Inspection and tests
Doctors and nurses first find out what is happening. Tests and examinations include: an interview about thoughts, mood and daily life; mental state examination (appearance, speech, mood, thinking, hearing or seeing things that are not there, and insight, which is how well the person understands the illness); a body check; blood tests; and sometimes scans of the brain and psychological tests.
Nursing: explain each test in simple words, ask permission, ease fear, keep privacy, observe behaviour, sleep, food and mood, and write exactly what is seen and heard, not guesses.
Treatment
Treatment usually combines several parts: medicines (such as antipsychotics, antidepressants, mood stabilisers and anti-anxiety drugs), talking therapies (such as cognitive behaviour therapy), activity and occupational therapy, group work, and in some severe cases a treatment given by doctors under anaesthesia called ECT. Physical care and family work go alongside.
Nursing: give medicine on time and check it is swallowed, watch for side effects (sleepiness, stiffness, weight gain, dry mouth), teach the person why the medicine matters, never stop it suddenly without the doctor, support therapy sessions and encourage small daily activities.
Acute phase
In the acute phase symptoms are strongest, such as strong fear, false beliefs, very high or very low mood, or confusion. The person may not sleep, eat or care for self and may be at risk of harming self or others.
Nursing aims: keep everyone safe (watch closely, remove risky objects, ask about thoughts of self-harm), reduce stimulation (quiet, simple room, few people), ensure rest, food and water, use calm de-escalation (slow voice, short sentences, open posture, personal space, no arguing with false beliefs), use the least restriction possible and follow the law on consent and rights. Medicines often begin now.
Chronic phase
In the chronic phase the illness is steadier but may last years, with some symptoms or low energy remaining. The aim moves from safety to recovery and living well.
Nursing aims: rehabilitation (daily living skills, routine, money handling, social skills, work or study), help to keep taking medicine and manage side effects, healthy habits (sleep, food, exercise, no substances), family education and support, links to community services, and relapse prevention: teach the person and family the early warning signs (poor sleep, withdrawal, odd thoughts) and what to do. Respect choices and build hope.
Key formulas and definitions
- Four blocks: tests, treatment, acute phase, chronic phase
- Acute aim: safety, calm, rest, food
- Chronic aim: skills, medicine habit, family support, relapse prevention
- De-escalation: slow voice, short words, space, no arguing with false beliefs
Worked examples
1. A person is very agitated and believes someone is chasing him. Which phase is this likely to be and what should the nurse do first?
Acute phase. Keep him and others safe, move to a quiet place, speak slowly and calmly, do not argue with his belief, stay near but give space, and call the doctor.
2. A woman on a mood-stabilising medicine says she wants to stop it because her hands shake and she feels well. What does the nurse do?
Listen, explain why the medicine keeps her well, say that stopping suddenly can bring the illness back, report the shaking to the doctor so the plan can change, and encourage her to keep taking it until the doctor decides.
3. In the chronic phase, a young man sleeps only 3 hours for two nights and avoids family. What should be done?
These can be early signs of relapse. The nurse or family should note them, talk calmly, contact the care team quickly and follow the relapse plan that was made earlier.
Common mistakes
- Arguing with a person about a false belief. Stay calm and focus on feelings and safety.
- Stopping psychiatric medicine because the person feels better. It can bring the illness back.
- Leaving a person in a loud, busy place during the acute phase.
- Forgetting family. In the chronic phase their teaching and support matter most.