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Mood Disorders:Depression and Suicide

Mood Disorders:Depression and Suicide

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Mood Disorders:Depression and Suicide

  1. 1. Mood Disorders:Depression and Suicide Depression Suicide
  2. 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 (dysthymia), recurrent, or single episode
  3. 3. Depression is common: <ul><li>Among elderly </li></ul><ul><li>Among people with chronic and some acute illnesses </li></ul><ul><li>Related to grief response </li></ul>
  4. 4. Symptoms of Depression: Mood Related <ul><li>Dysphoria or depressed mood </li></ul><ul><li>Despairing, tearful, anhedonia </li></ul><ul><li>Low self esteem feel worthless </li></ul><ul><li>May feel excess shame, guilt </li></ul><ul><li>May have stored up angry feelings </li></ul><ul><li>Mood related symptoms may be Diurnal, varying by time of day </li></ul>
  5. 5. Symptoms of Depression: Thought Related <ul><li>Slow speech and thought processes </li></ul><ul><li>Poverty of ideas </li></ul><ul><li>No sense of humor, libido </li></ul><ul><li>Rumination </li></ul><ul><li>Hopeless helpless negativistic thoughts </li></ul><ul><li>Low concentration ability </li></ul>
  6. 6. Symptoms of Depression: Behavior Noted <ul><li>Psychomotor retardation </li></ul><ul><li>Anergia </li></ul><ul><li>Decreased function at work, decreased participation in social activity, hobby </li></ul><ul><li>Decreased attention to appearance and hygiene </li></ul><ul><li>Suicide ideas and other self destructive behavior </li></ul>
  7. 7. Symptoms of Depression: Vegetative <ul><li>Altered sleep-hypersomnia, insomnia </li></ul><ul><li>Often with early morning awakening and </li></ul><ul><li>difficulty falling asleep </li></ul><ul><li>Altered nutrition-eating too much or not </li></ul><ul><li>enough, not the same as the eating disorder. </li></ul><ul><li>Altered self-care-bathing, grooming, attention </li></ul><ul><li>to detail </li></ul>
  8. 8. Adolescent manifestations of depression <ul><li>May or many not look like the symptom pattern already noted </li></ul><ul><li>May see: behavior changes, poor school performance, illegal behavior, drug use, hypersexuality </li></ul><ul><li>Acting out is common in kids and adolescents </li></ul>
  9. 9. Modifiers of Depression <ul><li>Psychotic Features </li></ul><ul><li>Seasonal Affective Disorder </li></ul><ul><li>Catatonic features </li></ul><ul><li>“ melancholic features” like prominent vegetative signs </li></ul><ul><li>Postpartum depression </li></ul><ul><li>Depression and Anxiety disorders often go hand and hand. </li></ul>
  10. 10. Psychologic theories of depression <ul><li>Cognitive theory-persistent automatic negative thought </li></ul><ul><li>Learned helplnessness-behavioral </li></ul><ul><li>Psychoanalytic-anger turned inward </li></ul><ul><li>Grief gone awry </li></ul>
  11. 11. Physiologic Theories of Depression <ul><li>Decreased levels of epinephrine and serotonin result in affective disturbance </li></ul><ul><li>Neuro endocrine link-to hypothyroid, cortisol levels, more </li></ul><ul><li>Genetic Connection </li></ul>
  12. 12. Antidepressant meds to know: <ul><li>SSRI: Celexa, Prozac, Paxil, Zoloft </li></ul><ul><li>Novels: Wellbutrin, Effexor, Remeron </li></ul><ul><li>TCA’s: Elavil, Sinequan, Tofranil </li></ul><ul><li>MAOI: Nardil </li></ul>
  13. 13. Points of Action of Antidepressant Medications
  14. 14. Central Serotonin Syndrome <ul><li>Hyperactivity and agitation </li></ul><ul><li>Elevated vital signs </li></ul><ul><li>Seizures, muscle rigidity </li></ul><ul><li>Irrationality, mood swings, hostility </li></ul><ul><li>Discuss Rx: Stop med, provide safe environment, block serotonin response with meds </li></ul>
  15. 15. Treatment with ECT <ul><li>Indications: prior good response, severe risk, non response to meds. OK cardiac status/surgery risk </li></ul><ul><li>Preop: Consent, teaching, NPO, prep </li></ul><ul><li>During: meds (3), seizure, nurse role </li></ul><ul><li>Post: Airway/breathing, fall risk, safety, reorientation, HA, when eat? </li></ul>
  16. 16. Nursing Intervention Issues <ul><li>Always assess suicide potential, catalogue depression symptoms thoroughly </li></ul><ul><li>Target the particular problems the individual is demonstrating </li></ul><ul><li>Be cognizant of need for patience, development of therapeutic rapport </li></ul>
  17. 17. Suicide Demographics <ul><li>Males succeed more than females, females attempt more often </li></ul><ul><li>Incidence increases at adolescence/young adulthood; then increases again as people move into early middle age. </li></ul><ul><li>Know the other high risk times </li></ul>
