Mental health nursing

In short

Mental health nursing is the specialty that applies the nursing process to people with mental illness and to the promotion of mental health, using the therapeutic nurse-patient relationship as its chief tool alongside drugs, psychotherapies and rehabilitation. India carries a large treatment gap (National Mental Health Survey 2015-16 found a current prevalence of mental morbidity of about 10.6% in adults, with roughly 80% of those affected not receiving care), so the nurse is often the first and most continuous contact. It is a full paper in the B.Sc Nursing curriculum (Mental Health Nursing, with clinical posting and practical/viva), is examined in the Indian Nursing Council-regulated exams, NORCET/AIIMS, RRB, ESIC and state staff-nurse recruitments, and is tested in interviews for psychiatric wards, de-addiction centres, NIMHANS/CIP/IHBAS type institutes, school and corporate counselling, and tele-MANAS. It is also the one specialty where the law — the Mental Healthcare Act, 2017 — directly dictates bedside practice.

Explained

Concepts, classification and the Indian legal frame

• Mental health is a state of well-being in which a person realises their abilities, copes with normal stress, works productively and contributes to the community (WHO). Mental illness under the Mental Healthcare Act (MHCA), 2017 means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour, capacity to recognise reality or ability to meet ordinary demands of life, including alcohol and drug misuse — but excluding mental retardation/intellectual disability.
• Classification systems: ICD-11 (WHO, in use; chapter on mental, behavioural and neurodevelopmental disorders) and DSM-5-TR (APA). Indian papers may still cite ICD-10 codes (F00-F99); quote the version the question uses.
• Key ICD-10 blocks to recall: F00-09 organic (dementia, delirium), F10-19 substance use, F20-29 schizophrenia and delusional disorders, F30-39 mood disorders, F40-48 neurotic/stress-related, F50-59 behavioural syndromes (eating, sleep), F60-69 personality disorders, F70-79 intellectual disability, F80-89 developmental, F90-98 childhood/adolescent.
• MHCA, 2017 — core provisions: right to access affordable mental healthcare; presumption of capacity to take decisions unless proved otherwise; advance directive (how a person wishes to be/not be treated when they lose capacity); nominated representative; right to community living, to confidentiality, to legal aid and to information.
• Section 115 decriminalises attempted suicide — the person is presumed to be under severe stress and is to be given care, not punished. Section 95 bans ECT without muscle relaxant and anaesthesia, bans ECT for minors except with guardian consent and Mental Health Review Board approval, and bans sterilisation as treatment and chaining in any form.
• Admissions: independent (voluntary) admission is the norm; supported admission (Sections 89/90) for a person who lacks capacity and poses risk — time-limited (up to 30 days under s.89) and reviewed by the Mental Health Review Board; Central and State Mental Health Authorities register establishments.
• Other statutes: NDPS Act, 1985 (narcotics, with provision for de-addiction and immunity for voluntary treatment seekers); Rights of Persons with Disabilities Act, 2016 (mental illness is a listed disability; certification and benefits); Protection of Children from Sexual Offences Act, 2012 and Juvenile Justice Act, 2015 (mandatory reporting duties); POCSO/JJ duties override confidentiality.
• Programmes: National Mental Health Programme (1982), District Mental Health Programme (1996, Bellary model) delivering care through CHCs/PHCs; Tele-MANAS 24×7 helpline (14416) since October 2022; National Tele Mental Health Programme; Ayushman Bharat Health and Wellness Centres include mental health in the comprehensive primary care package. Scheme details and helpline coverage change — verify the current list before quoting.

