Mental Health / Psychiatric Nursing
Psychiatric nursing tests mental status assessment, therapeutic communication, psychopathology, psychotropic drugs and legal rights. Exam items often ask for the most therapeutic nurse response.
Core rules
- Mental status examination covers appearance, behaviour, speech, mood and affect, thought, perception, cognition and insight.
- Therapeutic communication uses open questions, reflection, silence and clarification. Avoid false reassurance, advice-giving and arguing with delusions.
- Schizophrenia: positive symptoms include delusions and hallucinations; negative symptoms include apathy and social withdrawal. Antipsychotics can cause extrapyramidal symptoms and neuroleptic malignant syndrome.
- Depression: assess suicide risk directly; SSRIs are first-line. Mental Healthcare Act 2017 protects rights and regulates admission.
Worked example
A patient says, “I am worthless; everyone would be better off without me.” The nurse replies, “You feel worthless and are thinking others would be better off without you?” and asks directly about suicidal thoughts. Reasoning: reflection shows listening, and direct questioning does not increase risk; it clarifies urgency.
Traps
Responding with “Don't say that” or false reassurance; challenging a delusion; overlooking akathisia or NMS; failing to document suicidal ideation.