  18. 18. SAD PERSONS Scale <ul><li>S: sex –male </li></ul><ul><li>A: age – </li></ul><ul><li>D: depression </li></ul><ul><li>P: previous attempts </li></ul><ul><li>E: ETOH use </li></ul><ul><li>R: Rational thinking loss </li></ul><ul><li>S: social support lack </li></ul><ul><li>O: organized plan </li></ul><ul><li>N: no spouse </li></ul><ul><li>S: sickness </li></ul>
  19. 19. Types of suicide attempts and health care providers resp. <ul><li>Lethal: successful or capable of being successful </li></ul><ul><li>Non lethal: defined as a suicide attempt by attempter, but actions not likely to be sufficient to kill person </li></ul><ul><li>Self Mutilation: self destructive behavior that is not intended to kill self, just cause pain, draw blood, or punish </li></ul><ul><li>All types are at increased risk of killing self at a later point </li></ul>
  20. 20. Suicide Assessment Clues <ul><li>Overt statements, “I am thinking about ending it all.” </li></ul><ul><li>Covert Statements, “You’ll be better off without me.” </li></ul><ul><li>Lifting of severe depression sudden calm </li></ul><ul><li>Giving away, wills gathering means </li></ul><ul><li>Withdrawal, isolation, anxiety, depression </li></ul>
  21. 21. Suicide Risk Assessment <ul><li>Passive suicide ideas “God take me” </li></ul><ul><li>Active suicide ideas w/o plan </li></ul><ul><li>Active suicide ideas w/plan, no means </li></ul><ul><li>Active suicide ideas w/plan ready (look at lethality of plan, specificity, means, timing issues, command hallucinations) </li></ul>
  22. 22. Suicide Intervention Triad: Environment, Monitoring, and Interpersonal Intervention:
  23. 23. Some Interpersonal Interventions re Suicide <ul><li>Remain calm and do not respond with hostility or avoidance </li></ul><ul><li>Take it seriously and ask specific questions, decrease isolation </li></ul><ul><li>Convey: crisis is temporary, pain can be survived, help is available, and you are not alone </li></ul>
  24. 24. What are suicide precautions? <ul><li>Some degree of close observation of the client (discuss particulars) </li></ul><ul><li>Keeping harmful things off the unit—sharps, poisons, things to hang with </li></ul><ul><li>Designed to provide some safety during acute period, but do not let your guard down. </li></ul>
  25. 25. Unit 6 Mood Disorders: Bipolar Disorder
  26. 26. Mania: The Opposing Pole of Bipolar Disorder <ul><li>Some people cycle more rapidly than other; rapid cyclers more difficult to manage </li></ul><ul><li>Bipolar disorder is thought to be chronic, but very manageable </li></ul><ul><li>Often triggered by psychosocial or physical stressor </li></ul>
  27. 27. Mania: Mood Symptoms <ul><li>Euphoria, expansive mood </li></ul><ul><li>Unstable (labile) mood </li></ul><ul><li>Irritability, especially if limits set </li></ul><ul><li>Grandiose sense of self esteem, often covers underlying self doubt </li></ul>
  28. 28. Mania: Cognitive Symptoms <ul><li>Rapid pressured speech, thoughts </li></ul><ul><li>Excess humor, vulgar, hypersexual </li></ul><ul><li>Flight of Idea </li></ul><ul><li>Clang Association </li></ul><ul><li>Scattered thought, may be incoherent </li></ul><ul><li>Fault finding, manipulative </li></ul>
  29. 29. Mania: Behavioral Symptoms <ul><li>Hyperactivity, often prolonged, boundless energy </li></ul><ul><li>Wild spending, gambling, foolish ventures </li></ul><ul><li>Inappropriate grooming, excessive or seductive </li></ul><ul><li>Work and social relations impaired, e.g. may start a lot things, but not follow through </li></ul>
  30. 30. Mania: Physical Symptoms <ul><li>Decreased sleep (often the first sign of impending cycle) </li></ul><ul><li>Decreased eating, no time to eat </li></ul><ul><li>No time to go to the bathroom </li></ul>
  31. 31. Mania: Theories of Etiology <ul><li>Genetic </li></ul><ul><li>Complex biogenic amine disturbance </li></ul><ul><li>Social factors </li></ul>
  32. 32. Nursing Diagnosis: Risk for Injury
  33. 33. Nursing Diagnoses: <ul><li>Disturbed thought process </li></ul><ul><li>Imbalanced nutrition </li></ul><ul><li>Disturbed sleep pattern </li></ul><ul><li>Impaired social interaction </li></ul><ul><li>Ineffective individual coping </li></ul>
  34. 34. Nursing Care Issues <ul><li>Safety of self and others paramount (talk about risks) </li></ul><ul><li>Avoid environmental stimulation </li></ul><ul><li>Avoid competition, and difficulty lengthy tasks </li></ul><ul><li>Large muscle activity that is safe is good </li></ul><ul><li>Address sleep/rest, limit setting, and eating </li></ul><ul><li>Hygiene help </li></ul><ul><li>Note-easy to personalize their comments. </li></ul>
  35. 35. Lithium:
  36. 36. Anticonvulsants you need to know: <ul><li>Gabapentin (Neurontin), </li></ul><ul><li>phenytoin (Dilantin), </li></ul><ul><li>Valproic Acid </li></ul><ul><li>Klonopin and Valium (studied already) </li></ul><ul><li>Tegretol </li></ul><ul><li>Phenobarbital </li></ul>

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