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Mental Health & Pharmacology UHPAB JUNE 2025
SECTION A: Objective Questions (20 marks)
💡 Exam Strategy: Mental health questions often test your understanding of prioritization and therapeutic techniques. For pharmacology, know your drug classes and their specific uses!
1
The most effective treatment for positive symptoms of schizophrenic stupor is
(b) Milieu social therapy
Schizophrenic stupor is a catatonic state requiring immediate medical treatment (benzodiazepines, ECT). Among psychosocial options, milieu therapy provides the structured, supportive environment essential for catatonic patients. It offers consistent routines, reality orientation, and safe space while medical treatment takes effect. CBT and social skills training are ineffective in acute stupor; psychosocial education is for maintenance phase.
CATATONIA TREATMENT: "MED-FIRST" - Medical stabilization (Lorazepam/ECT), Environmental structure, De-escalation, Support, Time
2
Which of the following predisposes a patient to catatonic stupor?
(a) Manic depression
Catatonic stupor most commonly occurs in severe depressive episodes of bipolar disorder (manic-depression). The profound psychomotor retardation of major depression can progress to complete immobility and mutism. Catatonia is a specifier for depressive episodes in DSM-5, recognizing this strong association.
🧠 Catatonia Triggers: Severe depression (40%), Schizophrenia (30%), Medical conditions (20%), Mania (10%)
3
Which delusion is associated with catatonic stupor?
(c) Nihilistic
Nihilistic delusions ("Cotard's delusion") - the belief that one is dead, doesn't exist, or body parts are rotting - are classically associated with severe depression with catatonic features. These bizarre, fixed beliefs reflect the profound negation and psychomotor retardation seen in catatonic stupor secondary to depressive episodes.
DELUSION TYPES: "MUNG" - Mania = Grandiose, Unipolar depression = Unworthiness, Nihilistic = Severe depression/catatonia, General anxiety = Hypochondriasis
4
The first and foremost priority in managing a mental health crisis is
(d) Safety
Safety is the universal first priority in any mental health crisis, encompassing patient safety, staff safety, and safety of others. This principle guides all crisis interventions. Without ensuring a safe environment, no other therapeutic intervention can be effectively implemented. Safety assessment includes evaluating suicidal/homicidal ideation, access to means, impulsivity, and environmental hazards.
⚠️ Safety First Protocol: Assess → Ensure safety → De-escalate → Intervene → Follow up. Never compromise on safety!
5
Which of the following is a protective factor for suicidal tendencies?
(b) Social support
Social support is a powerful protective factor against suicide. Strong family connections, friendships, and community bonds provide emotional buffering, practical help, and a sense of belonging that counteracts isolation and hopelessness. Support networks can recognize warning signs, encourage treatment adherence, and provide crisis intervention.
SUICIDE RISK FACTORS: "SAD HOPELESS" - Substance abuse, Access to means, Depression, Hopelessness, Previous attempt, Older age, Social isolation, Ethanol use, Sickness, Sex (male)
6
Which of the following medical emergencies is commonly mistaken for a psychiatric emergency?
(b) Status epilepticus
Status epilepticus (continuous seizures >5 minutes) can present with altered consciousness, bizarre automatisms, post-ictal confusion, and violent movements that mimic psychosis, aggression, or catatonia. Complex partial seizures may involve staring, lip-smacking, fumbling movements that appear psychiatric. Without witnessing the seizure, clinicians may misdiagnose as acute psychosis or violent behavior.
🧪 Always Rule Out Medical! "Differential for psychosis": Hypoglycemia, seizures, delirium, drug intoxication, thyroid storm, CVA. Check vitals, glucose, pupils first!
7
Which of the following is relevant in supportive psychotherapy?
(a) Empathy
Empathy is the cornerstone of supportive psychotherapy. This approach focuses on providing emotional support, reassurance, and practical guidance to help patients cope with immediate life stresses. The therapist demonstrates genuine understanding of the patient's feelings, creating a therapeutic alliance that fosters trust and emotional stability.
SUPPORTIVE THERAPY CORE: "EARS" - Empathy, Acceptance, Reassurance, Support, Practical advice
8
A diagnosis of nocturnal enuresis is usually diagnosed after the child has attained the age of __________ years.
