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

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