Assessment: mental status examination and the nursing process

• History: identification, chief complaints with duration, history of present illness, treatment history, past psychiatric and medical history, family history (with pedigree), personal history (birth, development, schooling, occupation, sexual and marital history, substance use), premorbid personality.
• Mental Status Examination (MSE) — the sequence:
• General appearance and behaviour: grooming, eye contact, rapport, psychomotor activity, mannerisms, cooperativeness.
• Speech: rate, volume, tone, relevance, coherence, productivity (pressure of speech, mutism, neologism).
• Mood and affect: mood = sustained subjective emotion ("how have you been feeling?"); affect = observed, described by range, reactivity, congruence (blunted, flat, labile, inappropriate).
• Thought: stream, form (tangentiality, circumstantiality, flight of ideas, loosening of association, thought block), content (delusions, obsessions, phobias, suicidal ideas), possession (thought insertion, withdrawal, broadcasting).
• Perception: hallucinations (auditory, visual, tactile, olfactory, gustatory), illusions, depersonalisation, derealisation.
• Cognition: consciousness, orientation to time/place/person, attention and concentration (serial sevens, digit span), memory (immediate, recent, remote), intelligence, abstraction (proverbs, similarities).
• Insight (graded I to VI, from complete denial to awareness with willingness to change) and judgement (personal, social, test).
• Scales used in India: BPRS and PANSS (schizophrenia), HAM-D/BDI (depression), YMRS (mania), HAM-A (anxiety), MMSE and HMSE (Hindi Mental State Examination, for low-literacy elderly), AUDIT and CAGE (alcohol), Columbia suicide severity rating scale, GAF for functioning.
• Nursing process: assessment → nursing diagnosis (NANDA-I, e.g. "Risk for self-directed violence", "Disturbed sensory perception", "Impaired social interaction") → planning with measurable short- and long-term goals → implementation → evaluation. Document behaviour verbatim, not interpretation.

Therapeutic relationship, communication and psychosocial therapies

• Therapeutic nurse-patient relationship (Hildegard Peplau) — four phases: pre-interaction (self-awareness, chart review), orientation (contract, confidentiality, goals), working (exploration, problem-solving, resistance handled), termination (review gains, prepare for separation, handle regression).
• Core conditions: empathy (not sympathy), unconditional positive regard, genuineness, active listening, acceptance of the person while setting limits on behaviour.
• Therapeutic techniques: broad opening, open-ended questions, silence, reflection, restating, clarification, exploring, focusing, offering self, presenting reality, confrontation (only in a strong relationship), summarising.
• Non-therapeutic responses to avoid: false reassurance ("don't worry, all will be fine"), giving advice, asking "why", probing, belittling feelings, defending the hospital, stereotyped replies, changing the subject, arguing with a delusion.
• Defence mechanisms (Freud): denial, repression, suppression, regression, rationalisation, projection, displacement, reaction formation, sublimation (mature), identification, introjection, undoing, isolation of affect, compensation, conversion, dissociation, splitting (typical of borderline personality).
• Developmental frames examined: Freud's psychosexual stages; Erikson's eight psychosocial stages (identity vs role confusion in adolescence); Piaget's cognitive stages; Maslow's hierarchy; Kubler-Ross's five stages of grief; Caplan's three levels of prevention and crisis intervention (crisis resolves in roughly 4-6 weeks; intervention is brief, reality-oriented and focused on the here and now).
• Therapies the nurse assists with or runs: individual and group psychotherapy (Yalom's curative factors), cognitive behaviour therapy (identify cognitive distortions, thought record, behavioural activation), behaviour therapy (systematic desensitisation, flooding, aversion therapy, token economy, operant conditioning), family therapy, psychoeducation, social skills and assertiveness training, relaxation and Jacobson's progressive muscle relaxation, yoga and mindfulness, occupational and recreational therapy, milieu therapy (a planned therapeutic environment), motivational interviewing in addiction.
• Group dynamics: therapeutic groups 6-10 members, fixed time and place; nurse roles as leader, co-leader or observer.

