Mental Health (Psychiatric) Nursing
What this domain tests
Therapeutic communication, mental status examination, psychopathology, psychotropic drugs and their side-effects, crisis and suicide risk, de-addiction, electroconvulsive therapy, and the legal framework of the Mental Healthcare Act 2017.
Core rules
- Mental status examination: appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition, insight and judgement. Document observations, not interpretations.
- Therapeutic communication: open-ended questions, reflection, clarification, silence. Avoid false reassurance, "why" questions, advice-giving and changing the subject.
- Defence mechanisms: denial, projection, rationalisation, displacement, sublimation, reaction formation - identify from the described behaviour.
- Antipsychotics: typical agents cause extrapyramidal symptoms. Acute dystonia appears within hours to days; akathisia within days; parkinsonism within weeks; tardive dyskinesia after months to years.
- Neuroleptic malignant syndrome: rigidity, hyperthermia, autonomic instability, raised creatine kinase - stop the drug, give dantrolene or bromocriptine.
- Lithium: therapeutic 0.6–1.2 mEq/L; toxicity above 1.5 mEq/L with tremor, vomiting, ataxia, confusion. Thiazides and dehydration raise levels.
- Suicide risk: highest in the early recovery phase when energy returns but despair persists; ask directly and remove means.
Worked example
A patient on haloperidol for three days develops a fixed upward gaze and neck spasm. Reasoning: onset within days plus sustained muscle contraction equals acute dystonia, not tardive dyskinesia (which needs months). Management is parenteral anticholinergic such as promethazine or benztropine, not drug discontinuation alone.
Traps that cost marks
- Labelling acute dystonia as tardive dyskinesia; timing distinguishes them.
- Missing lithium toxicity when a patient on lithium starts a thiazide diuretic.
- Assuming suicide risk falls as soon as mood improves.
- Using reassurance ("everything will be fine") as if it were therapeutic communication.