Mental Health and Psychiatric Nursing
This domain tests mental state assessment, therapeutic communication, risk assessment, psychotropic medication safety and legal-ethical boundaries.
Core rules and concepts
- Mental state examination: appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition and insight.
- Therapeutic communication: open questions, reflection, clarification and silence. Avoid “why” questions, false reassurance, advice-giving and changing the subject.
- Suicide risk: ask directly about thoughts, plans, means and intent. Risk is higher with previous attempts, male sex, older age, isolation, substance use and access to means.
- Depression: first-line treatment is an SSRI plus psychological therapy; monitor for suicidal ideation early in treatment.
- Psychosis: antipsychotics; monitor for neuroleptic malignant syndrome with fever, rigidity, autonomic instability and raised creatine kinase.
- Lithium: therapeutic range about 0.6–1.2 mmol/L; toxicity causes tremor, vomiting, ataxia and confusion.
- Restraint: last resort, prescribed, time-limited and monitored for circulation and dignity.
Worked example
A patient says, “I have nothing to live for.” Do not reassure or change the subject. Ask directly, “Are you thinking about killing yourself?”, then explore plan, means and intent. Remove means, stay with the patient and escalate for urgent mental health assessment.
Traps that cost marks
- Colluding with delusions or giving false reassurance.
- Avoiding direct questions about suicide.
- Missing delirium as a physical cause of confusion.
- Failing to monitor lithium levels and renal function.