Principles and concepts in mental health

1. Principles and Concepts of
Mental Health Nursing
Mr. Johny Kutty Joseph
Assistant Professor
SMVDCoN

2. Signs and Symptoms of
Mental Illness
• Alterations of Personality & Behaviour
 A confirmed atheist turns into religious
 Social and outgoing person turns to
isolation.
• Alterations of Biological Functions
 Sleep: its pattern, quality, and duration
Appetite: pica, bulimia, anorexia
Sexual desire: libido, erectile dysfunction,
ejaculation disturbances.

3. Signs and Symptoms of
Mental Illness
• Disorders of Consciousness
 Clouding of Consciousness: diminution of
alertness. Organic and functional psychosis.
 Drowsiness: slipping into sleep though awake.
 Coma: unconscious and non responsive
 Qualitative changes: confusion, disorientation,
stereotypism etc.
 Fugue and dissociation: temporary alteration of
consciousness and identity.
 Stupor: conscious but unresponsive to
environment.

4. Signs and Symptoms of
Mental Illness
• Disorders of Attention and Concentration
 Distraction.
 Decreased span of attention.
 Narrowing of attention.
 seen in anxiety, mania, depression,
schizophrenia, substance abuse etc.

5. Signs and Symptoms of
Mental Illness
• Disorders of Orientation
 Time, Place, Person.
 Disorientation to own identity.
• Volitional Disturbances: It is the willful initiation
and control of one’s behaviour.
 Seen organic and functional disorders
 Immobility
 Mutism
 Stupor
 decreased drives (sleep, appetite, thirst etc.)

6. Signs and Symptoms of
Mental Illness
• Disorders of Motor Activity
 Increased Activity Level: Hyperactivity may be goal
oriented or not. (mania)
 Impulsivity, Restlessness, Agitation & Excitement
Decreased activity: Depression, slow and lack of
initiation of activities (akinesia) mutism, stupor etc.
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
• Disturbance in Posture and Expression
 Voluntary assumption of inappropriate and
bizarre positions.
 Waxy flexibility.
 Maintaining Psychological Pillow (head raised)
 Extremely cheerful, Odd Facial expressions or
grimacing.

8. Signs and Symptoms of
Mental Illness
• Disturbance in Motor Speech
 Echolalia and Palialia
• Disorders of perception
• Disorders of Mood
• Disorders of Memory
 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.

9. Signs and Symptoms of
Mental Illness
 Hypermnesia: Extreme degree of retention and
recall of events.
 Paramnesia: Distorted or falsified recall of
events. Confabulation (unintentional filling of gap
of memory with material which is untrue and
fanciful) Déjà vu ( an event though occurring for
first time seems familiar) jamais vu (feeling of
strangeness to familiar situations or events )
 Ganser syndrome: Approximate answers to the
questions asked; Eg. How many legs does the
cow has ? A: 3

10. Signs and Symptoms of
Mental Illness
• Disorders of Thought
• Disorders of Intelligence: Mental Retardation,
Intellectual deterioration occurs in dementia
and other organic conditions.
• Disorders of Insight and Judgment:
• 1: Personal judgment,
• 2: social judgment, and
• 3: test judgment.

11. Signs and Symptoms of
Mental Illness
• Insight is level of self awareness of his
disability and the need for help.
• 1: complete denial of illness
• 2: Slight awareness of being sick
• 3: Awareness of being sick attributed to
external or physical factor
• 4: Awareness of being sick due to something
unknown to self.
• 5: Intellectual insight
• 6: True emotional insight

12. Classification of Mental Illness
• 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.
• At present there are two major classification in
psychiatry, namely ICD 10 (1992) & DSM V
(2013).
• 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
• This is WHO’s classification for all diseases
& related health problems. •
• The chapter ‘F’ classifies psychiatric
disorder as mental & behavioral disorders &
codes them on an alphanumeric system from
F00 to F99.
• The Main Categories in ICD 10:-