(b) 5 years
According to DSM-5 criteria, nocturnal enuresis is diagnosed when involuntary voiding occurs at least twice weekly for 3 consecutive months in children aged 5 years or older (or equivalent developmental level). This age cutoff recognizes that most children achieve nocturnal continence by age 5, and delayed control becomes clinically significant.
📅 Key Milestone: 75% of children achieve nighttime dryness by age 5. If bedwetting persists beyond 5 with frequency >2x/week for 3 months, evaluate for enuresis.
9
Which of the following conditions presents with vandalism disorder?
(c) Conduct disorder
Conduct disorder is characterized by repetitive, persistent pattern of violating the rights of others and societal rules. Vandalism (deliberate destruction of property) is one of the 15 diagnostic criteria for conduct disorder, alongside aggression, theft, deceitfulness, and serious rule violations. It typically begins in childhood/adolescence and can progress to antisocial personality disorder.
CONDUCT DISORDER CRITERIA: "AGGREST" - Aggression to people/animals, Destruction of property, Deceitfulness/theft, Serious rule violations
10
The most obvious diagnostic procedure for status epilepticus is
(a) Clinical observation
Status epilepticus is a clinical diagnosis based on direct observation of seizure activity lasting >5 minutes or recurrent seizures without return to baseline consciousness. Immediate recognition and treatment is critical to prevent brain damage. EEG confirms but cannot be waited for in emergency. Clinical observation of continuous convulsive activity or altered consciousness with subtle motor signs is sufficient for diagnosis and immediate treatment initiation.
⏱️ Time is Brain! Every minute of status epilepticus increases neuronal injury. Treat first (benzodiazepines), investigate later. Clinical diagnosis saves lives!
11
Which of the following is NOT an example of anti-epileptic drug?
(b) Chlorpromazine
Chlorpromazine is a typical antipsychotic (phenothiazine) used for schizophrenia and psychosis. It lowers seizure threshold and can actually precipitate seizures, making it contraindicated in epilepsy. Phenobarbitone, phenytoin, and carbamazepine are all established antiepileptic drugs (AEDs) that stabilize neuronal membranes and reduce seizure activity.
AED CLASSES: "B-P-C-C-V-L-G-L" - Barbiturates, Phenytoin, Carbamazepine, Valproate, Levetiracetam, Gabapentin, Lamotrigine
12
Which of the following is NOT an anti-psychotic drug?
⚠️ All listed are antipsychotics!
This question appears to have an error. All four options are antipsychotic drugs: Risperidone (atypical), Clozapine (atypical, reserved for resistant cases), Olanzapine (atypical), and Haloperidol (typical). There is no correct answer among the options. This may be a trick question testing recognition that all are antipsychotics, or the exam may have intended to include a non-antipsychotic option but failed to do so.
🤔 Exam Tip: If all options appear correct, state this clearly and explain why. Shows critical thinking. Sometimes exam errors exist!
13
Which of the following is NOT a side effect of haloperidol?
(d) Increased libido
Haloperidol typically DECREASES libido and causes sexual dysfunction through dopamine blockade and hyperprolactinemia. It is not associated with increased libido. The drug's anticholinergic effects cause dry mouth, its D2 blockade causes extrapyramidal symptoms (muscle stiffness), and its antihistamine effects cause sedation.
HALOPERIDOL SIDE EFFECTS: "SEDA" - Sedation, Extrapyramidal symptoms, Dry mouth, Anticholinergic, Hyperprolactinemia, Decreased libido
14
The recommended dose of diazepam given rectally in children is __________ mg/kg body weight.
(a) 0.5 mg/kg
Rectal diazepam dose for acute seizures in children is 0.5 mg/kg (maximum 10-20 mg depending on formulation). This route provides rapid absorption from rectal mucosa, achieving therapeutic levels within 5-15 minutes. It's used for emergency seizure control when IV access is unavailable, particularly in community or home settings for prolonged seizures.
💊 Rectal Diazepam Formula: For 10kg child → 0.5 mg/kg × 10 kg = 5 mg. Standard preparation: 5 mg/mL or 10 mg/2 mL rectal solution.
15
The drug administered in treatment of patients with transient insomnia is
(a) Midazolam
Midazolam is preferred for transient (short-term) insomnia due to its very short half-life (1.5-2.5 hours) and rapid onset of action. It provides sleep induction without significant next-day sedation or hangover effect. It's ideal for situational insomnia (jet lag, hospitalization) but not for long-term use due to tolerance and dependence risk. Clonazepam, lorazepam, and diazepam have longer half-lives causing daytime sedation.
