Mood Disorders:Depression and Suicide

Slide 1: Mood Disorders:Depression and Suicide Depression Suicide

Slide 2: 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

Slide 3: Depression is common: Among elderly  Among people with chronic and some  acute illnesses Related to grief response 

Slide 4: 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

Slide 5: 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 

Slide 6: 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

Slide 7: 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

Slide 8: 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

Slide 9: 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.

Slide 10: Psychologic theories of depression Cognitive theory-persistent  automatic negative thought Learned helplnessness-  behavioral Psychoanalytic-anger turned  inward Grief gone awry 

Slide 11: Physiologic Theories of Depression Decreased levels of  epinephrine and serotonin result in affective disturbance Neuro endocrine link-to  hypothyroid, cortisol levels, more Genetic Connection 

Slide 12: Antidepressant meds to know: SSRI: Celexa, Prozac, Paxil, Zoloft  Novels: Wellbutrin, Effexor, Remeron  TCA’s: Elavil, Sinequan, Tofranil  MAOI: Nardil 

Slide 13: Points of Action of Antidepressant Medications

Slide 14: 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

Slide 15: 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?

Slide 16: 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

Slide 17: 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 

Slide 18: 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 

Slide 19: 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

Slide 20: 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 

Slide 21: 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)

Slide 22: Suicide Intervention Triad: Environment, Monitoring, and Interpersonal Intervention:

Slide 23: 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

Slide 24: 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.

Slide 25: Unit 6 Mood Disorders: Bipolar Disorder

Slide 26: 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

Slide 27: Mania: Mood Symptoms Euphoria, expansive  mood Unstable (labile) mood  Irritability, especially if  limits set Grandiose sense of self  esteem, often covers underlying self doubt

Slide 28: Mania: Cognitive Symptoms Rapid pressured speech, thoughts  Excess humor, vulgar, hypersexual  Flight of Idea  Clang Association  Scattered thought, may be incoherent  Fault finding, manipulative 

Slide 29: 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

Slide 30: 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

Slide 31: Mania: Theories of Etiology Genetic  Complex biogenic  amine disturbance Social factors 

Slide 32: Nursing Diagnosis: Risk for Injury

Slide 33: Nursing Diagnoses: Disturbed thought process  Imbalanced nutrition  Disturbed sleep pattern  Impaired social interaction  Ineffective individual coping 

Slide 34: 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. 

Slide 35: Lithium:

Slide 36: Anticonvulsants you need to know: Gabapentin (Neurontin),  phenytoin (Dilantin),  Valproic Acid  Klonopin and Valium (studied already)  Tegretol  Phenobarbital 