NCLEX Review: Mental Health Disorders Anxiety Disorders Generalized Anxiety Disorder (GAD) Excessive worry lasting 6 months or more Symptoms: Restlessness Muscle tension Fatigue Poor concentration Sleep disturbance Panic Disorder Sudden intense fear with: Chest pain Palpitations Shortness of breath Feeling of doom Nursing: Stay with client Calm environment Short/simple communication Phobias Irrational fear of object/situation Treatment: Exposure therapy CBT SSRIs sometimes used OCD (Obsessive-Compulsive Disorder) Obsessions = intrusive thoughts Compulsions = repetitive behaviors to reduce anxiety Nursing: Do not suddenly stop rituals Set limits gradually Encourage coping skills PTSD Triggered after traumatic event Symptoms: Flashbacks Hypervigilance Nightmares Avoidance Priority: Safety Trauma-informed care Depression Disorders Major Depressive Disorder Symptoms SIGECAPS: Sleep changes Interest loss Guilt Energy low Concentration poor Appetite changes Psychomotor changes Suicidal thoughts Nursing Priorities Suicide assessment Nutrition/hydration Sleep/rest Medication adherence Medications SSRIs Examples: Sertraline Fluoxetine Teachings: Takes weeks to work Do not stop abruptly Watch for serotonin syndrome Serotonin Syndrome Symptoms: Agitation Fever Tremor Hyperreflexia Diarrhea Bipolar Disorder Mania Symptoms Mnemonic: DIG FAST Distractibility Indiscretion Grandiosity Flight of ideas Activity increased Sleep deficit Talkative Nursing Care Reduce stimulation Set firm limits High-calorie finger foods Encourage rest Medications Mood Stabilizers Lithium Anticonvulsants Lithium Toxicity Therapeutic level: 0.6–1.2 mEq/L Toxic signs: Tremor Vomiting Confusion Ataxia Severe diarrhea Important: Maintain sodium/fluid intake Dehydration increases toxicity risk Schizophrenia Spectrum Disorders Positive Symptoms Things added: Hallucinations Delusions Paranoia Disorganized speech Negative Symptoms Things lost: Flat affect Social withdrawal Anhedonia Lack of motivation Hallucination Nursing Response Present reality “I do not hear the voices.” Assess for command hallucinations Delusions Do NOT argue. Respond: “I understand this feels real to you.” Antipsychotics First Generation Haloperidol Risk: EPS Tardive dyskinesia Neuroleptic malignant syndrome (NMS) Second Generation Olanzapine Risperidone Risk: Weight gain Diabetes Metabolic syndrome EPS Symptoms Acute dystonia Akathisia Parkinsonism Tardive dyskinesia Treatment: Benztropine Diphenhydramine Neuroleptic Malignant Syndrome Medical emergency: Fever Rigidity Confusion Elevated CK Personality Disorders Cluster A Odd/eccentric Paranoid Schizoid Schizotypal Cluster B Dramatic/emotional Antisocial Borderline Histrionic Narcissistic Borderline Personality Disorder Fear of abandonment Splitting staff Self-harm risk Nursing: Consistent boundaries Team communication Cluster C Anxious/fearful Avoidant Dependent Obsessive-compulsive personality disorder Eating Disorders Anorexia Nervosa Severe restriction Distorted body image Bradycardia Electrolyte imbalance Priority: Monitor cardiac status Daily weights Observe after meals Bulimia Nervosa Binge/purge behavior Normal weight often seen Complications: Hypokalemia Dental erosion Substance Use Disorders Alcohol Withdrawal Starts within hours after last drink

NCLEX Review: Mental Health DisordersAnxiety Disorders

Generalized Anxiety Disorder (GAD)

  • Excessive worry lasting 6 months or more

  • Symptoms:

    • Restlessness

    • Muscle tension

    • Fatigue

    • Poor concentration

    • Sleep disturbance

Panic Disorder

  • Sudden intense fear with:

    • Chest pain

    • Palpitations

    • Shortness of breath

    • Feeling of doom

  • Nursing:

    • Stay with client

    • Calm environment

    • Short/simple communication

Phobias

  • Irrational fear of object/situation

  • Treatment:

    • Exposure therapy

    • CBT

    • SSRIs sometimes used

OCD (Obsessive-Compulsive Disorder)

  • Obsessions = intrusive thoughts

  • Compulsions = repetitive behaviors to reduce anxiety

  • Nursing:

    • Do not suddenly stop rituals

    • Set limits gradually

    • Encourage coping skills

PTSD

  • Triggered after traumatic event

  • Symptoms:

