Mental Health and Psychiatric Nursing
This domain tests risk assessment, therapeutic communication, and safe management of acute psychiatric presentations, including substance withdrawal. Suicide rates in Mongolia are high, particularly among young men, and alcohol use disorder is common, so these topics carry real weight.
Core rules
- Mental state examination covers appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition and insight, plus risk.
- Ask directly about suicide. Asking does not increase risk. Ask about plan, means, intent and previous attempts, and document the answers.
- Involuntary admission requires a diagnosed mental disorder plus danger to self or others or serious deterioration, with documented review. Confirm the current statutory timeframes under Mongolian mental health law rather than relying on memory.
- Delirium is acute, fluctuating and marked by inattention; look for hypoxia, infection, drugs, pain and alcohol withdrawal. Treat the cause.
- Alcohol withdrawal: benzodiazepines titrated to a withdrawal scale, thiamine before any glucose-containing fluid, and never abrupt cessation in a dependent patient.
- Neuroleptic malignant syndrome: rigidity, hyperthermia, autonomic instability, raised creatine kinase - stop the antipsychotic, cool the patient, and use dantrolene or bromocriptine as prescribed.
Worked example
A 45-year-old man is tremulous three days after his last drink: HR 120, sweating, visual hallucinations, disoriented. Reasoning: alcohol withdrawal with delirium. Give a benzodiazepine per protocol, give thiamine 100 mg IV before glucose, check glucose, electrolytes and magnesium, monitor observations hourly, and keep the environment calm and lit. Restraint is avoided unless there is immediate danger, because it worsens agitation.
Traps
Arguing with a delusion; promising absolute secrecy; labelling acute confusion in an older inpatient as dementia; sedating without checking glucose and oxygen first; missing the risk assessment because the patient 'seems calm'.