Key Takeaways
- Anxiety disorders involve excessive worry or fear that interferes with daily functioning
- Depression is characterized by persistent sadness, loss of interest, and may include suicidal ideation
- All patients expressing suicidal thoughts should be taken seriously and reported immediately
- Substance use disorders are medical conditions that require treatment, not moral failings
- The LPN/LVN observes for mental health symptoms and reports to the supervising RN
Last updated: January 2026
Mental Health Concepts
Mental health affects every aspect of a person's life. The LPN/LVN must recognize common mental health conditions, provide supportive care, and ensure patient safety.
Anxiety Disorders
Types of Anxiety Disorders:
| Disorder | Characteristics |
|---|---|
| Generalized Anxiety | Excessive worry about many things, most days |
| Panic Disorder | Sudden episodes of intense fear with physical symptoms |
| Social Anxiety | Fear of social situations, judgment by others |
| Phobias | Intense fear of specific object or situation |
| PTSD | Re-experiencing trauma, avoidance, hyperarousal |
| OCD | Obsessive thoughts, compulsive behaviors |
Signs and Symptoms of Anxiety:
| Physical | Psychological |
|---|---|
| Tachycardia | Worry, dread |
| Diaphoresis | Restlessness |
| Shortness of breath | Difficulty concentrating |
| Trembling | Irritability |
| GI disturbances | Sense of impending doom |
| Muscle tension | Sleep disturbance |
Nursing Interventions:
- Remain calm and present
- Use simple, clear communication
- Reduce environmental stimuli
- Teach and encourage relaxation techniques
- Provide reassurance without being dismissive
- Report severe anxiety to RN
Depression
Signs and Symptoms:
| Category | Manifestations |
|---|---|
| Mood | Sadness, hopelessness, emptiness |
| Interest | Loss of pleasure in activities (anhedonia) |
| Sleep | Insomnia or hypersomnia |
| Energy | Fatigue, lack of motivation |
| Appetite | Increased or decreased, weight changes |
| Concentration | Difficulty thinking, making decisions |
| Psychomotor | Agitation or slowing |
| Worth | Guilt, worthlessness |
| Death | Thoughts of death, suicidal ideation |
Risk Factors for Depression:
- Personal or family history
- Chronic illness
- Major life changes/losses
- Certain medications
- Substance use
- Social isolation
- Trauma history
Nursing Interventions:
- Build therapeutic relationship
- Listen without judgment
- Encourage activity as tolerated
- Ensure safety
- Monitor for suicidal ideation
- Report symptoms to RN
Suicide Assessment
Warning Signs:
- Talking about wanting to die
- Seeking means (weapons, medications)
- Hopelessness
- Feeling trapped or in unbearable pain
- Social withdrawal
- Giving away possessions
- Saying goodbye
- Increased substance use
- Mood changes, especially sudden calm after depression
Risk Factors:
- Previous suicide attempt
- Mental health disorder
- Substance abuse
- Chronic illness
- Recent loss
- Social isolation
- Access to lethal means
- Family history of suicide
Nursing Response to Suicidal Statements:
| Do | Don't |
|---|---|
| Take all statements seriously | Dismiss or minimize |
| Ask directly about suicidal thoughts | Avoid the topic |
| Stay with the patient | Leave patient alone |
| Notify RN and provider immediately | Promise to keep it secret |
| Remove potentially harmful items | Assume patient is just seeking attention |
| Document accurately | Ignore because patient "seems fine" |
Asking About Suicide:
- "Are you thinking about hurting yourself?"
- "Do you have thoughts of suicide?"
- "Do you have a plan?"
- "Do you have access to means?"
Substance Use Disorders
Substances of Abuse:
- Alcohol
- Opioids
- Stimulants (cocaine, methamphetamine)
- Sedatives (benzodiazepines, barbiturates)
- Cannabis
- Hallucinogens
- Tobacco/nicotine
Signs of Substance Use Disorder:
- Loss of control over use
- Continued use despite consequences
- Tolerance (needing more for same effect)
- Withdrawal symptoms when stopping
- Neglecting responsibilities
- Social/interpersonal problems
- Cravings
Withdrawal Syndromes:
| Substance | Withdrawal Signs | Concern |
|---|---|---|
| Alcohol | Tremor, anxiety, seizures, delirium tremens | Can be life-threatening |
| Opioids | Muscle aches, GI upset, anxiety | Uncomfortable but rarely fatal |
| Benzodiazepines | Anxiety, tremor, seizures | Can be life-threatening |
| Stimulants | Fatigue, depression, increased appetite | Not typically dangerous |
Nursing Approach:
- Treat as medical condition, not moral failing
- Non-judgmental attitude
- Assess for withdrawal
- Monitor vital signs
- Report signs of withdrawal to RN
- Provide safety measures
- Refer to treatment resources
Delirium vs. Dementia
| Feature | Delirium | Dementia |
|---|---|---|
| Onset | Sudden (hours to days) | Gradual (months to years) |
| Duration | Temporary, reversible | Progressive, chronic |
| Consciousness | Altered, fluctuating | Clear until late stages |
| Attention | Severely impaired | Relatively preserved |
| Cause | Medical illness, medication | Brain disease |
| Reversibility | Usually reversible | Generally not reversible |
Delirium Triggers (Think DELIRIUM):
- D - Drugs/alcohol
- E - Electrolyte imbalances
- L - Lack of oxygen
- I - Infection
- R - Retention (urine/stool)
- I - Intracranial events
- U - Undernutrition
- M - Metabolic disturbances
Nursing Safety Measures
For patients with mental health concerns:
- Environmental safety (remove harmful items)
- One-to-one observation when needed
- Frequent check-ins
- Documentation of status and behaviors
- Communication with team
- Support for family
On the NCLEX-PN
Expect questions about:
- Recognizing signs of anxiety and depression
- Responding to suicidal statements
- Differentiating delirium from dementia
- Substance use disorders and withdrawal
Test Your Knowledge
A patient on a medical unit tells the LPN, "I just don't want to be here anymore. I wish I could fall asleep and never wake up." What should the LPN do FIRST?
A
B
C
D
Test Your Knowledge
An elderly patient who was alert this morning is now confused, agitated, and unable to focus on the LPN's questions. This presentation is most consistent with:
A
B
C
D
Test Your Knowledge
When caring for a patient with alcohol use disorder who has not had a drink in 24 hours, the LPN should monitor for:
A
B
C
D