Major disorders and their nursing management

• Schizophrenia: positive symptoms (delusions, hallucinations, disorganised speech and behaviour), negative symptoms (avolition, alogia, anhedonia, affective flattening, asociality), cognitive deficits. Subtypes historically paranoid, catatonic, hebephrenic, simple, residual (ICD-11 drops subtypes). Nursing: short, clear, concrete sentences; do not argue with or reinforce delusions — present reality and voice doubt; reduce stimuli during hallucinations and use distraction/focusing; ensure food and fluids if there is poisoning delusion (serve sealed/self-chosen food); monitor adherence and depot injections; psychoeducation on high expressed emotion in the family.
• Catatonia: stupor, mutism, negativism, waxy flexibility, posturing, echolalia, echopraxia. Nursing: nutrition and hydration, bowel/bladder care, position change and passive exercises to prevent contractures and DVT, skin and mouth care, continue talking to the patient; lorazepam and ECT are the common treatments.
• Bipolar affective disorder — mania: elevated mood, grandiosity, pressure of speech, flight of ideas, decreased need for sleep, overspending, disinhibition. Nursing: calm low-stimulus environment, firm consistent limits, finger foods and high-calorie drinks for a patient who cannot sit to eat, channel energy into non-competitive activity, protect from exploitation and from exhausting themselves, monitor sleep and weight.
• Depression: persistently low mood, anhedonia, fatigue, worthlessness, guilt, poor concentration, death wishes; biological symptoms — early morning wakening, diurnal variation, loss of appetite and libido, weight change. Nursing: suicide precautions, sit with the patient without demanding talk, simple structured activity, assist self-care without taking it over, watch the paradoxical risk period when energy returns before mood lifts.
• Suicide: assess intent, plan, means, lethality, previous attempts, hopelessness, impulsivity, substance use, recent loss, chronic pain, lack of support. Nursing: ask directly about suicidal thoughts (asking does not plant the idea), remove sharps, cords, belts, matches, excess drugs; one-to-one or 15-minute observation as ordered; no-suicide/safety plan; never promise to keep a suicidal disclosure secret; after an attempt the care is clinical, not punitive (s.115 MHCA).
• Anxiety disorders: generalised anxiety, panic disorder (abrupt attacks peaking in ~10 minutes with palpitations, choking, fear of death), phobias, social anxiety; OCD (obsessions plus compulsions, now separate from anxiety disorders in ICD-11); PTSD (re-experiencing, avoidance, hyperarousal after a traumatic event). Nursing: stay with the patient in panic, speak slowly in short sentences, breathing and relaxation exercises, graded exposure, do not abruptly stop rituals early in treatment — set a time-limited schedule and reduce gradually.
• Somatic symptom, dissociative and conversion disorders: symptoms are real to the patient and not feigned; avoid confrontation and unnecessary investigations, attend to the person rather than only the symptom, identify secondary gain and stressors.
• Personality disorders: cluster A odd/eccentric (paranoid, schizoid, schizotypal), cluster B dramatic/erratic (antisocial, borderline, histrionic, narcissistic), cluster C anxious (avoidant, dependent, obsessive-compulsive personality). Nursing: consistent team approach, clear boundaries, avoid being split, manage self-harm with a safety plan.
• Substance use disorders: dependence = craving, tolerance, withdrawal, loss of control, salience, continued use despite harm. Alcohol withdrawal 6-72 hours — tremor, sweating, anxiety, seizures; delirium tremens at 48-96 hours with clouding, agitation, visual hallucinations, autonomic storm — a medical emergency. Nursing: CIWA-Ar monitoring, benzodiazepine taper as prescribed, thiamine before any glucose (to prevent Wernicke's encephalopathy), hydration, quiet lit room, no restraint unless unavoidable; then relapse prevention, Alcoholics Anonymous and family work. Opioid withdrawal is distressing but rarely fatal; opioid substitution with buprenorphine or methadone is given at registered centres under NDPS rules.
• Organic disorders: delirium — acute, fluctuating, clouded consciousness, reversible, treat the cause; dementia — chronic, progressive, clear consciousness, memory first. Nursing for dementia overlaps with the geriatric note: here focus on orientation cues, routine, safety and caregiver support.
• Child and adolescent problems (ADHD, autism spectrum, conduct disorder, enuresis, learning disorder) and intellectual disability are examined here as psychiatric conditions; developmental care is covered in the child health note.
• Psychiatric emergencies: suicide attempt, violence, delirium tremens, stupor, neuroleptic malignant syndrome, serotonin syndrome, lithium toxicity, severe extrapyramidal reaction, acute drug overdose, rape/trauma crisis.