14. ICD 10 - 1992
• F00 – F09 Organic, Including Symptomatic,
Mental disorders
• F00 – Dementia in Alzheimer’s disease
• F01 – Vascular dementia
• F04 – Organic amnestic syndrome
• F05 – Delirium
• F06 – Other mental disorders due to brain
damage & dysfunction & to physical disease
• F07 – Personality & behavioral disorders due
to brain disease, damage & dysfunction

15. ICD 10 - 1992
• F10 – F19 Mental & behavioral Disorders due to
Psychoactive Substance use
• F10 – Mental & behavioral disorders due to use of
alcohol
• F11 - Mental & behavioral disorders due to use of
opioids
• F12 – Mental & behavioral disorders due to use of
cannabinoids
• F13 – Mental & behavioral disorders due to use of
sedatives & hypnotics
• F14 – Mental & behavioral disorders due to use of
cocaine
• F16 – Mental & behavioral disorders due to use of
hallucinogens (Eg. LSD/Lysergic Acid)

16. ICD 10 - 1992
• F20 – F29 Schizophrenia, Schizotypal &
Delusional Disorders
• F20 – Schizophrenia
• F20.0 – Paranoid Schizophrenia
• F20.1 – Hebephrenic Schizophrenia
• F20.2 – Catatonic Schizophrenia
• F20.3 – Undifferentiated Schizophrenia
• F20.4 – Post-schizophrenia depression
• F20.5 – Residual Schizophrenia
• F20.6 – Simple Schizophrenia

17. ICD 10 - 1992
• F21 – Schizotypal disorder
• F22 – Persistent delusional disorders
• F23 – Acute & Transient psychotic disorders
• F24 – Induced Delusional disorders
• F25 – Schizoaffective disorders

18. ICD 10 - 1992
• F30 – F39 Mood (affective) Disorders
• F30 – Manic episode
• F31 – Bipolar affective disorder
• F32 – Depressive episode
• F33 – Recurrent depressive disorder
• F34 – Persistent mood disorder

19. ICD 10 - 1992
• F40 – F49 Neurotic, Stress-rapid & somato-form
disorders
• F40 – Phobic anxiety disorders
• F41 – Other anxiety disorders
• F42 – Obsessive – Compulsive disorder
• F43 – Reaction severe stress & adjustment
disorders
• F44 – Dissociative (Conversion) disorders
• F45 – Somatoform disorders

20. ICD 10 - 1992
• F50 – F59 Behavioral syndromes associated
with physiological disturbances & physical
factors
• F50 – Eating Disorders
• F51 – Non-organic sleep disorders
• F52 – Sexual dysfunction

21. ICD 10 - 1992
• F60 – F69 Disorders of adult personality &
behavior
• F60 – Specific personality disorders
• F60.0 – Paranoid personality disorders
• F60.1 – Schizoid personality disorders
• F60.2 – Dissocial personality disorders
• F60.3 – Emotionally unstable personality
disorder
• F60.4 – Histrionic personality disorders
• F60.5 – Anankastic (OCD) personality disorders
• F60.6 – Anxious personality disorders
• F60.7 – Dependent personality disorders

22. ICD 10 - 1992
• F61 – Mixed & other personality disorders
• F62 – Enduring personality changes, not
attributable to brain damage & disease
• F63 – Habit & impulse disorders
• F64 – Gender identity disorders
• F65 – Disorders of sexual preference

23. ICD 10 - 1992
• F70 – F79 Mental Retardation
• F70 – Mild Mental Retardation
• F71 – Moderate Mental Retardation
• F72 – Severe Mental Retardation
• F73 – Profound Mental Retardation

24. ICD 10 - 1992
• F80 – F89 Disorders of psychological
development
• F80 – Specific developmental disorders of
speech & language
• F81 – Specific developmental disorders of
scholastic skills
• F82 – Specific developmental disorders of
motor function
• F83 – Mixed specific developmental disorders
• F84 – Pervasive developmental disorders

