Mental Health and Psychiatric Nursing
Mental health questions test recognition of common conditions, safe communication, risk assessment and the interface between physical and psychological care - an area where stigma still delays treatment in Cambodia.
Assessment
Use a mental state examination: appearance, behaviour, speech, mood and affect, thought content and form, perception, cognition and insight. Ask directly about suicidal thoughts; asking does not plant the idea. Screen for alcohol use, which often presents as insomnia, gastric pain or family violence rather than as a request for help.
Therapeutic communication
Use open questions, reflection and silence. Do not argue with delusions or hallucinations; acknowledge the feeling and redirect to a reality-based activity. Give information simply, involve the family with the patient's consent, and maintain confidentiality.
Worked example
A man says, "There is no point in living any more." Reasoning: this is a direct risk statement and must be explored, not changed as a subject. Ask about plan, means, previous attempts and support. Action: do not leave him alone, remove accessible means, arrange urgent review, inform the responsible clinician, and document the assessment. Confidentiality yields to the duty to protect life.
Common drug effects
Extrapyramidal symptoms and neuroleptic malignant syndrome (fever, rigidity, altered consciousness) with antipsychotics; lithium toxicity (tremor, vomiting, ataxia) when the patient is dehydrated.
Traps
Responding with "don't worry" or false reassurance; promising secrecy about suicidal intent; restraining a patient as a first option rather than after de-escalation; missing delirium in an older patient and labelling it as psychiatric illness.