Mental Health and Psychiatric Nursing
Core concepts
Psychiatric nursing tests therapeutic communication, safety, and recognition of major disorders: depression, bipolar disorder, anxiety disorders, schizophrenia, personality disorders, substance use, and eating disorders. Know the therapeutic relationship, boundary setting, suicide risk assessment, de-escalation, and the side effects of psychotropic medications (especially antipsychotics and lithium).
Traps candidates fall for
- Giving advice, false reassurance, or "why" questions; therapeutic responses reflect feelings and explore.
- Missing the highest-priority risk: a patient with suicidal ideation needs direct safety assessment and supervision, not teaching.
- Forgetting that depression can present as somatic complaints or irritability.
- Overlooking dangerous side effects: antipsychotics can cause neuroleptic malignant syndrome (fever, rigidity, altered mental status) and tardive dyskinesia; lithium toxicity shows tremor, vomiting, and confusion.
- Confusing mania (elevated mood, decreased sleep, grandiosity) with simple anxiety.
- Ignoring that a patient with an eating disorder may have life-threatening electrolyte disturbances.
Rule of thumb
Safety first: assess suicide and violence risk before anything else, and use direct, nonjudgmental questions. Asking about suicide does not plant the idea.
Worked example
A patient says, "Everyone would be better off without me." The best response is to ask directly about suicidal thoughts and a plan, then ensure supervision and notify the team. Changing the subject or offering reassurance ("You have so much to live for") blocks assessment and is not therapeutic.