BENZODIAZEPINE CHOICE: "Short insomnia = Short drug" - Midazolam (short), Lorazepam (intermediate), Diazepam (long)
16
Which of the following drugs is NOT an oncology drug?
(d) Vardenafil
Vardenafil is a PDE5 inhibitor used for erectile dysfunction, not cancer treatment. The "-afil" suffix indicates this class. Capecitabine is a fluoropyrimidine prodrug for breast/colorectal cancer, cladribine is a purine analog for hairy cell leukemia, and clofarabine is a purine nucleoside analog for acute lymphoblastic leukemia. All three "-abine" drugs are antimetabolite chemotherapy agents.
ONCOLOGY DRUG SUFFIXES: "-abine" = antimetabolites, "-platin" = platinum compounds, "-mustine" = alkylating agents, "-afil" = PDE5 inhibitors (NOT oncology)
17
Which of the following drugs do nurses administer in treatment of manic episodes?
(c) Lithium carbonate
Lithium carbonate is the gold standard mood stabilizer for acute mania and maintenance. It reduces the intensity and frequency of manic episodes through multiple mechanisms including inhibition of inositol monophosphatase and modulation of neurotransmitter signaling. Nurses must monitor serum levels (0.6-1.2 mEq/L), renal function, and thyroid function due to narrow therapeutic index and toxicity risk.
MANIA TREATMENT: "LMNOP" - Lithium, Mood stabilizers (Valproate), Neuroleptics, Other (benzodiazepines), Psychoeducation
18
Which of the following drugs is administered in treatment of generalised tonic clonic seizures?
(a) Carbamazepine
Carbamazepine is first-line monotherapy for generalized tonic-clonic seizures. It stabilizes neuronal membranes by blocking voltage-gated sodium channels, preventing spread of seizure activity. Highly effective with well-established efficacy. Also used for partial seizures and trigeminal neuralgia. Requires monitoring of liver enzymes and blood counts due to rare but serious adverse effects.
🎯 Seizure-Specific Drugs: GTCS = Carbamazepine/Valproate, Absence = Ethosuximide, Myoclonic = Clonazepam, Partial = Carbamazepine/Lamotrigine
19
Which of the following drugs is contra-indicated in pregnancy?
(a) Bleomycin
Bleomycin is an antineoplastic antibiotic (chemotherapy agent) that is absolutely contraindicated in pregnancy (Category D). It is highly teratogenic and mutagenic, causing severe fetal malformations, growth retardation, and spontaneous abortion. It inhibits DNA synthesis and cell division, affecting rapidly dividing fetal tissues. Pregnancy must be excluded before initiation and effective contraception is mandatory during treatment.
PREGNANCY DRUG CATEGORIES: A = Safe, B = No evidence of risk, C = Risk can't be ruled out, D = Positive evidence of risk, X = Contraindicated
20
Which of the following drugs suppresses lactation?
(c) Bromocriptine
Bromocriptine is a dopamine D2 receptor agonist that suppresses prolactin secretion from the anterior pituitary, thereby inhibiting lactation. It was historically used for elective suppression of postpartum lactation. However, its use has declined due to risk of hypertension, stroke, and psychosis. Preferred method now is supportive (tight bra, ice packs, analgesics) due to safety concerns.
⚠️ Bromocriptine Warning: WHO advises against routine use for lactation suppression due to maternal deaths from hypertension, stroke, and seizures. Use non-pharmacological methods instead!
SECTION B: Fill in the Blank Spaces (10 marks)
21
A form of schizophrenia characterised by body rigidity is called ________________
Catatonic schizophrenia
Catatonic schizophrenia is characterized by prominent psychomotor disturbances including stupor (rigidity, immobility), excessive motor activity, extreme negativism, mutism, and peculiar voluntary movements. DSM-5 now classifies this as "schizophrenia with catatonia" specifier. Requires immediate medical intervention due to risk of dehydration, malnutrition, and exhaustion.
22
A therapy which aims at understanding a person's problem and to finding appropriate coping mechanisms is ________________
Supportive psychotherapy (or Insight-oriented therapy)
Supportive psychotherapy focuses on strengthening defenses, providing emotional support, and helping patients develop practical coping strategies for current life problems. It differs from psychodynamic therapy by being present-focused and less interpretive. Core techniques include empathy, reassurance, suggestion, and encouragement of adaptive behaviors.