Psychopharmacology, ECT and physical treatments

• Typical antipsychotics (haloperidol, chlorpromazine, fluphenazine depot): block D2 receptors; high risk of extrapyramidal side effects — acute dystonia (hours-days, treat with promethazine/trihexyphenidyl), akathisia (restlessness), parkinsonism, tardive dyskinesia (late, may be irreversible). Watch for neuroleptic malignant syndrome: fever, lead-pipe rigidity, altered sensorium, autonomic instability, raised CPK — stop the drug, cool, hydrate, inform doctor immediately.
• Atypical antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole, clozapine): fewer EPS, more metabolic effects — weight, lipids, glucose. Clozapine is for treatment-resistant schizophrenia and needs regular leucocyte counts because of agranulocytosis; report fever or sore throat at once; also causes sialorrhoea, sedation, seizures at high dose, myocarditis.
• Antidepressants: SSRIs (fluoxetine, sertraline, escitalopram) — nausea, insomnia, sexual dysfunction, hyponatraemia, risk of serotonin syndrome if combined with other serotonergic drugs; TCAs (imipramine, amitriptyline) — anticholinergic effects, postural hypotension, cardiotoxic in overdose; SNRIs (venlafaxine, duloxetine); MAOIs — tyramine-free diet (no cheese, red wine, fermented or aged foods) to avoid hypertensive crisis. Therapeutic effect takes 2-4 weeks (up to 6); the patient must be told, or they will stop early.
• Mood stabilisers: lithium — narrow therapeutic index, serum level about 0.6-1.2 mEq/L for maintenance (laboratory ranges vary slightly; follow the local lab and prescriber). Sample 12 hours after the last dose. Early toxicity: coarse tremor, vomiting, diarrhoea, ataxia, slurred speech, drowsiness; later: convulsions, coma. Maintain normal salt and 2.5-3 litres fluid daily, avoid dehydration, NSAIDs, thiazides and low-salt diets; monitor thyroid and renal function. Also sodium valproate (avoid in women of childbearing potential — teratogenic), carbamazepine (rash, leucopenia, hyponatraemia), lamotrigine (rash/SJS).
• Anxiolytics and hypnotics: benzodiazepines (lorazepam, diazepam, clonazepam) — short courses only, dependence and withdrawal seizures, respiratory depression with alcohol; antidote flumazenil. Buspirone is non-dependence-forming.
• Anti-dementia: donepezil, rivastigmine, galantamine (cholinesterase inhibitors), memantine.
• ECT: modified ECT under general anaesthesia with a muscle relaxant is mandatory in India (MHCA s.95). Indications: severe depression with suicidal risk or refusal to eat, catatonia, treatment-resistant schizophrenia, severe mania, puerperal psychosis. Nursing: informed written consent; nil by mouth 6-8 hours; remove dentures, jewellery, metal, nail polish; empty bladder; stop and record pre-ECT vitals and investigations; atropine as prescribed; during — airway, mouth gag, support limbs without forcing; after — lateral/recovery position, airway and vitals until fully awake, orient repeatedly for transient confusion and memory loss, do not leave alone, document seizure duration. Common course 6-12 sittings, usually 2-3 a week.
• Restraint and seclusion: last resort, only on a written order with reason, type and duration, after de-escalation has failed; never for staff convenience or as punishment. Nursing: least restrictive method, limbs in anatomical position, circulation and skin check every 15-30 minutes, release one limb at a time for exercise, offer food, fluid and toilet, continuous observation, documentation and debriefing; MHCA prohibits chaining absolutely.

