Psychiatric and Mental Health Nursing
Psychiatric and Mental Health Nursing
This domain tests mental status examination, therapeutic communication, major psychiatric disorders, psychotropic drug effects and mental health law. Safety and therapeutic relationship questions dominate.
Core rules
- Mental status examination: appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition and insight.
- Therapeutic communication uses open-ended questions, reflection, silence and clarification. Do not argue with delusions or give false reassurance.
- Schizophrenia has positive symptoms (hallucinations, delusions) and negative symptoms (flat affect, avolition). Antipsychotics can cause extrapyramidal symptoms and tardive dyskinesia.
- Neuroleptic malignant syndrome: fever, lead-pipe rigidity, altered consciousness and raised creatine kinase. Stop the drug and treat with dantrolene or bromocriptine.
- Lithium therapeutic range is 0.6–1.2 mEq/L; toxicity causes tremor, ataxia and vomiting.
- Mental Healthcare Act 2017 gives rights, advance directives and a nominated representative.
Worked example
A patient on haloperidol develops temperature 39 °C, lead-pipe rigidity, confusion and creatine kinase 2000 U/L. This is neuroleptic malignant syndrome, not extrapyramidal symptoms, because fever and altered consciousness are present. The drug is stopped immediately.
Traps
- Never challenge a delusion directly; acknowledge the feeling instead.
- SSRIs take 2–4 weeks to act.
- Do not stop antipsychotics abruptly without medical advice.