Mood Disorders:Depression and Suicide Depression Suicide

Depression • Common treatable mental illness • May be unipolar (i.e. person only gets depressed) or bipolar (episodes of mania and depression cycle) • May be situational (related to events) or not • May be chronic low level (dysthymia), recurrent, or single episode

Depression is common: Among elderly Among people with chronic and some acute illnesses Related to grief response

Among elderly

Among people with chronic and some acute illnesses

Related to grief response

Symptoms of Depression: Mood Related Dysphoria or depressed mood Despairing, tearful, anhedonia Low self esteem feel worthless May feel excess shame, guilt May have stored up angry feelings Mood related symptoms may be Diurnal, varying by time of day

Dysphoria or depressed mood

Despairing, tearful, anhedonia

Low self esteem feel worthless

May feel excess shame, guilt

May have stored up angry feelings

Mood related symptoms may be Diurnal, varying by time of day

Symptoms of Depression: Thought Related Slow speech and thought processes Poverty of ideas No sense of humor, libido Rumination Hopeless helpless negativistic thoughts Low concentration ability

Slow speech and thought processes

Poverty of ideas

No sense of humor, libido

Rumination

Hopeless helpless negativistic thoughts

Low concentration ability

Symptoms of Depression: Behavior Noted Psychomotor retardation Anergia Decreased function at work, decreased participation in social activity, hobby Decreased attention to appearance and hygiene Suicide ideas and other self destructive behavior

Psychomotor retardation

Anergia

Decreased function at work, decreased participation in social activity, hobby

Decreased attention to appearance and hygiene

Suicide ideas and other self destructive behavior

Symptoms of Depression: Vegetative Altered sleep-hypersomnia, insomnia Often with early morning awakening and difficulty falling asleep Altered nutrition-eating too much or not enough, not the same as the eating disorder. Altered self-care-bathing, grooming, attention to detail

Altered sleep-hypersomnia, insomnia

Often with early morning awakening and

difficulty falling asleep

Altered nutrition-eating too much or not

enough, not the same as the eating disorder.

Altered self-care-bathing, grooming, attention

to detail

Adolescent manifestations of depression May or many not look like the symptom pattern already noted May see: behavior changes, poor school performance, illegal behavior, drug use, hypersexuality Acting out is common in kids and adolescents

May or many not look like the symptom pattern already noted

May see: behavior changes, poor school performance, illegal behavior, drug use, hypersexuality

Acting out is common in kids and adolescents

Modifiers of Depression Psychotic Features Seasonal Affective Disorder Catatonic features “ melancholic features” like prominent vegetative signs Postpartum depression Depression and Anxiety disorders often go hand and hand.

Psychotic Features

Seasonal Affective Disorder

Catatonic features

“ melancholic features” like prominent vegetative signs

Postpartum depression

Depression and Anxiety disorders often go hand and hand.

Psychologic theories of depression Cognitive theory-persistent automatic negative thought Learned helplnessness-behavioral Psychoanalytic-anger turned inward Grief gone awry

Cognitive theory-persistent automatic negative thought

Learned helplnessness-behavioral

Psychoanalytic-anger turned inward

Grief gone awry

Physiologic Theories of Depression Decreased levels of epinephrine and serotonin result in affective disturbance Neuro endocrine link-to hypothyroid, cortisol levels, more Genetic Connection

Decreased levels of epinephrine and serotonin result in affective disturbance

Neuro endocrine link-to hypothyroid, cortisol levels, more

Genetic Connection

Antidepressant meds to know: SSRI: Celexa, Prozac, Paxil, Zoloft Novels: Wellbutrin, Effexor, Remeron TCA’s: Elavil, Sinequan, Tofranil MAOI: Nardil

SSRI: Celexa, Prozac, Paxil, Zoloft

Novels: Wellbutrin, Effexor, Remeron

TCA’s: Elavil, Sinequan, Tofranil

MAOI: Nardil

Points of Action of Antidepressant Medications

Central Serotonin Syndrome Hyperactivity and agitation Elevated vital signs Seizures, muscle rigidity Irrationality, mood swings, hostility Discuss Rx: Stop med, provide safe environment, block serotonin response with meds

Hyperactivity and agitation

Elevated vital signs

Seizures, muscle rigidity

Irrationality, mood swings, hostility

Discuss Rx: Stop med, provide safe environment, block serotonin response with meds

Treatment with ECT Indications: prior good response, severe risk, non response to meds. OK cardiac status/surgery risk Preop: Consent, teaching, NPO, prep During: meds (3), seizure, nurse role Post: Airway/breathing, fall risk, safety, reorientation, HA, when eat?

Indications: prior good response, severe risk, non response to meds. OK cardiac status/surgery risk

Preop: Consent, teaching, NPO, prep

During: meds (3), seizure, nurse role

Post: Airway/breathing, fall risk, safety, reorientation, HA, when eat?

Nursing Intervention Issues Always assess suicide potential, catalogue depression symptoms thoroughly Target the particular problems the individual is demonstrating Be cognizant of need for patience, development of therapeutic rapport

Always assess suicide potential, catalogue depression symptoms thoroughly

Target the particular problems the individual is demonstrating

Be cognizant of need for patience, development of therapeutic rapport

Suicide Demographics Males succeed more than females, females attempt more often Incidence increases at adolescence/young adulthood; then increases again as people move into early middle age. Know the other high risk times

Males succeed more than females, females attempt more often

Incidence increases at adolescence/young adulthood; then increases again as people move into early middle age.