25. ICD 10 - 1992
• F90 – F98 Behavioral & emotional Disorders with
onset usually occurring in childhood &
adolescence
• F90 – Hyperkinetic disorders
• F91 – Conduct disorders
• F93 – Emotional disorders with onset specific to
childhood
• F94 – Disorders of social functioning with onset
specific to childhood & adolescence
• F95 – Tic Disorders
• F98 – Other behavioral & emotional disorders
with onset usually occurring in childhood &
adolescence

26. ICD 10 - 1992
• F99 – Unspecified mental Disorders

27. DSM – V (2013)
• DSM V (Diagnostic & Statistical Manual) – 2013.
• This is the classification of mental disorders by
the American Psychiatric Association (APA).
• The pattern adopted by DSM V is of Multi-axial
systems.
• A multi-axial system that evaluates patients
along several versatile contains Five axes.

28. DSM – V (2013)
• The Five Axes of DSM V Are:-
• Axis I : Clinical psychiatric diagnosis
• Axis II : Personality disorder & mental
retardation
• Axis III ; General medical conditions
• Axis IV : Psychosocial & environmental
problems
• Axis V : Global assessment of functioning in
current & past one year.

29. DSM – V (2013)
• The diagnostic criteria and codes in DSM 5 are
• 1.2.1: Neurodevelopmental disorders
• 1.2.2: Schizophrenia spectrum and other
psychotic disorders.
• 1.2.3: Bipolar and related disorders.
• 1.2.4: Depressive disorders
• 1.2.5: Anxiety disorders
• 1.2.6: OCD
• 1.2.7: Trauma and stress related disorders
• 1.2.8: Dissociative disorders
• 1.2.9: Somatic symptoms and related disorders.

30. DSM – V (2013)
• 1.2.10: Feeding and eating disorders
• 1.2.11: sleep wake disorders
• 1.2.12: sexual dysfunction.
• 1.2.13: gender dysphoria /identity
• 1.2.14: disruptive, impulse control and conduct
disorders.
• 1.2.15: substance related and addictive
disorders.
• 1.2.16: Neuro cognitive disorders
• 1.2.17: paraphilic disorders
• 1.2.18: personality disorders.

31. Indian Classification 1971
It is modification to ICD 8 by Indian Psychiatrists.
• A: Psychosis
Functional (Schizophrenia / simple /
hebephrenic / catatonic / paranoid)
Affective: (mania and depression)
Organic: (Acute and Chronic)
• B: Neurosis
 Anxiety Neurosis
 Depressive neurosis
 Hysterical neurosis
 OCD
Phobic Neurosis

32. Indian Classification 1971
• C: Special disorders
 Childhood disorders
Personality disorders
Substance abuse
Mental retardation

33. Factors influencing Personality
• Biological Factors
 Heredity: gene and its traits
Endocrine glands: thyroid gland can cause
mania / depression. Parathyroid glands monitor
calcium that cause nervous excitability.
Physique: size, strength, physical appearance
and dominance or inferiority.
Nervous System: rate of transmission and level
of neurotransmitters.

34. Factors influencing Personality
• Environmental Factors.
 Family (family reactions, parents, morality,
social norms, tolerant fathers increase
emotional stability and self confidence,
overprotective mothers, submissive mothers,
Birth order etc.)
 School (friendships, type of curriculum,
facilities)
Teacher (reactions, personality and
relationship)
Peer Group (development of self concept,
sharing, cooperation, sexuality, intimacy etc.)

35. Factors influencing Personality
• Environmental Factors.
 Sibling relationship (number of children,
developing cooperation / sharing/
aggressiveness traits, jealousy, rivalry,
unhealthy comparisons by parents, )
Mass Media (attitudes, values, beliefs, role
models, addictive programmes)
Culture ( moral values, beliefs, religion,
geographical / dietary / hormonal influence on
personality.)