Community mental health, rehabilitation and the nurse's roles

• Levels of prevention: primary — mental health promotion, life-skills education, stress management, premarital and genetic counselling, de-stigmatisation; secondary — early case finding, screening at PHC level, crisis intervention, prompt treatment; tertiary — rehabilitation, prevention of relapse and disability, vocational training.
• Rehabilitation: day care centres, halfway homes, sheltered workshops, supported employment, family-based care, self-help and user groups, disability certification and benefits under the RPwD Act, 2016.
• Nurse's roles: care provider, counsellor, educator, advocate (consent, confidentiality, dignity), case manager, milieu manager, member of the multidisciplinary team (psychiatrist, clinical psychologist, psychiatric social worker, occupational therapist), researcher.
• Ethical and legal duties: informed consent, confidentiality with its lawful exceptions (danger to self or others, court order, POCSO/JJ reporting), documentation, duty of care, vicarious liability, professional boundaries, no dual relationships, Indian Nursing Council code of ethics and professional conduct.
• Stigma is the biggest barrier to care in India — families delay, use faith healing first, and conceal illness; nursing work includes psychoeducation, home visits and follow-up by phone or tele-consultation.
• Nurse's own mental health: supervision, reflective practice, management of counter-transference, burnout and compassion fatigue.

Key points

• Mental illness (MHCA 2017) - substantial disorder of thinking, mood, perception, orientation or memory grossly impairing judgement or behaviour; excludes intellectual disability.
• Presumption of capacity - every person is assumed able to decide about their treatment unless assessed otherwise.
• Advance directive and nominated representative - two MHCA instruments letting a person control care when capacity is lost.
• Section 115 MHCA - attempted suicide is not a crime; the person gets care and rehabilitation.
• Section 95 MHCA - unmodified ECT banned; ECT for minors only with guardian consent and Review Board approval; chaining banned.
• Supported admission - time-limited admission of a person lacking capacity with risk, reviewed by the Mental Health Review Board.
• Peplau's phases - pre-interaction, orientation, working, termination; the relationship itself is the therapeutic tool.
• MSE order - appearance/behaviour, speech, mood and affect, thought, perception, cognition, insight and judgement.
• Hallucination vs illusion vs delusion - perception without stimulus; misinterpreted real stimulus; fixed false belief.
• Positive vs negative symptoms - delusions and hallucinations respond well to drugs; avolition and flat affect respond poorly.
• Never argue with a delusion - voice doubt, present reality, focus on the underlying feeling.
• Mania nursing - low stimulus, firm limits, finger foods, non-competitive activity, protect sleep.
• Depression's danger window - suicide risk rises when energy returns before mood lifts.
• Ask directly about suicide - direct enquiry reduces risk; it never implants the idea.
• Lithium - narrow index, 12-hour post-dose sampling, steady salt and fluids, watch tremor, vomiting, ataxia.
• Clozapine - agranulocytosis; any fever or sore throat is reported the same day; regular blood counts.
• NMS - fever, rigidity, altered sensorium, raised CPK; stop the antipsychotic and treat as an emergency.
• Thiamine before glucose in alcohol withdrawal, to prevent Wernicke's encephalopathy.
• Restraint - written order, least restrictive, 15-30 minute checks, documented, never punitive; chaining illegal.
• DMHP and Tele-MANAS (14416) - the delivery arms of the National Mental Health Programme at district and helpline level.

Formulas and examples

Mental health nursing is largely non-numerical, but these scored tools and dose calculations are examined.