23
An altered state of consciousness induced by suggestibility is called ________________
Hypnosis
Hypnosis is a trance-like state of focused attention, heightened suggestibility, and vivid imagery. It involves induction by a hypnotist using verbal repetition and mental images. Uses include pain management, anxiety reduction, habit disorders, and anesthesia. Not the same as sleep - EEG shows alpha waves characteristic of relaxed wakefulness.
24
A form of suicide attempt which occurs while the patient is on treatment is known as ________________
Parasuicide (or Suicidal gesture/Attempt)
Parasuicide refers to non-fatal self-harm behaviors, often impulsive, without clear intent to die. It may occur during treatment when underlying depression is inadequately controlled, side effects emerge, or psychosocial stressors overwhelm coping capacity. Indicates need for urgent treatment review and intensification of suicide precautions.
25
The expression of hostility and rage with intent to injure is referred to as ________________
Aggression (or Violence)
Aggression is any behavior intended to harm another person physically or psychologically. It ranges from verbal threats to physical assault. In mental health settings, requires immediate safety measures, de-escalation techniques, and possibly chemical/physical restraint. Underlying causes include psychosis, intoxication, personality disorders, or neurological conditions.
26
Protrusion of the tongue is a common side effect of a drug called ________________
Haloperidol (or typical antipsychotics / phenothiazines)
Tardive dyskinesia - involuntary repetitive movements including tongue protrusion, lip smacking, grimacing - is a serious side effect of long-term typical antipsychotic use (haloperidol, chlorpromazine). Caused by dopamine receptor supersensitivity in basal ganglia. Often irreversible. Prevention includes using lowest effective dose and switching to atypical antipsychotics.
TD SYMPTOMS: "POMP" - Protrusion of tongue, Oromandibular movements, Grimacing, Puckering of lips
⚠️ Irreversible! Tardive dyskinesia occurs in 20-30% of long-term typical antipsychotic users. Screen regularly using AIMS test. Switch to atypicals early!
27
Antipsychotic drugs that target hallucination and delusions are generally classified as ________________
Typical (first-generation) antipsychotics or neuroleptics
Typical antipsychotics (e.g., haloperidol, chlorpromazine) are potent dopamine D2 receptor antagonists that directly target positive symptoms (hallucinations, delusions, disorganized thinking). They are called "neuroleptics" because of their neurological side effects. Atypicals also treat positive symptoms but with less EPS and some efficacy for negative symptoms.
28
The class A drug which is administered to terminally ill cancer patients for pain relief is called ________________
Morphine (or other strong opioids like diamorphine, fentanyl)
Morphine is the gold standard WHO Step 3 opioid for severe cancer pain. Class A (controlled substance) due to addiction potential but essential for palliative care. Used when moderate opioids (codeine) fail. Provides analgesia, sedation, anxiolysis. Side effects: constipation, respiratory depression, nausea. Titrated to effect with no "maximum dose" in cancer pain.
29
The average adult dose of methotrexate is ________________ mg
7.5 to 25 mg per week (for rheumatoid arthritis) or 15-30 mg/day for 5 days (for cancer)
The dose depends heavily on indication: For rheumatoid arthritis: 7.5-25 mg once weekly. For cancer (e.g., choriocarcinoma): 15-30 mg daily for 5 days in cycles. For psoriasis: 10-25 mg weekly. CRITICAL: Always given with folic acid to reduce toxicity. Requires CBC, LFT, and renal monitoring due to bone marrow suppression, hepatotoxicity, and nephrotoxicity.
💊 High Alert Medication! Methotrexate error (daily vs weekly dosing) can be fatal. Double-check indication, dose, frequency, and folic acid supplementation.
30
A commonly used vinca alkaloid in treatment of cancer is called ________________
Vincristine (or Vinblastine, Vinorelbine)
Vincristine is a plant alkaloid derived from Catharanthus roseus (Madagascar periwinkle). It inhibits microtubule polymerization, arresting cells in metaphase. Used for acute lymphoblastic leukemia, lymphomas, Wilms tumor. Major side effect: peripheral neuropathy (dose-limiting), myelosuppression, SIADH. NEVER give intrathecally (fatal neurotoxicity). Vesicant - causes severe tissue necrosis if extravasates.