36. Theories of Personality Development
• Psycho Analytic Theory
 Oral, Anal, Phallic, Latent, Genital
• Psycho social development theory
 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
• Theory of Cognitive development
 Sensori-motor (0-2), pre-opeartaional (2-6),
concrete operational (6-12), formal operational (12-
15).
• Theory of Moral Development
Level 1 4-10 years (Pre - conventional / self
centered orientation, egocentric judgment,
punishment and obedience etc)
Level 2 10-13 years ( Conventional Level:
interpersonal orientation, law / order orientation )
Level 3 (13 +) (Post conventional level) (social
contract legalistic orientation, universal ethical
orientation)

38. Theories of Personality Development
• Humanistic Theories;
• Carl Rogerson’s theory: The organism is the individual’s
entire frame of reference. It represents the totality of
experiences ie. conscious and unconscious. The self is the
accepted awareness part of experience
Maslow’s hierarchy of needs.
Behavioral Theories: (classic conditioning and
operant conditioning)
Revise defense mechanisms.

39. Etiology of Mental Illness
• Predisposing Factors: The factors that determine
an individual’s susceptibility to mental illness.
• Genetic make-up
• Physical damage to CNS
• Adverse psychosocial influence.
• Precipitating Factors: these are events that occur
shortly before the onset of a disorder an dappear
to have induced it.
• Physical stress
• Psychosocial stress
• Perpetuating Factors: responsible for aggravating
or prolonging the diseases.

40. Etiology of Mental Illness
• Perpetuating Factors:
• Biological Factors
• Physiological Factors
• Psychological Factors
• Social Factors.

41. Etiology of Mental Illness
• Biological Factors
 Heredity: sibling studies have shown that
unfavorable heredity causes on third of the mental
problems.
 Biochemical Factors: disturbance in
neurotransmitters.
 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
• Physiological Factors
Critical periods of life such as puberty,
menstruation, pregnancy, delivery, peurperium and
climacteric.
 These periods are marked not only by endocrine
changes but also diminished psychological status
and adaptive capacity.

43. Etiology of Mental Illness
• Psychological Factors
Unsocial and reserved people may develop
schizoid personality disorders.
 strained IPR at home, work, school, loss of
prestige, loss of job etc.
 Childhood insecurities due to faulty parenting,
over strictness, over leniency, over protection,
rejection, unhealthy comparisons, etc.
 social and recreational deprivations resulting
in boredom, isolation etc.

44. Etiology of Mental Illness
• Psychological Factors
Marriage problems like forced bachelorhood,
disharmony due to childlessness, educational
and financial incompatibility.
Sexual difficulties such as unhealthy attitude,
guilt feelings of masturbation, pre and extra
marital relationship and worries.
 Stress, frustration etc.

45. Etiology of Mental Illness
• Social Factors
Poverty
Unemployment
Injustice
Insecurities
Migration
Urbanization
Social problems such as Gambling, Alcoholism,
Prostitution, Broken homes, Divorce, religion,
traditions, political problems etc.

46. Psychopathology of mental illness
• 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.
• It was found by Karl Jaspers in 1913 and
termed as mental phenomena.
• This tries to define the 4 D’s of an abnormality
are: Deviance, Distress, Dysfunction and
Danger.

47. Psychopathology of mental illness
• A. Deviance: the deviation of individual actions
or unacceptability of his behaviour.
• B. Distress: feeling of deep trouble affected by
illness.
• C. Dysfunction: a maladaptive behaviour that
impairs the individual’s ability to perform
normal daily functions.
• D. Danger: dangerous and violent behaviour
directed to others.

48. Review Nervous System
• CNS
 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
• CNS
 Midbrain: relaying message sto hugher brain
centers. It has RAS center of consciousness.
 Hindbrain: it has medulla, pons and
cerebellum. It controls digestions, respiration,
impulse transmission, coordination of body
movement, and circulation.
Spinal Cord: Channel of communication. Reflex
centers
• PNS; role of somatic and autonomic nervous
system.

50. Review Nervous System
• Integrative functions of the Nervous System:
 the cerebral cortex integrates sensory input
and motor output.
 Structure of neuron
Synapses: synaptic transmission.
Neurotransmitters Four categories of
neurotransmitters are cholinergics, amino
acids, monoamines, neuropeptides.

