Psychiatric and Mental Health Nursing
Psychiatric nursing tests therapeutic communication, recognition of psychotropic adverse effects, risk assessment and legal provisions. PGIMER items often quote a patient statement and ask for the nurse's best response, so the wording of options matters.
Therapeutic communication
- Use open questions, reflection, restatement, silence and clarification. Avoid 'why' questions, false reassurance, advice-giving, changing the subject and value judgements.
- Example: the patient says nobody cares whether they live or die. A therapeutic reply reflects feeling: 'You feel that no one would notice if you were gone.' Not: 'Don't say that, everyone cares.'
Medication effects
- Typical antipsychotics cause extrapyramidal symptoms. Acute dystonia responds to promethazine or benztropine; akathisia to propranolol; parkinsonism to trihexyphenidyl; tardive dyskinesia requires review and often a switch to clozapine.
- Clozapine carries agranulocytosis risk, so white cell counts are monitored.
- Lithium: therapeutic 0.6–1.2 mEq/L; toxicity above 1.5 with tremor, vomiting, ataxia and seizures. Maintain salt and fluid intake; avoid thiazides and NSAIDs.
Worked example
Two days after starting haloperidol, a patient develops fever of 39.5°C, generalised rigidity, confusion, fluctuating blood pressure and a creatine kinase of 2000. This is neuroleptic malignant syndrome. Stop the drug, give supportive care, and use dantrolene or bromocriptine as prescribed. Reasoning: fever plus rigidity plus autonomic instability plus raised CK is the classic tetrad; dystonia affects only muscle groups and does not cause fever.
Risk and law
Ask directly about suicidal ideation; a no-harm contract is not a substitute for observation. The Mental Healthcare Act 2017 provides advance directives, nominated representatives and restricts involuntary admission.
Traps
Choosing reassurance options, attributing fever to infection without checking for rigidity, and forgetting that antidepressants need 2–4 weeks before benefit appears.