.
ï¶ Structure of neuron
ï¶Synapses: synaptic transmission.
ï¶Neurotransmitters Four categories of
neurotransmitters are cholinergics, amino
acids, monoamines, neuropeptides.
51. Review Nervous System
ï¶Significant Neurotransmitters.
ï Acetylcholine: the pathology and treatment of
Alzheimerâs disease and Parkinsonism.
ï Dopamine : the pathology and treatment of
schizophrenia and Parkinsonism.
ï GABA: the pathology and treatment of anxiety.
ï Glutamate: the pathology and treatment of
Alzheimerâs disease.
ï Norepinephrine: the pathology and treatment of
mania and depression.
ï Serotonine: the pathology and treatment of
mania and depression.
52. Review Nervous System
ï¶Biological theories: mental disorders are
caused by imbalance in the complex process of
brain structures communicating with each
other through neurotransmission.
ï¶The neuro endocrine theories: interaction
between nervous an dendocrine systems and
the hormones that stimulate the neurone.
ï¶Psychoimmunology: stress and its effect on
bodyâs immune system.
53. General Principles of Mental Health
Nursing
ï¶Patient is accepted as exactly he is
ïŒ being non judgmental and non punitive. No
chaining.
ïŒBeing sincerely interested in the patient
ïŒ recognizing and reflecting on the feelings
which patient may express.
ïŒ Talking with a purpose.
ïŒ Listening
ïŒ Permitting the patient to express strongly held
emotions.
54. General Principles of Mental Health
Nursing
ï¶ Use self understanding as a therapeutic
example.
ï¶ Consistency is used to contribute to patientâs
security.
ï¶ Reassurance should be given in a subtle and
acceptable manner.
ï¶Patients behaviour is changed through
emotional experience and not by rational
interpretation.
ï¶Unnecessary increase in the anxiety of
patientâs should be avoided
55. General Principles of Mental Health
Nursing
ï¶ objective observation of the patient to
understand his behaviour.
ï¶ maintain realistic nurse patient relationship.
ï¶ Avoid physical and verbal force as much as
possible.
ï¶ Nursing care is centered on the patient as a
person and not on the control of symptoms.
ï¶ all explanations of procedures and other
routines are given according to the patients
level of understanding.
ï¶ many procedures are modified but basic
principles remain unaltered.
56. Standards of Mental Health Nursing
The standards help in fulfilling the professions
obligation and to provide quality of care. This was
proposed in 1973.
ï¶Professional Practice Standards
ï Theory
ï Data Collection
ï Diagnosis
ï Planning
ï Intervention (psychotherapeutic, health teaching,
activities of daily living, somatic therapies,
therapeutic environment, psychotherapy )
ï Evaluation
57. Standards of Mental Health Nursing
ï¶Professional Performance Standards: the nurse
evaluate responses to nursing actions in order
to revise database, nursing diagnosis, and
nursing care plan
ï Peer Review
ï Continuing Education
ï Interdisciplinary collaboration
ï Utilization of community health systems.
ï Research
58. Qualities of Mental Health Nurse
ï¶ Self awareness
ï¶Self acceptance
ï¶Accepting the patient
ï¶Sincere interest on patient.
ï¶ Empathizing with patient.
ï¶ Reliability
ï¶ Professionalism
ï¶ Accountability
ï¶ Critical thinking ability.
59. Skills of Mental Health Nurse
ï¶ Personal skills: Self awareness and Adaptability
ï¶ Care values and attitudes
ïŒ respect rights, self esteem, honest, confidence,
ethical boundaries.
ï¶ Counseling Skills.
ï¶ Behaviour Skills
ïŒ to increase adaptive behaviour (reinforcement, token
economy)
ïŒ to decrease maladaptive behaviour (extinction,
restraining, overcorrection)
ïŒ To teach ne behaviour. (modeling, shaping, chaining
etc.)
60. Skills of Mental Health Nurse
ï¶ Supervisory skills
ï¶ Teaching skills.
ï¶ Crisis Skills
61. Conceptual Models
ï¶ It is organize a complex body of
knowledge ie. human behaviour.
ï¶ The following models tries to explain
human behaviour.
ï¶ Existential Model
ï¶Psychoanalytical Model
ï¶ Behavioral Model
ï¶ Interpersonal Model
ï¶ Medical Model
ï¶ Nursing Model
62. Existential Model
ï¶ Unlike other models it centers on the personâs
present experiences rather than past ones.
ï¶The major Concepts are:-
ï¶Rational emotive therapy: people have
automatic thoughts, that cause them
unhappiness in certain situation. Here the
patient can follow A (identify thoughts) B (blank
space to be filled) C (reaction to stimuli).
ï¶Gestalt therapy: Self awareness leads to self
acceptance and responsibility for ones own
thoughts and feelings. It can be motivated.
63. Existential Model
ï¶Reality Therapy: people who are unsuccessful
often blame their problems on others, system,
society. The people need to find their own
identity through responsible behaviour.
ï¶Role of Patient and Therapist: Patient
participates in meaningful experiences to learn
about self. Therapists helps in this clarification.
ï¶Application to Nursing: nurse works to restore
the patient to a state of full life from self
alienation.