VINCA ALKALOIDS: "V-V-V" - Vincristine, Vinblastine, Vinorelbine. Side effects: "NIP" - Neuropathy, Immunosuppression, Paralytic ileus
SECTION B: Short Essay Questions (10 marks)
31
State five (5) dangers of cancer drugs to the patient. (5 marks)
Cancer chemotherapy agents are non-selective and affect rapidly dividing normal cells:
1. Bone marrow suppression (myelosuppression): Leads to life-threatening neutropenia (infection risk), anemia (fatigue, hypoxia), and thrombocytopenia (bleeding risk). Nadir typically occurs 7-14 days post-treatment.
2. Gastrointestinal toxicity: Severe nausea/vomiting, mucositis (painful ulcers), diarrhea, and potential for hemorrhage and malnutrition requiring IV fluids and TPN.
3. Organ damage: Cardiotoxicity (anthracyclines cause irreversible CHF), nephrotoxicity (cisplatin), hepatotoxicity (methotrexate), pulmonary fibrosis (bleomycin), neurotoxicity (vincristine).
4. Alopecia and dermatological effects: Complete hair loss causing psychological distress, radiation recall dermatitis, nail changes, and photosensitivity.
5. Secondary malignancies: Alkylating agents and topoisomerase inhibitors damage DNA, increasing risk of therapy-related acute myeloid leukemia (t-AML) years later, with poor prognosis.
☠️ Chemotherapy is Poison! Remember: "Kill cancer cells before killing patient." Requires vigilant monitoring of CBC, organ function, and supportive care (antiemetics, growth factors, transfusions).
32
Outline five (5) measures of protecting children against mental illness. (5 marks)
Primary prevention focuses on reducing risk factors and building resilience:
1. Early attachment and bonding: Promote secure parent-child attachment through responsive caregiving, skin-to-skin contact, and consistent nurturing in first 1000 days. Prevents future anxiety and depression.
2. Safe and stable home environment: Protect from abuse, neglect, domestic violence, and parental substance abuse. Provide consistent discipline, routines, and emotional support to build security.
3. Early developmental screening: Regular assessment at well-child visits identifies delays in speech, motor, social skills. Early intervention (occupational therapy, speech therapy) prevents secondary mental health problems.
4. School-based mental health programs: Anti-bullying policies, peer support groups, counseling services, and life skills education (emotion regulation, problem-solving) build resilience.
5. Community support systems: Access to recreational activities, mentoring programs, and reducing socioeconomic barriers. Poverty is a major risk factor; providing basic needs and opportunities prevents stress-related disorders.
CHILD PROTECTION: "SAFE-GUARD" - Secure attachment, Abuse prevention, Family support, Early screening, Development monitoring, Education, Community resources
SECTION C: Long Essay Questions (60 marks)
33
State adult dose, two (2) indications, two (2) contra-indications and four (4) side effects of the following drugs:
(a) Phenytoin. (5 marks)
(b) Sildenafil. (5 marks)
(c) Benzhexol. (5 marks)
(d) Lithium carbonate. (5 marks)
(a) Phenytoin. (5 marks)
(b) Sildenafil. (5 marks)
(c) Benzhexol. (5 marks)
(d) Lithium carbonate. (5 marks)
(a) Phenytoin:
Adult dose: 300-400 mg/day orally in single or divided doses (maintenance). Loading dose: 15-20 mg/kg IV for status epilepticus.
Indications: (1) Generalized tonic-clonic seizures, (2) Partial (focal) seizures. Also used for status epilepticus.
Contra-indications: (1) Sinus bradycardia/heart block, (2) Porphyria. Also contraindicated in hypersensitivity.
Side effects: (1) Nystagmus and ataxia (cerebellar toxicity), (2) Gingival hyperplasia, (3) Hirsutism and coarsening of facial features, (4) Osteomalacia from vitamin D deficiency.
(b) Sildenafil:
Adult dose: 50 mg orally once daily as needed, taken 1 hour before sexual activity (range: 25-100 mg). Maximum once daily.
Indications: (1) Erectile dysfunction, (2) Pulmonary arterial hypertension (as Revatio brand at 20 mg TID).
Contra-indications: (1) Concurrent nitrates (risk of fatal hypotension), (2) Severe cardiovascular disease/unstable angina.
Side effects: (1) Headache and flushing, (2) Visual disturbances (blue tinge), (3) Dyspepsia, (4) Priapism (prolonged painful erection >4 hours).
