Psychiatry
Psychiatry
The psychiatric station tests mental state examination, risk assessment, and safe communication. You must ask directly about suicidal ideation, self-harm, psychosis, and substance use, and formulate risk rather than tick boxes. New Zealand law and culture matter: the Mental Health (Compulsory Assessment and Treatment) Act 1992, confidentiality limits, and whānau involvement with consent.
Core rules
- MSE: appearance, behaviour, speech, mood, affect, thought form/content, perception, cognition, insight.
- Risk: ask about thoughts, plans, means, intent, protective factors, and previous attempts.
- Exclude medical causes: delirium, thyroid disease, substance intoxication/withdrawal, medication effects.
- Capacity: understand, retain, weigh, communicate; if absent, act in best interests and consider the Act.
- Use a trained interpreter; do not use family members for sensitive disclosure.
Worked example
A 24-year-old man reports hearing voices commenting on him and believes his neighbours are poisoning him. Reasoning: MSE shows paranoid delusions and auditory hallucinations; risk assessment reveals no suicidal intent but he has stopped eating. You arrange a medical screen, urine drug screen, and urgent psychiatric review; explain confidentiality and involve his family only with consent; consider the Mental Health Act if he refuses necessary assessment.
Traps
Asking leading questions, missing organic disease, documenting no risk without a plan, and breaching confidentiality unnecessarily.