NCLEX Review Guide: Mental Health & Mood Disorders

Mental Health Fundamentals

• Mental health encompasses emotional, psychological, and social well-being, affecting how individuals think, feel, and behave in daily life.
• Mental health problems exist on a continuum from mild distress to severe psychiatric disorders requiring intensive intervention.
• Therapeutic communication is the foundation of all psychiatric nursing interventions and patient relationships.

Major Depressive Disorder (MDD)

• MDD requires at least 5 symptoms present for 2+ weeks, including depressed mood or loss of interest/pleasure (anhedonia).
• Classic symptoms include: sleep disturbances, appetite changes, fatigue, guilt, concentration problems, psychomotor changes, and suicidal ideation.
• Highest suicide risk occurs when depression begins to lift and energy returns - monitor closely during early treatment.

Bipolar Disorder

• Bipolar I requires at least one manic episode lasting 7+ days (or hospitalization), while Bipolar II involves hypomanic episodes with major depression.
• Manic episodes feature elevated/irritable mood with 3+ symptoms: grandiosity, decreased sleep need, pressured speech, racing thoughts, distractibility, increased activity, poor judgment.
• Treatment focuses on mood stabilizers (lithium, anticonvulsants) with careful monitoring of therapeutic levels and side effects.

Therapeutic Communication Techniques

1. Use open-ended questions to encourage expression: "Tell me more about how you're feeling."
2. Practice active listening with reflection: "It sounds like you're feeling overwhelmed."
3. Avoid giving advice, false reassurance, or asking "why" questions that can seem judgmental.
4. Maintain professional boundaries while showing genuine concern and empathy.

Safety Interventions

• Suicide assessment is priority - ask directly about suicidal thoughts, plans, and means.
• Implement safety precautions: remove harmful objects, provide constant observation if indicated, create safety contracts.
• For manic patients: provide calm environment, set limits on behavior, ensure adequate nutrition and rest.

Antidepressants

• SSRIs (fluoxetine, sertraline) are first-line treatment with fewer side effects than older antidepressants.
• Black box warning: Increased suicide risk in patients under 25 during first 2 months of treatment.
• Therapeutic effects take 2-6 weeks; educate patients about delayed onset and importance of compliance.

Mood Stabilizers

• Lithium requires regular monitoring: therapeutic level 0.6-1.2 mEq/L, with toxicity risk above 1.5 mEq/L.
• Monitor for lithium toxicity signs: nausea, vomiting, diarrhea, tremors, confusion, seizures.
• Anticonvulsants (valproic acid, carbamazepine) used as alternatives with hepatic and hematologic monitoring required.

Commonly Confused Concepts

• Bipolar I vs II: Bipolar I has full manic episodes; Bipolar II has hypomanic episodes with major depression.
• Therapeutic vs. Non-therapeutic communication: Avoid "why" questions, giving advice, or false reassurance.
• Depression timing: Highest suicide risk is when depression begins to improve, not at the worst point.

Self-Assessment Checklist

• ☐ Can identify 5+ symptoms of major depression
• ☐ Understand difference between mania and hypomania
• ☐ Know therapeutic communication techniques
• ☐ Understand suicide risk assessment
• ☐ Know lithium therapeutic levels and toxicity signs
• ☐ Understand antidepressant black box warning