Psychiatric and Mental Health Nursing
Psychiatric and Mental Health Nursing tests therapeutic relationships, mental state assessment, risk management and psychotropic safety, within Egypt's Mental Health Law No. 71 of 2009, which protects patients' rights to dignity, confidentiality and voluntary treatment.
Therapeutic communication and the mental state examination
Use open questions, reflection, clarification and silence; avoid false reassurance, advice-giving, arguing with delusions and why-questions. The mental state examination covers appearance and behaviour, speech, mood and affect, thought form and content, perception including hallucinations, cognition, insight and judgement. Assess risk explicitly: suicidal ideation, plan, means, previous attempts and protective factors.
Risk management
Ask directly about suicide risk. High risk means an immediate plan, access to means or a recent attempt - ensure continuous observation, remove ligatures and sharp objects, involve family with consent, and document. For violence risk, assess triggers, keep an exit route, call for help and use de-escalation first; restraint is a last resort, prescribed, time-limited, monitored and documented.
Psychotropic adverse effects
- Antipsychotics: extrapyramidal symptoms (acute dystonia, treated with procyclidine or benztropine), akathisia, parkinsonism, tardive dyskinesia and raised prolactin.
- Neuroleptic malignant syndrome: fever, rigidity, autonomic instability and raised creatine kinase - stop the drug, cool, hydrate, and consider dantrolene or bromocriptine.
- SSRIs: serotonin syndrome (agitation, clonus, hyperthermia, diarrhoea) - stop the drug and give supportive care, with cyproheptadine if severe. Also sexual dysfunction and hyponatraemia in older adults.
- Lithium: narrow therapeutic index - monitor levels, thyroid and renal function; toxicity causes tremor, vomiting, ataxia and seizures.
- Clozapine: agranulocytosis - monitor white cell counts and report sore throat or fever.
Special situations
Delirium is a medical emergency: acute onset, fluctuating attention and disorientation demand a search for the cause (infection, drugs, hypoxia, withdrawal). Postpartum psychosis is both an obstetric and a psychiatric emergency.
Worked example
A 24-year-old man on haloperidol for three days develops a stiff neck, eyes rolling upward and difficulty speaking. What is happening and what do you do? Reasoning: this is acute dystonia, an extrapyramidal reaction. Give the prescribed anticholinergic (procyclidine or benztropine) promptly, reassure the patient, notify the prescriber and document. Increasing the antipsychotic would worsen it; this is not a seizure.
Traps that cost marks
- Colluding with or challenging a delusion.
- Restraining without a prescription, monitoring or reassessment.
- Missing medical causes of agitation.
- Failing to monitor lithium levels or clozapine blood counts.