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EXAM 3 MENTAL HEALTH
Mood Disorders, Depression & Suicidal
| Question | Answer |
|---|---|
| Mood/Affective Disorders | Pervasive alterations in emotions manifested by depression or mania, or both. Interference with life, long-term sadness, agitation, or elation |
| Depressive Disorders | All include Sadness, emptiness, irritability, somatic (body) concerns, and impairment of thinking and they all impact a person's ability to function. Also will see self-doubt, guilt, anger, alterations in activities once enjoyed, low self-esteem, changes in behaviors at work and meaningful relationships. No cure but treatment helps |
| Suicide Risk Factors | Most common psychiatric disorder associated with this disease is depression. Genetics, Stress, Hormonal, Cognitive, Adverse Childhood Experiences (ACEs). Psychiatric conditions such as anxiety. Female gender, and personality substance use disorders, and chronic or disabling medical conditions. |
| Major Depressive Disorder | Each episode lasts at least 2 weeks. But can last months or years, but most clear within 6 months. Symptoms include Loss of pleasure in nearly all activities, change in eating habits, unintentional wt loss/gain, hyper/insomnia, impaired concentration, impaired decision making, decreased problem solving skills, inability to cope with daily life, worthlessness, hopelessness, despair, thoughts of death/suicide , overwhelming fatigue, ruminating negative thoughts |
| Dysthymic Disorder | Chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of sadness and hopelessness that are milder than those of depression |
| Cyclothymic Disorder | Characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning |
| Substance-Induced Depressive or Bipolar Disorder | A significant disturbance in a mood that is a direct physiological consequence of ingested substances such as alcohol, other drugs, or toxins |
| Fall Seasonal Affective Disorder (SAD) | Most commonly is winter depression where people experience increased sleep, appetite, and carbohydrate cravings, weight gain, interpersonal conflict, irritability, and heaviness in the extremities beginning in late autumn and abating in spring and summer. |
| Spring Seasonal Affective Disorder (SAD) | Second subtype, it is less common with symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall. SAD is often treated with light therapy. |
| Postpartum Depression | Most common complication of pregnancy in developed countries. Symptoms are consistent with those of depression with the onset within 4 weeks of delivery |
| Postpartum Psychosis | Severe and debilitating psychiatric illness, with acute onset in the days following childbirth. Symptoms begin with fatigue, sadness, emotional lability, poor memory, and confusion and progress to delusions, hallucinations, poor insight and judgement, and loss of contact with reality. Medical emergency. |
| Nonsuicidal Self-Injury | self-harming/maladaptive coping mechanisms- cutting, burning, hair pulling or eye lash pull “trichotillomania” |
| Disruptive Mood Dysregulation Disorder | Persistent angry or irritable mood, punctuated by severe, recurrent temper outbursts that are not in keeping with the provocation or situation, beginning before age 10 |
| Electroconvulsive Therapy (ECT) | Used for clients who do not respond to antidepressants or those who experience intolerable side effects at therapeutic doses. Usually receive 6-15 treatments. NPO after midnight before, may be mildly confused after. |
| Interpersonal Therapy | Focuses on difficulties in relationships, such as grief reactions, role disputes, and role transitions |
| Behavior Therapy | Seeks to increase the frequency of the clients positively reinforcing interactions with the environment and to decrease negative interactions. It focuses on improving social skills |
| Cognitive Therapy | Focuses on how the person thinks about the self, others, and the future and interprets his or her experiences. Focuses on the person's distorted thinking, which, in turn, influences feelings, behavior, and functional abilities. |
| Hypertensive Crisis | Increase in BP, increased HR and patient complains of palpitations, increase temps, facial flushing, sudden explosive headache, pupillary dilation, diaphoresis. Treatment: Discontinue MAOI and give Phentolamine (Regitine), treat fever if symptomatic |
| Serotonin Syndrome | Changes in mental status, autonomic instability, neuromuscular hyperactivity. Treatment: Cyproheptadine. HARMFUL SYMPTOMS are hyperthermia, autonomic instability, rigidity, myoclonus fever, unconsciousness, loss of intestinal control (diarrhea) |
| Nursing Process (outcome identification) in Depression | Free of self-injury, independently carry out ADLs, balance of rest, sleep, and activity, evaluate self-attributes realistically, socializing, return to occupation or school, medication compliance, verbalization of recurrence |
| Nursing Process (interventions) in Depression | Providing safety (suicide precautions), promoting a therapeutic relationship, promoting ADLs and physical care, using therapeutic communication, managing medications, client and family teaching |
| Absolute, Dichotomous Thinking | Tendency to view everything in polar categories (i.e., all or none, black or white) |
| Arbitrary Inference | Drawing a specific conclusion without sufficient evidence (i.e., jumping to [negative] conclusions) |
| Specific Abstraction | Focusing on a single (often minor) detail while ignoring other, more significant aspects of the experience (i.e., concentrating on one small [negative] detail while discounting positive aspects) |
| Overgeneralization | Forming conclusions based on too little or too narrow experience (i.e., if one experience was negative, then all similar experiences will be negative) |
| Magnification and Minimization | Overvaluing or undervaluing the significance of a particular event (i.e., one small negative event is the end of the world or a positive experience is totally discounted) |
| Personalization | Tendency to self-reference external events without basis (i.e., believing that events are directly related to oneself, whether they are or not) |
| Bipolar Disorder | mood fluctuates between extremes of mania and depression |
| Hypomania | Period of abnormally and persistently elevated, expansive or irritable mood with other mild symptoms of mania. Does not impair the person's ability to function (may actually be productive) and no psychotic features (no delusions or hallucinations) |
| Mixed Episodes | Diagnosed when the person experiences both mania and depression nearly every day for at least 1 week. Often involve rapid cycling |
| Bipolar I Disorder | One or more manic or mixed episodes usually accompanied by major depressive episodes |
| Bipolar II Disorder | One or more major depressive episodes accompanied by at least one hypomanic episodic |
| Flight of Ideas | Racing, often unconnected thoughts |
| Anergia | Lack of energy |
| Pressured Speech | Unrelenting, rapid, often loud talking without pauses |
| Euthymic | Average affect & mood |
| Nursing Process (Interventions) in bipolar | Provide safety, meeting physiological needs, providing therapeutic communication, promoting appropriate behaviors, managing medications, providing client and family teaching |
| Treatment in Bipolar | Psychopharmacology, Lithium (mood stabilizer), Anticonvulsant Drugs, psychotherapy, useful in mildly depressive or normal portion or normal portion of bipolar cycle. Not useful during manic stages. |
| Lithium Therapeutic Level | 0.6-1.2 mEq/L. Toxicity is 1.5 mEq/L or greater |
| Symptoms of Lithium Toxicity | Severe nausea, vomiting, severe hand tremors, confusion, and vision changes. |
| Suicide | The intentional act of killing oneself |
| Suicidal Ideation | Thinking about killing oneself |
| Suicide Assessment | Previous suicide attempts (especially within the first 2 years, more importantly within the first 3 months). Warnings of suicidal intent, risky behavior, lethality assessment. |
| Suicide Outcome Identification | Safe from harming self or others. No-suicide contracts, list of positive attributes. |
| Suicide Interventions | Using an authoritative role, providing a safe environment, creating a support system list |
| Nurses Response in Suicidal Patients | Need for unconditional positive regard for person, avoidance of client blame, nonjudgmental approach and tone, belief that one person can make a difference in another's life. Possible devastation of staff if client commits suicide |
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