(c) Benzhexol (Trihexyphenidyl):
Adult dose: 1-2 mg daily, gradually increasing to 5-15 mg/day in divided doses for Parkinson's disease.
Indications: (1) Parkinson's disease (adjunct to levodopa), (2) Drug-induced extrapyramidal symptoms (EPS) from antipsychotics.
Contra-indications: (1) Narrow-angle glaucoma, (2) Prostatic hypertrophy/urinary retention. Also contraindicated in GI obstruction.
Side effects: (1) Dry mouth and blurred vision (anticholinergic), (2) Constipation and urinary retention, (3) Confusion and hallucinations in elderly, (4) Tachycardia.
(d) Lithium Carbonate:
Adult dose: 900-1800 mg/day in divided doses (maintenance). Acute mania: up to 2400 mg/day. Monitor serum levels: 0.6-1.2 mEq/L.
Indications: (1) Acute mania in bipolar disorder, (2) Maintenance therapy to prevent recurrence of manic and depressive episodes.
Contra-indications: (1) Significant renal impairment, (2) Pregnancy (especially first trimester - risk of Ebstein anomaly). Also contraindicated in Addison's disease.
Side effects: (1) Fine tremor and muscle weakness, (2) Polyuria and polydipsia (nephrogenic diabetes insipidus), (3) Hypothyroidism, (4) Nausea and diarrhea.
📊 Critical Monitoring: Phenytoin (levels, LFTs), Sildenafil (BP with nitrates), Benzhexol (IOP in glaucoma), Lithium (serum levels, TSH, creatinine every 3-6 months)!
34
(a) Describe with rationale five (5) measures employed to prevent suicidal attempts for patients admitted in hospital. (10 marks)
(b) Explain ten (10) responsibilities of a nurse in assessment for suicidal behaviour. (10 marks)
(b) Explain ten (10) responsibilities of a nurse in assessment for suicidal behaviour. (10 marks)
(a) Hospital Suicide Prevention Measures:
1. Continuous observation (1:1 constant nursing): Assign dedicated staff member to remain within arm's reach of high-risk patient at all times. RATIONALE: Prevents unsupervised attempts, provides immediate intervention, and deters impulsive acts.
2. Environmental safety and ligature risk removal: Remove all potential means - belts, shoelaces, sharps, glass items, cords, plastic bags. RATIONALE: Eliminates tools for hanging, cutting, suffocation which account for 75% of inpatient suicides.
3. Safety room placement near nursing station: House patient in room with unbreakable windows, no anchor points, and clear visibility. RATIONALE: Enables frequent visual checks and rapid response while maintaining patient dignity.
4. Restricted visiting policies and contraband checks: Screen all visitors and belongings for potential weapons or medications. RATIONALE: Prevents smuggling of means and protects patient from harmful external influences.
5. Rapid medication stabilization and ECT if indicated: Aggressively treat underlying depression/psychosis with close monitoring. RATIONALE: Reduces suicidal ideation intensity and provides neurochemical stabilization within 48-72 hours.
(b) Nurse Responsibilities in Suicidal Behaviour Assessment:
1. Establish therapeutic rapport: Create trusting relationship to encourage honest disclosure of suicidal thoughts without fear of judgment or immediate punitive measures.
2. Direct questioning about ideation: Ask explicitly: "Are you having thoughts of killing yourself?" - this does NOT plant the idea but rather provides permission to talk about it.
3. Assess severity and specificity of plan: Determine if there is a specific method, timeline, means availability, and lethality. "When, where, how" questions reveal immediacy of risk.
4. Evaluate protective factors: Identify reasons for living (family, faith, future plans) and social support systems. Presence of strong protectors may mitigate risk.
5. Review past suicidal behavior: Document previous attempts, methods, hospitalizations, and family history. Strongest predictor of future suicide is past attempt.
6. Assess command hallucinations: Ask if voices are telling patient to harm themselves. Command hallucinations significantly increase violence risk and require immediate intervention.
7. Monitor for warning signs: Observe for giving away possessions, sudden mood improvement (may indicate decision to attempt), preoccupation with death, social withdrawal.
8. Conduct risk stratification: Use standardized tools like SAD PERSONS scale or Columbia Protocol to quantify risk level and guide management decisions.
9. Document comprehensively: Record verbatim statements, observed behaviors, assessment findings, and interventions in objective, non-judgmental language for legal and clinical continuity.
