![Suicidal
or
Deliberate Self Harm?
Perceived Lethality
[as perceived by the client, not the clinician]
The “Attention Seeking” Myth
[created in the 1960s; a “truism” via repetition]](https://image.slidesharecdn.com/session5lecture-150116193408-conversion-gate01/85/Mood-Disorders-and-Suicide-52-320.jpg)
Uploaded byPaul McNamara
Mood Disorders and Suicide
This document provides an overview of assessing and nursing patients with mood disorders. It discusses several specific mood disorders including major depression, bipolar disorder, dysthymia, and cyclothymia. Treatment strategies covered include pharmacotherapy with antidepressants and mood stabilizers, psychotherapy, electroconvulsive therapy, and managing self-harm and suicide risk. Nursing approaches focus on containment, awareness, resilience, engagement and the use of tools like cognitive behavioral therapy and dialectical behavior therapy.
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Mood Disorders and Suicide
- 1. Assessing and nursingthe person with a problem with mood Nursing the person who self- harms/is suicidal Paul McNamara RGN (RAH), RPN (SAMHS), BN (Flin.), MMHN (USQ), Cert IMH (WCHN), CMHN, FACMHN @meta4RN #NS3360
- 2. Acknowledgements Roianne West @RoianneWest +Nurses 1988-2015
- 3. Teaching Assumption Probable LifeExperience Limited Clinical Experience
- 4. Learning Outcomes Depression Mania Self Harm & Suicide Electroconvulsive Therapy (ECT)
- 5. Today’s Presentation MoodDisorders Overview Specific Mood Disorders Treatment Strategies Self Harm & Suicide ECT
- 6. Today’s Presentation MoodDisorders Overview Specific Mood Disorders Treatment Strategies Self Harm & Suicide ECT
- 7. Mood Disorders Clinically Significant Functioning Quality of Life Subjective & Objective
- 8.
- 9. Prevalence lifetime ~ 20%depression year ~ 6% major depression ~ 10% pregnant women ~ 16% new mums < 2% BPAD SANE 2005 & 2009, ABS 2006
- 10. meds in last2/52 = 19% Aust adults Depression Sleep Anxiety Other ABS 2006
- 11. Youth Prevalence 4 to17 ~ 14% mental health problem ? 50% depression high risk behaviours & suicidal thoughts BPAD ~ teenage years SANE 2005 & 2009, ABS 2006
- 12. Risk Factors Genetic (31-42%) Loss/Trauma/Abuse/Stressors Supports Alcohol & Other Drugs Illness/Disability Neurochemical/Neurotransmitters Circadian Rhythms, Melatonin & Sleep
- 13. Melatonin, Nurses &Onset Insomnia 0 10 20 30 40 50 60 Baseline Placebo Melatonin Sadeghniiat-Haghighi et al. 2008
- 14.
- 15.
- 16.
- 17. 10 10 12 9 7 Jargon Alert PartI <- TIME -> <-MOOD-> Euphoria Euthymia Dysphoria
- 18. 10 10 12 9 7 Jargon Alert PartII <- TIME -> <-MOOD-> Mania Hypomania Euthymia Mild Depression Moderate Depression Severe Depression
- 19.
- 20.
- 21.
- 22. Mania Hypomania psychosis - delusions- hallucinations euphoric/irritable - elated - grandiose – labile - weight libido - disinhibition/promiscuity activity - judgement - $pending - sleep impulsivity - empathy - thoughts loose associations - pressured speech signs&symptoms
- 23.
- 24. Depression Major Depression signs&symptoms mood –flat - amotivated - rumination - tearful - irritable anxious – labile - pain/tolerance libido - inhibition - withdrawn – isolative - activity catastrophising - negative - egocentric orsleep - orweight - thoughts poverty of speech - self harm/suicidal ideation psychomotor retardation or agitation psychosis - delusions - hallucinations
- 25. 10 10 12 9 7 Euthymic <- TIME -> <-MOOD-> moodflat amotivated rumination tearful irritable anxious labile pain/tolerance libido inhibition withdrawn isolative activity catastrophising negative egocentric orsleep orweight thoughts poverty of speech self harm/suicidal ideation psychomotor retardation or agitation psychosis delusions hallucinations psychosis delusions hallucinations euphoric/irritable elated grandiose labile libido weight disinhibition/promiscuity activity judgement $pending sleep impulsivity empathy thoughts loose associations pressured speech
- 27. Today’s Presentation MoodDisorders Overview Specific Mood Disorders Treatment Strategies Self Harm & Suicide ECT
- 29. 10 10 12 9 7 Visualising Mood Disorders <-TIME -> <-MOOD-> Mania Hypomania Euthymia Mild Depression Moderate Depression Severe Depression
- 30.
- 31. 10 10 12 9 7 Major Depression <- TIME-> <-MOOD->
- 32.
- 33. 10 10 12 9 7 BPAD I <- TIME-> <-MOOD->
- 34. 10 10 12 9 7 BPAD II <- TIME-> <-MOOD->
- 35. 10 10 12 9 7 Rapid Cycling BPAD <-TIME -> <-MOOD->
- 36.
- 37. 10 10 12 9 7 Manic Episode <- TIME-> <-MOOD->
- 38. 10 10 12 9 7 Hypomanic Episode <- TIME-> <-MOOD->
- 39. 10 10 12 9 7 <- TIME -> <-MOOD-> VisualisingClinical Placement
- 40.