Know the other high risk times

SAD PERSONS Scale S: sex –male A: age – D: depression P: previous attempts E: ETOH use R: Rational thinking loss S: social support lack O: organized plan N: no spouse S: sickness

S: sex –male

A: age –

D: depression

P: previous attempts

E: ETOH use

R: Rational thinking loss

S: social support lack

O: organized plan

N: no spouse

S: sickness

Types of suicide attempts and health care providers resp. Lethal: successful or capable of being successful Non lethal: defined as a suicide attempt by attempter, but actions not likely to be sufficient to kill person Self Mutilation: self destructive behavior that is not intended to kill self, just cause pain, draw blood, or punish All types are at increased risk of killing self at a later point

Lethal: successful or capable of being successful

Non lethal: defined as a suicide attempt by attempter, but actions not likely to be sufficient to kill person

Self Mutilation: self destructive behavior that is not intended to kill self, just cause pain, draw blood, or punish

All types are at increased risk of killing self at a later point

Suicide Assessment Clues Overt statements, “I am thinking about ending it all.” Covert Statements, “You’ll be better off without me.” Lifting of severe depression sudden calm Giving away, wills gathering means Withdrawal, isolation, anxiety, depression

Overt statements, “I am thinking about ending it all.”

Covert Statements, “You’ll be better off without me.”

Lifting of severe depression sudden calm

Giving away, wills gathering means

Withdrawal, isolation, anxiety, depression

Suicide Risk Assessment Passive suicide ideas “God take me” Active suicide ideas w/o plan Active suicide ideas w/plan, no means Active suicide ideas w/plan ready (look at lethality of plan, specificity, means, timing issues, command hallucinations)

Passive suicide ideas “God take me”

Active suicide ideas w/o plan

Active suicide ideas w/plan, no means

Active suicide ideas w/plan ready (look at lethality of plan, specificity, means, timing issues, command hallucinations)

Suicide Intervention Triad: Environment, Monitoring, and Interpersonal Intervention:

Some Interpersonal Interventions re Suicide Remain calm and do not respond with hostility or avoidance Take it seriously and ask specific questions, decrease isolation Convey: crisis is temporary, pain can be survived, help is available, and you are not alone

Remain calm and do not respond with hostility or avoidance

Take it seriously and ask specific questions, decrease isolation

Convey: crisis is temporary, pain can be survived, help is available, and you are not alone

What are suicide precautions? Some degree of close observation of the client (discuss particulars) Keeping harmful things off the unit—sharps, poisons, things to hang with Designed to provide some safety during acute period, but do not let your guard down.

Some degree of close observation of the client (discuss particulars)

Keeping harmful things off the unit—sharps, poisons, things to hang with

Designed to provide some safety during acute period, but do not let your guard down.

Unit 6 Mood Disorders: Bipolar Disorder

Mania: The Opposing Pole of Bipolar Disorder Some people cycle more rapidly than other; rapid cyclers more difficult to manage Bipolar disorder is thought to be chronic, but very manageable Often triggered by psychosocial or physical stressor

Some people cycle more rapidly than other; rapid cyclers more difficult to manage

Bipolar disorder is thought to be chronic, but very manageable

Often triggered by psychosocial or physical stressor

Mania: Mood Symptoms Euphoria, expansive mood Unstable (labile) mood Irritability, especially if limits set Grandiose sense of self esteem, often covers underlying self doubt

Euphoria, expansive mood

Unstable (labile) mood

Irritability, especially if limits set

Grandiose sense of self esteem, often covers underlying self doubt

Mania: Cognitive Symptoms Rapid pressured speech, thoughts Excess humor, vulgar, hypersexual Flight of Idea Clang Association Scattered thought, may be incoherent Fault finding, manipulative

Rapid pressured speech, thoughts

Excess humor, vulgar, hypersexual

Flight of Idea

Clang Association

Scattered thought, may be incoherent

Fault finding, manipulative

Mania: Behavioral Symptoms Hyperactivity, often prolonged, boundless energy Wild spending, gambling, foolish ventures Inappropriate grooming, excessive or seductive Work and social relations impaired, e.g. may start a lot things, but not follow through

Hyperactivity, often prolonged, boundless energy

Wild spending, gambling, foolish ventures

Inappropriate grooming, excessive or seductive

Work and social relations impaired, e.g. may start a lot things, but not follow through

Mania: Physical Symptoms Decreased sleep (often the first sign of impending cycle) Decreased eating, no time to eat No time to go to the bathroom

Decreased sleep (often the first sign of impending cycle)

Decreased eating, no time to eat

No time to go to the bathroom

Mania: Theories of Etiology Genetic Complex biogenic amine disturbance Social factors

Genetic

Complex biogenic amine disturbance

Social factors

Nursing Diagnosis: Risk for Injury

Nursing Diagnoses: Disturbed thought process Imbalanced nutrition Disturbed sleep pattern Impaired social interaction Ineffective individual coping

Disturbed thought process

Imbalanced nutrition

Disturbed sleep pattern

Impaired social interaction

Ineffective individual coping

Nursing Care Issues Safety of self and others paramount (talk about risks) Avoid environmental stimulation Avoid competition, and difficulty lengthy tasks Large muscle activity that is safe is good Address sleep/rest, limit setting, and eating Hygiene help Note-easy to personalize their comments.

Safety of self and others paramount (talk about risks)

Avoid environmental stimulation

Avoid competition, and difficulty lengthy tasks

Large muscle activity that is safe is good

Address sleep/rest, limit setting, and eating

Hygiene help

Note-easy to personalize their comments.

Lithium:

Anticonvulsants you need to know: Gabapentin (Neurontin), phenytoin (Dilantin), Valproic Acid Klonopin and Valium (studied already) Tegretol Phenobarbital

Gabapentin (Neurontin),

phenytoin (Dilantin),

Valproic Acid

Klonopin and Valium (studied already)

Tegretol

Phenobarbital