Therapies, crisis care, and self-care
Mental health treatment includes talking therapies, medications, and crisis interventions. Caring for others also requires nurses to care for themselves. For study only, not clinical guidance: always follow your programme, current local protocols, and supervising clinicians.
Psychotherapies
Cognitive behavioural therapy (CBT) helps people identify and change unhelpful thoughts and behaviours; it has strong evidence for depression and anxiety. Dialectical behaviour therapy (DBT) teaches emotion regulation and distress tolerance, originally for borderline personality disorder. Other approaches include interpersonal therapy and family therapy.
Psychiatric medications
Antidepressants (such as SSRIs) take several weeks to work; nurses monitor for early side effects and, especially in young people, for increased suicidal thinking when starting. Antipsychotics treat psychosis; second-generation drugs can cause weight gain and metabolic problems, while some cause movement disorders. Mood stabilisers such as lithium require blood level monitoring.
Neuroleptic malignant syndrome
Neuroleptic malignant syndrome is a rare but life-threatening reaction to antipsychotics, with high fever, severe muscle rigidity, confusion, and unstable vital signs. It is a medical emergency: the drug is stopped and supportive care given. Serotonin syndrome, from excess serotonergic drugs, causes agitation, fever, sweating, and muscle twitching.
Crisis intervention
A crisis occurs when a person's usual coping fails. Crisis intervention focuses on immediate safety, calm support, clarifying the problem, mobilising coping and support, and planning next steps. In the US, the 988 Suicide and Crisis Lifeline, launched in 2022, can be reached by call or text.
De-escalation
For agitated patients, de-escalation uses a calm voice, respect, active listening, offering choices, and giving space while maintaining safety, standing at an angle near an exit rather than blocking one. It aims to resolve situations without restraint or seclusion, which carry physical and psychological risks.
Electroconvulsive therapy
Electroconvulsive therapy (ECT) is given under general anaesthesia with muscle relaxants and is effective for severe depression, especially when other treatments have failed or rapid response is needed. Common side effects include temporary memory problems and headache. Nurses prepare patients and monitor recovery.
Nurse self-care and burnout
Mental health work can be emotionally demanding. Burnout involves exhaustion, cynicism, and reduced effectiveness; compassion fatigue arises from repeated exposure to others' suffering. Protective factors include supervision, peer support, boundaries, rest, and organisational support. Nurses who look after themselves give safer care.
Worked example
A patient becomes loud and angry, pacing near the nurses' station. The nurse approaches calmly, keeps a safe distance with a clear exit, uses the patient's name, lowers her voice, acknowledges his frustration, and offers choices: 'Would you like to talk in the quiet room or have some water first?' The patient calms down, and no restraint is needed.
Key takeaways
CBT and DBT are evidence-based therapies. Antidepressants take weeks and need monitoring for suicidal thoughts when starting; antipsychotics need metabolic and movement monitoring; lithium needs levels. Neuroleptic malignant and serotonin syndromes are emergencies. Crisis intervention prioritises safety and coping; 988 provides crisis support in the US. De-escalation avoids restraint. ECT helps severe depression. Nurse self-care prevents burnout.
Flashcard
Changes unhelpful thoughts and behaviours
Check your understanding
A patient on an antipsychotic develops a high fever, rigid muscles, and confusion. What should the nurse suspect?