51. Review Nervous System
Significant Neurotransmitters.
 Acetylcholine: the pathology and treatment of
Alzheimer’s disease and Parkinsonism.
 Dopamine : the pathology and treatment of
schizophrenia and Parkinsonism.
 GABA: the pathology and treatment of anxiety.
 Glutamate: the pathology and treatment of
Alzheimer’s disease.
 Norepinephrine: the pathology and treatment of
mania and depression.
 Serotonine: the pathology and treatment of
mania and depression.

52. Review Nervous System
Biological theories: mental disorders are
caused by imbalance in the complex process of
brain structures communicating with each
other through neurotransmission.
The neuro endocrine theories: interaction
between nervous an dendocrine systems and
the hormones that stimulate the neurone.
Psychoimmunology: stress and its effect on
body’s immune system.

53. General Principles of Mental Health
Nursing
Patient is accepted as exactly he is
 being non judgmental and non punitive. No
chaining.
Being sincerely interested in the patient
 recognizing and reflecting on the feelings
which patient may express.
 Talking with a purpose.
 Listening
 Permitting the patient to express strongly held
emotions.

54. General Principles of Mental Health
Nursing
 Use self understanding as a therapeutic
example.
 Consistency is used to contribute to patient’s
security.
 Reassurance should be given in a subtle and
acceptable manner.
Patients behaviour is changed through
emotional experience and not by rational
interpretation.
Unnecessary increase in the anxiety of
patient’s should be avoided

55. General Principles of Mental Health
Nursing
 objective observation of the patient to
understand his behaviour.
 maintain realistic nurse patient relationship.
 Avoid physical and verbal force as much as
possible.
 Nursing care is centered on the patient as a
person and not on the control of symptoms.
 all explanations of procedures and other
routines are given according to the patients
level of understanding.
 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.
Professional Practice Standards
 Theory
 Data Collection
 Diagnosis
 Planning
 Intervention (psychotherapeutic, health teaching,
activities of daily living, somatic therapies,
therapeutic environment, psychotherapy )
 Evaluation

57. Standards of Mental Health Nursing
Professional Performance Standards: the nurse
evaluate responses to nursing actions in order
to revise database, nursing diagnosis, and
nursing care plan
 Peer Review
 Continuing Education
 Interdisciplinary collaboration
 Utilization of community health systems.
 Research

58. Qualities of Mental Health Nurse
 Self awareness
Self acceptance
Accepting the patient
Sincere interest on patient.
 Empathizing with patient.
 Reliability
 Professionalism
 Accountability
 Critical thinking ability.

59. Skills of Mental Health Nurse
 Personal skills: Self awareness and Adaptability
 Care values and attitudes
 respect rights, self esteem, honest, confidence,
ethical boundaries.
 Counseling Skills.
 Behaviour Skills
 to increase adaptive behaviour (reinforcement, token
economy)
 to decrease maladaptive behaviour (extinction,
restraining, overcorrection)
 To teach ne behaviour. (modeling, shaping, chaining
etc.)

60. Skills of Mental Health Nurse
 Supervisory skills
 Teaching skills.
 Crisis Skills

61. Conceptual Models
 It is organize a complex body of
knowledge ie. human behaviour.
 The following models tries to explain
human behaviour.
 Existential Model
Psychoanalytical Model
 Behavioral Model
 Interpersonal Model
 Medical Model
 Nursing Model

62. Existential Model
 Unlike other models it centers on the person’s
present experiences rather than past ones.
The major Concepts are:-
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).
Gestalt therapy: Self awareness leads to self
acceptance and responsibility for ones own
thoughts and feelings. It can be motivated.

63. Existential Model
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.
Role of Patient and Therapist: Patient
participates in meaningful experiences to learn
about self. Therapists helps in this clarification.
Application to Nursing: nurse works to restore
the patient to a state of full life from self
alienation.

