Mental Health and Psychiatric Nursing
Core concepts
Psychiatric nursing requires therapeutic communication, safety assessment, and knowledge of major disorders and treatments: depression, anxiety disorders, bipolar disorder, schizophrenia, substance use, personality disorders, and trauma-related conditions. Know suicide and violence risk assessment - direct questioning does not increase risk - and the nursing priorities of safety, milieu management, and least restrictive intervention. Understand psychotropic classes (antidepressants, antipsychotics, mood stabilizers, anxiolytics), their therapeutic lag, and their serious adverse effects, including serotonin syndrome, neuroleptic malignant syndrome, and lithium toxicity. Recognize signs of withdrawal and the principles of de-escalation.
Traps
The classic errors are (1) avoiding direct questions about suicidal ideation; (2) choosing reassurance ("everything will be fine") over exploration; (3) missing that an improving but still depressed patient may be at higher suicide risk as energy returns; and (4) misattributing physical symptoms of psychiatric medication toxicity to the illness. Another trap is using confrontation with an agitated patient rather than calm, brief, concrete communication.
Rule of thumb
Safety first, then rapport. When risk is present, ask directly, assess plan and means, remove means where possible, and escalate - reassurance is not assessment.
Worked example
A patient on an SSRI presents with agitation, diaphoresis, tremor, and hyperreflexia. These suggest serotonin syndrome. The correct action is to stop the serotonergic agents, notify the provider, monitor vitals, and provide supportive care - not to interpret the symptoms as worsening anxiety.