• Example 1 - CIWA-Ar decision. A 42-year-old man, last drink 30 hours ago, scores: tremor 4, sweating 3, anxiety 3, agitation 2, nausea 2, headache 2, tactile 1, auditory 1, visual 1, orientation 1 = 20. A score above 15 means severe withdrawal with high seizure risk → inform the doctor at once, expect a loading benzodiazepine regimen, 1-2 hourly reassessment, parenteral thiamine before any dextrose, quiet lit room, seizure precautions.
• Example 2 - lithium monitoring. Last dose 9 pm Monday; the correct sample time is 9 am Tuesday (12 h later). Reported level 1.8 mEq/L with coarse tremor, vomiting and unsteady gait. Interpretation: above the 1.5 mEq/L toxicity threshold → withhold the next dose, inform the doctor immediately, maintain hydration and salt, monitor neurological status and urine output, check whether the patient began a low-salt diet or an NSAID (both raise lithium).
• Example 3 - antipsychotic metabolic monitoring. A patient on olanzapine weighed 62 kg at 1.65 m on admission; after 12 weeks he weighs 71 kg.
  • Baseline BMI = 62 / (1.65²) = 62 / 2.7225 = 22.8 kg/m² (normal by Asian cut-offs).
  • Now BMI = 71 / 2.7225 = 26.1 kg/m² (obese by Asian cut-offs); gain = 9 kg, i.e. 14.5% of baseline weight.
  • Action: a gain above 7% is clinically significant → report for review of drug choice, check fasting glucose and lipids, diet and 30-minute daily activity plan, weekly weight chart.
• Example 4 - treatment gap. In a district of 1,20,000 adults, a 10.6% current prevalence predicts 12,720 adults with a mental disorder; the DMHP clinic has 1,850 on its register. Treatment gap = (12,720 − 1,850) / 12,720 × 100 = 85.5%. Nursing implication: case finding through ASHAs and PHC screening, not more OPD slots alone.
• Example 5 - antidepressant counselling. Sertraline 50 mg once daily started on day 0; the patient returns on day 10 saying "no benefit, I am stopping". Correct response: SSRIs act over 2-4 weeks (up to 6 for full response), early side effects usually settle, abrupt stopping causes discontinuation symptoms, and the plan continues 6-12 months after remission in a first episode; reassess suicidal ideas, since risk can persist while mood is still low.

Where it is used

• Psychiatric hospitals and institutes: NIMHANS Bengaluru, CIP Ranchi, IHBAS Delhi, LGBRIMH Tezpur, state mental health hospitals and medical college psychiatry wards — staff nurse, ward in-charge, ECT suite nurse, nursing officer (NORCET/AIIMS, PGIMER, JIPMER, ESIC, RRB recruitments).
• District Mental Health Programme and primary care: DMHP staff nurse/community nurse running satellite clinics, follow-up and drug adherence with ASHAs and ANMs at PHC/CHC and Ayushman Arogya Mandir level.
• De-addiction and rehabilitation: government and NGO de-addiction centres, opioid substitution therapy clinics under NDPS rules, halfway homes, sheltered workshops, Alcoholics Anonymous liaison.
• Tele-mental health and helplines: Tele-MANAS counsellors and nurses, hospital crisis lines, corporate employee assistance programmes, insurer-run tele-triage.
• Schools, colleges and industry: school health and counselling roles, college wellness cells, occupational health nursing for stress, shift work and substance use, disaster and crisis response teams.
• Specialist and non-clinical routes: liaison psychiatry in general hospitals (ICU delirium, post-partum psychosis, self-harm), clinical research coordinator in psychopharmacology trials, nursing tutor for the mental health nursing paper, forensic psychiatric settings and prison health.