64. Psychoanalytical Model
Psychoanalytical model was first
conceptualized by Sigmund Freud in the
late 19th century
Psycho analytical model mainly focused
on
Nature of deviant human behaviour
Proposed a new perspective on human
development

65. Psychoanalytical Model: Basic
Assumptions
All human behaviour is caused and thus is
capable of explanation.
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.
This libido is closely associated with
physiological or instinctual drives eg. Hunger,
thirst, elimination and sex
Personality of human being can be understood
by 3 major segments . They are ID, EGO and
superego.

66. Psychoanalytical Model: Basic
Assumptions
ID represents the most primitive structure of the
human personality. Id is based on impulsive,
pleasure oriented principle and disconnected
with reality of mind.
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.
SUPER EGO referred as “perfection principle”
and which internalizes the values, legal and
moral regulations, social expectations set forth
by primary care givers.

67. Psychoanalytical Model: Basic
Assumptions
The human personality functions on three
levels of awareness. They are Conscious,
Preconscious and unconscious.
Human personality development unfolds
through five innate psychosexual stages. They
are Oral stage, Anal stage, Phallic stage,
Latency stage, Genital stage.
Psychoanalysis uses free association and
dream analysis to reconstruct the personality
as developed by Freud.

68. Psychoanalytical Model: Process
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.
Dream analysis refers to an analysis of patients
dreams, which symbolically communicate areas
of intra-psychic conflicts.

69. Psychoanalytical Model: Roles
Role of patient
Freely revealing all his thoughts, feeling &
dreams.
Patient uses free association.
Social interaction.
Establish IPR Role of Therapist.
Shadow person.
Reveals nothing personal.
Uses dream analysis he searches for patterns
in verbalizations and the areas of intra-psychic
conflicts.

70. Psychoanalytical Model: Roles
Role of Therapist
Helps the patients to recognize intrapsychic
conflicts by using interpretation.
Therapist encourages verbalization.
He is usually out of the patients sight,
To ensure that non-verbal responses do not
influence the patient.
Should have a some limit/ boundaries.
Conflicts are worked out through a healthier
resolution.
This releases previously invested libido for
mature adult functioning.

71. Behavioral Model: Assumptions
All behaviour is learnt
 all behaviour occurs in response to stimulus.
 human being are passive organisms that can be
conditioned.
Deviation from normal behavior occur when
undesirable behaviour has been reinforced.

72. Behavioral Model: Therapeutic
approaches
Systemic Desensitization
Token Reinforcement
Shaping: teaching new behaviour eg eye contact
Chaining: helping to perform complex task step
by step.
Prompting/Persuading
Flooding
Aversion Therapy
Assertiveness and social skill training.

73. Behavioral Model: Roles
Therapist
 helps to unlearn maladaptive behaviour.
 use anxiety as a motivational force.
 teach new behaviour.
Provide reinforcement.
Patient
 active participant
 practice behavioral techniques
Does homework and reinforcement exercises.

74. Interpersonal Model: Assumptions
Human being are social beings
Human personality is determined in the context
of social interactions.
Anxiety motivates human behaviour and helps
in building the self esteem.
Security mechanisms are used to reduce the
anxiety.
Early life experiences with parents especially
mother influence development.
Human development proceeds through infancy,
childhood, juvenility, pre adolescence, early
adolescence, and late adolescence.

75. Interpersonal Model: Role
Patient
 share his concerns with therapist and
participate in the relationship to the best of his
ability.
Relationship making itself is the model
As the patient matures his ability to related
improves and it broadens the life experience.
Therapist
Therapist is a participant observer who always
remain in the relation.
Active engagement to establish trust and
uncritical acceptance.

76. Medical Model
Deviant behaviour is a manifestation of a
disorder of CNS.
It suspects abnormality of brain,
neurotransmitters, impulses etc.
It focus on diagnosis and treatment based on
condition.
Environmental and social factors are also
considered.
Stress and stressors are also considered and
the stress threshold is genetically determined.

77. Medical Model
The psychiatrist examines the patient H/C, P/E,
MSE.
Collect additional data if any.
Make diagnosis and carry out further
observations of patients behaviour.
Plan the treatment such as somatic treatment
such as pharmacology, ECT, and other.