10. Implement and communicate safety plan: Ensure constant observation is initiated, team is informed, psychiatrist is notified immediately, and family is engaged in safety planning and psychoeducation.
🚨 Suicide Assessment is CONTINUOUS: Risk fluctuates hourly. Document every shift, every change in status, every interaction. Never assume risk is resolved even if patient denies ideation.
35
(a) Outline five (5) characteristic physical features of severe mental retardation. (5 marks)
(b) Describe four (4) methods used to diagnose mental retardation. (8 marks)
(c) State seven (7) primary prevention measures of mental retardation. (7 marks)
(b) Describe four (4) methods used to diagnose mental retardation. (8 marks)
(c) State seven (7) primary prevention measures of mental retardation. (7 marks)
(a) Physical Features of Severe Mental Retardation (IQ 20-34):
1. Dysmorphic facial features: Abnormal skull shape (microcephaly, macrocephaly), widely spaced eyes, low-set ears, flattened nasal bridge - often indicative of genetic syndromes (Down, Fragile X, fetal alcohol syndrome).
2. Gross motor delays and abnormal gait: Unable to walk until age 4-6 years, may never achieve independent ambulation. Ataxic, spastic, or puppet-like movements common.
3. Growth retardation: Short stature, failure to thrive, obesity in institutional settings due to poor feeding, hypothyroidism, or genetic disorders affecting metabolism.
4. Sensory impairments: High prevalence of visual deficits (cataracts, cortical blindness) and hearing loss (untreated infections, genetic syndromes) compounding intellectual disability.
5. Self-injurious behaviors and stereotypies: Hand-biting, head-banging, rocking, spinning - often due to inability to communicate needs, sensory seeking, or frustration from limited adaptive skills.
(b) Methods to Diagnose Mental Retardation:
1. Standardized intelligence testing: Administer tools like Wechsler Adult Intelligence Scale (WAIS) or Stanford-Binet Intelligence Scales. Must show IQ <70 (2 standard deviations below mean) for diagnosis. Testing must be culturally appropriate and consider sensory/motor limitations.
2. Adaptive behavior assessment: Use Vineland Adaptive Behavior Scales to evaluate conceptual skills (language, literacy), social skills (interpersonal relationships, responsibility), and practical skills (self-care, occupational skills). Must show significant limitations in 2+ areas.
3. Comprehensive medical and genetic evaluation: Includes karyotyping for chromosomal abnormalities (Down syndrome, Fragile X), metabolic screening (PKU, hypothyroidism), neuroimaging (MRI for brain malformations), and prenatal/perinatal history review.
4. Developmental history and clinical observation: Gather detailed prenatal, birth, and developmental milestones history from multiple caregivers. Direct observation of child's play, communication, and social interaction in natural settings provides functional assessment beyond test scores.
(c) Primary Prevention Measures of Mental Retardation:
1. Genetic counseling and prenatal screening: Identify carrier status for inherited disorders (Tay-Sachs, Fragile X), offer amniocentesis, CVS for high-risk pregnancies to inform reproductive decisions.
2. Rubella immunization: Ensure all girls are vaccinated before childbearing age to prevent congenital rubella syndrome (deafness, cataracts, heart defects, MR).
3. Prevention of neural tube defects: Periconceptual folic acid supplementation (0.4 mg daily) reduces risk by 70%. Fortification of staple foods with folate.
4. Prevention of birth injuries: Quality antenatal care, skilled birth attendance, emergency obstetric care to prevent hypoxic-ischemic encephalopathy from birth asphyxia.
5. Treatment of neonatal jaundice: Prompt phototherapy or exchange transfusion for severe hyperbilirubinemia prevents kernicterus-induced brain damage and subsequent mental retardation.
6. Prevention of lead poisoning: Remove lead-based paints, screen high-risk children, treat elevated levels >45 µg/dL to prevent neurotoxicity and cognitive impairment.
7. Early treatment of infections: Prompt diagnosis and treatment of meningitis, encephalitis, and congenital infections (CMV, toxoplasmosis) with appropriate antibiotics/antivirals.
PREVENTION STRATEGIES: "RUBRIC-PL" - Rubella vaccination, Ultrasound screening, Birth injury prevention, Rubella, Immunization, Counseling, Periconceptual folate, Lead screening
👶 Critical Period: Most brain development occurs in first trimester. Prevention must start BEFORE pregnancy - folic acid, vaccination, nutrition, avoiding teratogens!