Interview questions

• Q: How will you respond to a patient who says the staff are poisoning his food? A: Do not argue or agree; acknowledge that the fear feels real, state reality simply, and let him choose sealed or self-served food while monitoring his intake and weight.
• Q: What is the difference between mood and affect? A: Mood is the patient's sustained, reported emotional state; affect is the emotional expression the nurse observes, graded by range, reactivity and congruence with mood.
• Q: Does asking about suicide increase the risk? A: No — direct, calm enquiry about ideas, plan and means lowers risk and is the only reliable way to assess lethality.
• Q: What nursing care does a patient receive before modified ECT? A: Written informed consent, nil by mouth 6-8 hours, removal of dentures, jewellery, metal and nail polish, bladder emptied, baseline vitals and investigations checked, pre-medication as prescribed, and the patient and family reassured about transient confusion and memory loss.
• Q: Why is unmodified ECT not allowed in India? A: Section 95 of the Mental Healthcare Act, 2017 requires anaesthesia and a muscle relaxant; without them there is fracture, dislocation and aspiration risk.
• Q: A patient on clozapine reports fever and sore throat. What do you do? A: Treat it as possible agranulocytosis — inform the doctor the same day, send an urgent leucocyte and neutrophil count, monitor temperature, and withhold the dose only on medical instruction.
• Q: How do you nurse a patient in acute mania who will not sit down to eat? A: Offer high-calorie finger foods and fluids he can carry, reduce stimuli, set firm consistent limits, channel energy into non-competitive activity, and chart intake, sleep and weight.
• Q: What is the earliest sign of lithium toxicity and what will you check? A: Coarse tremor with vomiting, diarrhoea and unsteady gait; withhold the dose, inform the doctor, send a serum level timed 12 hours post-dose, and look for dehydration, a low-salt diet, NSAIDs or diuretics.
• Q: When may a patient be restrained? A: Only after de-escalation fails, on a written order stating reason, method and duration, using the least restrictive means, with 15-30 minute circulation and skin checks and full documentation; chaining is prohibited outright.
• Q: What is an advance directive under the MHCA, 2017? A: A written statement of how a person wishes to be treated, or not treated, for mental illness if they later lose capacity, along with the nominated representative who will act for them.
• Q: Differentiate delusion, hallucination and illusion with one example each. A: A delusion is a fixed false belief (being followed by police); a hallucination is a perception with no stimulus (hearing voices in an empty room); an illusion is a misinterpreted real stimulus (a rope seen as a snake).
• Q: Why must thiamine be given before glucose in alcohol withdrawal? A: Glucose load in a thiamine-deficient patient can precipitate Wernicke's encephalopathy, which may progress to irreversible Korsakoff's psychosis.
• Q: What will you teach a family about expressed emotion? A: High criticism, hostility and emotional over-involvement predict relapse in schizophrenia; teach calm, non-critical communication, realistic expectations and shared supervision of medication.

Common mistakes

• Writing interpretations instead of observations in records ("patient was aggressive" rather than the words, actions and trigger).
• Giving false reassurance, advice or "why" questions and calling it therapeutic communication.
• Arguing with or, worse, going along with a delusion or hallucination instead of voicing doubt and presenting reality.
• Dropping suicide precautions when a depressed patient "looks better" — the risk period is when energy returns first.
• Confusing EPS, tardive dyskinesia, NMS and serotonin syndrome, or missing rigidity with fever as an emergency.
• Taking a lithium sample at the wrong time, or forgetting that dehydration, low salt, NSAIDs and thiazides raise the level.
• Quoting the Indian Lunacy Act or Mental Health Act, 1987 — both superseded by the Mental Healthcare Act, 2017 — or calling attempted suicide an offence.
• Using restraint or seclusion for convenience, without a written order, timed checks and documentation.
• Promising a suicidal patient that a disclosure will be kept secret from the team.

Related topics

Psychology and sociology for nurses · Pharmacology of psychotropic drugs · Geriatric nursing (dementia and delirium) · Community health nursing and national health programmes · Nursing ethics, law and the Mental Healthcare Act, 2017 · Child health nursing (developmental and behavioural disorders)