Psychiatric and Mental Health Nursing
What this domain tests
Mental status examination, therapeutic communication, major psychiatric disorders, psychotropic drug monitoring, suicide risk and mental health law.
Core rules
- MSE: appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition, insight and judgment.
- Therapeutic communication: open-ended questions, reflection, clarification, silence and empathy. Avoid 'why' questions, false reassurance and giving advice.
- Depression: SIGECAPS; SSRIs are first-line; watch for serotonin syndrome (agitation, hyperthermia, clonus).
- Schizophrenia: positive symptoms (delusions, hallucinations) and negative symptoms (flat affect, avolition); antipsychotics; monitor for extrapyramidal symptoms and neuroleptic malignant syndrome (fever, rigidity, autonomic instability, raised CK).
- Lithium: therapeutic 0.6–1.2 mEq/L; toxicity above 1.5; monitor sodium and fluid; dehydration raises levels.
- Suicide: ask directly, assess plan, means and intent, ensure safety, involve family; a no-suicide contract is not a substitute for assessment.
- Mental Health Care Act 2017: rights, capacity, nominated representative and admission safeguards.
Worked example
A patient on lithium has tremor, vomiting, ataxia and a level of 1.8 mEq/L. This is lithium toxicity. Withhold the drug, obtain urgent medical review, check renal function and electrolytes, and monitor fluid balance. Do not simply reassure because the patient is 'still talking'.
Traps
Thinking that asking about suicide plants the idea; using social chat as therapeutic communication; missing NMS because the patient is 'just agitated'; and ignoring lithium levels in a dehydrated patient.