Mental Health and Psychiatric Nursing
This domain tests therapeutic communication, suicide and violence risk assessment, psychosis, mood disorders, substance use, and the legal framework of the Mental Health Treatment Law 1991.
Core rules
- Ask directly about suicidal ideation, plan, intent, means, and protective factors; direct questions do not increase risk.
- Use least-restrictive care. Involuntary admission requires a mental disorder plus danger to self or others or serious deterioration, and must follow statutory psychiatric review.
- Maintain confidentiality except where law or safety requires disclosure.
- Monitor psychotropic adverse effects: lithium levels and toxicity, clozapine and agranulocytosis, antipsychotic extrapyramidal effects, and metabolic syndrome.
- Use de-escalation first: calm environment, clear limits, and oral medication before restraint when possible.
- Rule out delirium and medical causes before attributing symptoms to psychiatric illness.
Worked example
A patient says, “Everyone would be better off if I were dead,” and describes a plan to take pills. Ask directly about intent, plan, access, and previous attempts. Do not promise secrecy. Remove means, initiate constant observation according to policy, notify the psychiatrist, and document the assessment and actions. Reason: expressed ideation with a plan is a high-risk situation requiring immediate safety measures.
Traps
- Promising confidentiality that cannot be kept when there is serious risk.
- Assuming acute confusion is psychiatric when delirium is possible.
- Stopping lithium abruptly or ignoring tremor, vomiting, and ataxia.
- Using stigmatizing language that reduces trust.