64. Psychoanalytical Model
ï¶Psychoanalytical model was first
conceptualized by Sigmund Freud in the
late 19th century
ï¶Psycho analytical model mainly focused
on
ïŒNature of deviant human behaviour
ïŒProposed a new perspective on human
development
65. Psychoanalytical Model: Basic
Assumptions
ï¶All human behaviour is caused and thus is
capable of explanation.
ï¶All human behaviour from birth to old age is
driven by an energy called libido. This will
reduce the tension through the attainment of
pleasure.
ï¶This libido is closely associated with
physiological or instinctual drives eg. Hunger,
thirst, elimination and sex
ï¶Personality of human being can be understood
by 3 major segments . They are ID, EGO and
superego.
66. Psychoanalytical Model: Basic
Assumptions
ï¶ID represents the most primitive structure of the
human personality. Id is based on impulsive,
pleasure oriented principle and disconnected
with reality of mind.
ï¶Ego is also called the rational self or reality
principle. It represents the feeling of I concept
and touch with reality and it includes logical
thinking, reasoning, intelligence and also it helps
to gain strength.
ï¶SUPER EGO referred as âperfection principleâ
and which internalizes the values, legal and
moral regulations, social expectations set forth
by primary care givers.
67. Psychoanalytical Model: Basic
Assumptions
ï¶The human personality functions on three
levels of awareness. They are Conscious,
Preconscious and unconscious.
ï¶Human personality development unfolds
through five innate psychosexual stages. They
are Oral stage, Anal stage, Phallic stage,
Latency stage, Genital stage.
ï¶Psychoanalysis uses free association and
dream analysis to reconstruct the personality
as developed by Freud.
68. Psychoanalytical Model: Process
ï¶Free association is the verbalization of
thoughts while they occur, with any conscious
screening or censorship. It is always
unconscious censorship of thoughts and
impulses that threaten the ego.
ï¶Dream analysis refers to an analysis of patients
dreams, which symbolically communicate areas
of intra-psychic conflicts.
69. Psychoanalytical Model: Roles
Role of patient
ï¶Freely revealing all his thoughts, feeling &
dreams.
ï¶Patient uses free association.
ï¶Social interaction.
ï¶Establish IPR Role of Therapist.
ï¶Shadow person.
ï¶Reveals nothing personal.
ï¶Uses dream analysis he searches for patterns
in verbalizations and the areas of intra-psychic
conflicts.
70. Psychoanalytical Model: Roles
Role of Therapist
ï¶Helps the patients to recognize intrapsychic
conflicts by using interpretation.
ï¶Therapist encourages verbalization.
ï¶He is usually out of the patients sight,
ï¶To ensure that non-verbal responses do not
influence the patient.
ï¶Should have a some limit/ boundaries.
ï¶Conflicts are worked out through a healthier
resolution.
ï¶This releases previously invested libido for
mature adult functioning.
71. Behavioral Model: Assumptions
ï¶All behaviour is learnt
ï¶ all behaviour occurs in response to stimulus.
ï¶ human being are passive organisms that can be
conditioned.
ï¶Deviation from normal behavior occur when
undesirable behaviour has been reinforced.
72. Behavioral Model: Therapeutic
approaches
ï¶Systemic Desensitization
ï¶Token Reinforcement
ï¶Shaping: teaching new behaviour eg eye contact
ï¶Chaining: helping to perform complex task step
by step.
ï¶Prompting/Persuading
ï¶Flooding
ï¶Aversion Therapy
ï¶Assertiveness and social skill training.
73. Behavioral Model: Roles
ï¶Therapist
ïŒ helps to unlearn maladaptive behaviour.
ïŒ use anxiety as a motivational force.
ïŒ teach new behaviour.
ïŒProvide reinforcement.
ï¶Patient
ïŒ active participant
ïŒ practice behavioral techniques
ïŒDoes homework and reinforcement exercises.
74. Interpersonal Model: Assumptions
ï¶Human being are social beings
ï¶Human personality is determined in the context
of social interactions.
ï¶Anxiety motivates human behaviour and helps
in building the self esteem.
ï¶Security mechanisms are used to reduce the
anxiety.
ï¶Early life experiences with parents especially
mother influence development.
ï¶Human development proceeds through infancy,
childhood, juvenility, pre adolescence, early
adolescence, and late adolescence.
75. Interpersonal Model: Role
ï¶Patient
ïŒ share his concerns with therapist and
participate in the relationship to the best of his
ability.
ïŒRelationship making itself is the model
ïŒAs the patient matures his ability to related
improves and it broadens the life experience.
ï¶Therapist
ïŒTherapist is a participant observer who always
remain in the relation.
ïŒActive engagement to establish trust and
uncritical acceptance.
76. Medical Model
ï¶Deviant behaviour is a manifestation of a
disorder of CNS.
ï¶It suspects abnormality of brain,
neurotransmitters, impulses etc.
ï¶It focus on diagnosis and treatment based on
condition.
ï¶Environmental and social factors are also
considered.
ï¶Stress and stressors are also considered and
the stress threshold is genetically determined.
77. Medical Model
ï¶The psychiatrist examines the patient H/C, P/E,
MSE.
ï¶Collect additional data if any.
ï¶Make diagnosis and carry out further
observations of patients behaviour.
ï¶Plan the treatment such as somatic treatment
such as pharmacology, ECT, and other.