    • Flashbacks

    • Hypervigilance

    • Nightmares

    • Avoidance

  • Priority:

    • Safety

    • Trauma-informed care

Depression DisordersMajor Depressive DisorderSymptoms

  • SIGECAPS:

    • Sleep changes

    • Interest loss

    • Guilt

    • Energy low

    • Concentration poor

    • Appetite changes

    • Psychomotor changes

    • Suicidal thoughts

Nursing Priorities

  1. Suicide assessment

  2. Nutrition/hydration

  3. Sleep/rest

  4. Medication adherence

MedicationsSSRIs

Examples:

  • Sertraline

  • Fluoxetine

Teachings:

  • Takes weeks to work

  • Do not stop abruptly

  • Watch for serotonin syndrome

Serotonin Syndrome

Symptoms:

  • Agitation

  • Fever

  • Tremor

  • Hyperreflexia

  • Diarrhea

Bipolar DisorderMania Symptoms

Mnemonic: DIG FAST

  • Distractibility

  • Indiscretion

  • Grandiosity

  • Flight of ideas

  • Activity increased

  • Sleep deficit

  • Talkative

Nursing Care

  • Reduce stimulation

  • Set firm limits

  • High-calorie finger foods

  • Encourage rest

MedicationsMood Stabilizers

  • Lithium

  • Anticonvulsants

Lithium Toxicity

Therapeutic level:
0.6–1.2 mEq/L0.6–1.2 mEq/L

Toxic signs:

  • Tremor

  • Vomiting

  • Confusion

  • Ataxia

  • Severe diarrhea

Important:

  • Maintain sodium/fluid intake

  • Dehydration increases toxicity risk

Schizophrenia Spectrum DisordersPositive Symptoms

Things added:

  • Hallucinations

  • Delusions

  • Paranoia

  • Disorganized speech

Negative Symptoms

Things lost:

  • Flat affect

  • Social withdrawal

  • Anhedonia

  • Lack of motivation

Hallucination Nursing Response

  • Present reality

  • “I do not hear the voices.”

  • Assess for command hallucinations

Delusions

Do NOT argue.
Respond:

  • “I understand this feels real to you.”

AntipsychoticsFirst Generation

  • Haloperidol

Risk:

  • EPS

  • Tardive dyskinesia

  • Neuroleptic malignant syndrome (NMS)

Second Generation

  • Olanzapine

  • Risperidone

Risk:

  • Weight gain

  • Diabetes

  • Metabolic syndrome

EPS Symptoms

  • Acute dystonia

  • Akathisia

  • Parkinsonism

  • Tardive dyskinesia

Treatment:

  • Benztropine

  • Diphenhydramine

Neuroleptic Malignant Syndrome

Medical emergency:

  • Fever

  • Rigidity

  • Confusion

  • Elevated CK

Personality DisordersCluster A

Odd/eccentric

  • Paranoid

  • Schizoid

  • Schizotypal

Cluster B

Dramatic/emotional

  • Antisocial

  • Borderline

  • Histrionic

  • Narcissistic

Borderline Personality Disorder

  • Fear of abandonment

  • Splitting staff

  • Self-harm risk

Nursing:

  • Consistent boundaries

  • Team communication

Cluster C

Anxious/fearful

  • Avoidant

  • Dependent

  • Obsessive-compulsive personality disorder

Eating DisordersAnorexia Nervosa

  • Severe restriction

  • Distorted body image

  • Bradycardia

  • Electrolyte imbalance

Priority:

  • Monitor cardiac status

  • Daily weights

  • Observe after meals

Bulimia Nervosa

  • Binge/purge behavior

  • Normal weight often seen

Complications:

  • Hypokalemia

  • Dental erosion

Substance Use DisordersAlcohol Withdrawal

Starts within hours after last drink.

Symptoms:

  • Tremors

  • Anxiety

  • Tachycardia

  • Seizures

  • Delirium tremens

Treatment:

  • Benzodiazepines

  • Thiamine

  • Safety precautions

Opioid Overdose

Signs:

  • Respiratory depression

  • Pinpoint pupils

Antidote:

  • Naloxone

Suicide PrecautionsHighest Risk Clients

  • Prior attempts

  • Specific plan

  • Means available

  • Hopelessness

Nursing Priorities

  1. Safety first

  2. Direct suicide questions

  3. One-to-one observation if needed

  4. Remove dangerous objects

Do NOT:

  • Promise secrecy

  • Leave high-risk client alone

Therapeutic CommunicationBest Responses

  • Open-ended questions

  • Reflection

  • Silence

  • Clarification

Avoid

  • Giving advice

  • “Why” questions

  • False reassurance

  • Changing subject