- 41. Today’s Presentation MoodDisorders Overview Specific Mood Disorders Treatment Strategies Self Harm & Suicide ECT
- 42. Nursing Approaches Shared humanity Lifebalance No loss is trivial Assessing cues Pacing the development of the therapeutic relationship Assessing the person within their socio-cultural context
- 43. Nursing Approaches C ontainment Awareness R esilience E ngagement
- 44. Emotional Intelligence Psychoeducation Rational EmotiveTherapy Cognitive Behavioural Therapy Interpersonal Therapy Occupational therapy Psychotherapy Supportive Therapy Dialectical Behaviour Therapy Tools of the Trade
- 46.
- 47. Clinical Supervision process ofreflection one clinician to another: support professional development education clinical practice skills
- 49.
- 50. Mood Stabilisers Lithium Anticonvulsants are antipsychoticsclinically indicated?
- 51. Today’s Presentation MoodDisorders Overview Specific Mood Disorders Treatment Strategies Self Harm & Suicide ECT
- 52. Suicidal or Deliberate Self Harm? PerceivedLethality [as perceived by the client, not the clinician] The “Attention Seeking” Myth [created in the 1960s; a “truism” via repetition]
- 53. Self Harm Maladaptive Coping SelfLoathing Release Empowerment NOT “Attention Seeking” Watch Counter-Transference
- 54.
- 57. Suicide 1997 2723 deaths per 100000: Men 23.6 Women 6.2 Male Youth 18.6 Female Youth 5.3 2008 2191 deaths per 100 000: Men 16 Women 4.5 Male Youth 9.4 Female Youth 3.2
- 58. Compare and Contrast. 1997 population~18.5m suicide 2723 drowning 276 MVA 1801 2008 population ~21.5m suicide 2191 drowning 159 MVA 1402
- 59. What’s Changed? 1999: NationalSuicide Prevention Strategy www.livingisforeveryone.com.au www.mindhealthconnect.org.au ? Community Awareness ? Life Promotion Officers ? Access and… ? + ? + ?
- 60. Risk loss: recent/anniversary men20 - 54 intoxication mental illness exposed to suicide rural and remote areas Aboriginal & Torres Strait Islander people
- 61. Nursing Strategies Authentic Engagement/TherapeuticRapport Risk Assessment Risk Management CARE Framework
- 62. Risk Assessment Ideation Plan Means Timeframe Intent Lethality Rapport Recent Losses? PreviousAttempts Previous Exposure Alcohol & Other Drugs Resources/Supports Psychopathology ? Contract
- 63. Protective Factors Strong PerceivedSocial Supports Family Cohesion Peer Group Affiliation Good Coping Mechanisms Good Problem Solving Skills Positive Values & Beliefs Ability to Seek & Access Help Resilience Social Participation Early Intervention
- 64. Today’s Presentation MoodDisorders Overview Specific Mood Disorders Treatment Strategies Self Harm & Suicide ECT
- 65. ECT Electroconvulsive Therapy History vHollywood v Clinical Evidence
- 66. ECT v AED Indications Strength/Mechanism PatientPreparation Efficacy
- 67.
- 68.
- 69. Today’s Presentation MoodDisorders Overview Specific Mood Disorders Treatment Strategies Self Harm & Suicide ECT
- 70. References Athanasos, P. (2009).Mood Disorders. In R. Elder, K. Evans & D. Nizette (Eds), Psychiatric and mental health nursing (pp. 267-284). Sydney: Elsevoir Australia. Australian Bureau of Statistics (1999), Causes of Death, Australia, 1997, cat. No. 3302.0, ABS, Canberra Australian Bureau of Statistics (2006), National Health Survey: Summary of Results, Australia, 2004-05, cat. no. 4364.0, ABS, Canberra. Australian Bureau of Statistics (2008), Causes of Death, Australia, 2006, cat. No. 3303.0, ABS, Canberra Australian Institute of Health and Welfare (AIHW): Harrison JE, Pointer S and Elnour AA (2009). A review of suicide statistics in Australia. Injury research and statistics series no. 49. Cat. no. INJCAT 121. Adelaide: AIHW. Loo, C., Schweitzer, I. & Pratt, C. (2006) Recent advances in optimising electroconvulsive therapy. Australian and New Zealand Journal of Psychiatry, 40, pp. 632-638 Mindframe National Media Initiative (2009) Facts and statistics. Retrieved 22 March 2009 from: http://www.mindframe-media.info Palmer, C. (2009). Mood Disorders. In R. Elder, K. Evans & D. Nizette (Eds), Psychiatric and mental health nursing (pp. 450-451). Sydney: Elsevoir Australia. Sadeghniiat-Haghighi, K., Aminian, O., Pouryaghoub, G. & Yazdi, Z. (2008) Efficacy and hypnotic effects of melatonin in shift-work nurses: double-blind, placebo-controlled crossover trial. Journal of Circadian Rhythms. 6:10. Retrieved 22 March 2009 from: http://www.jcircadianrhythms.com/content/6/1/10 SANE Australia. (2005). Bipolar Disorder. Retrieved 22 March 2009 from: http://www.sane.org/information/factsheets/bipolar_disorder.html SANE Australia. (2009). Depression. Retrieved 22 March 2009 from: http://www.sane.org/Information/Factsheets/Depression.html Shepperd, C. & McAllister, M. (2003). CARE: A framework for responding therapeutically to the client who self-harms. Journal of Psychiatric and Mental Health Nursing, 10, pp. 442-447