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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 17 Mood Disorders and Suicide.

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Presentation on theme: "Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 17 Mood Disorders and Suicide."— Presentation transcript:

1 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 17 Mood Disorders and Suicide

2 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mood Disorders Affective disorders –Pervasive alterations in emotions manifested by depression, mania, or both –Interference with life; long-term sadness, agitation, or elation Individuals with mood disorders throughout history

3 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mood Disorders (cont.) Most common psychiatric diagnosis associated with suicide –Depression one of the most important risk factors for it

4 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Categories of Mood Disorders Major depressive disorder Bipolar disorder Related disorders –Dysthymic disorder –Cyclothymic disorder –Substance-induced depressive or bipolar disorder –Seasonal affective disorder –Postpartum depression, psychosis, premenstrual dysphoric disorder –Nonsuicidal self-injury

5 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology Biologic theories –Genetic theories –Neurochemical theories: serotonin, norepinephrine; possibly acetylcholine and dopamine –Neuroendocrine influences: hormones

6 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology (cont.) Psychodynamic theories –Freud: self-deprecation –Bibring: ideal ego –Jacobson: superego over powerless ego Mania: defense against underlying depression

7 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations Masking of depression by other behaviors considered age appropriate –School phobia, hyperactivity, learning disorders, failing grades, antisocial behaviors –Substance abuse, gangs, risk behaviors, eating disorders, compulsive behaviors Somatic complaints –Major manifestation among cultures that avoid verbalizing emotions

8 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Depression is most commonly associated with suicide.

9 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Depression is considered the most common diagnosis that results in suicide.

10 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Major Depressive Disorder Incidence: women to men 2:1 –Decreases with age in women; increases with age in men; highest in single, divorced people 50% to 60% will suffer recurrence Approximately 20% will develop a chronic form of depression Symptoms range from mild to severe

11 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Major Depressive Disorder (cont.) Symptoms: sad mood, lack of interest in life activities (2 weeks or more), and at least four other symptoms: –Changes in eating habits → weight gain or loss –Hypersomnia or insomnia –Impaired concentration, decision making, or problem solving –Worthlessness, hopelessness, despair, guilt –Thoughts of death/suicide –Overwhelming fatigue, negative thinking

12 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychopharmacology Selective serotonin reuptake inhibitors (see Table 17.1) Cyclic antidepressants (see Table 17.2) Atypical antidepressants (see Table 17.3) Monoamine oxidase inhibitors (MAOIs) (see Table 17.4)

13 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Medical Treatments and Psychotherapy Electroconvulsive therapy (ECT) Psychotherapy (combined with medications) –Interpersonal therapy: relationship difficulties –Behavior therapy: reinforcement of positive interactions –Cognitive therapy: correction of cognitive distortions (see Table 17.5) Investigational treatments

14 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Major Depressive Disorder and Nursing Process Application Assessment –History –General appearance, motor behavior (psychomotor retardation, latency of response, psychomotor agitation) –Mood, affect (anhedonia) –Thought process, content (rumination, suicide) –Sensorium, intellectual processes (impaired memory)

15 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Major Depressive Disorder and Nursing Process Application (cont.) Assessment (cont.) –Judgment, insight (impairment) –Self-concept (worthlessness) –Roles, relationships (difficulty in this area) –Physiologic, self-care considerations –Depression rating scales Self-rating scales: Zung, Beck Clinician rating scale: Hamilton Rating Scale

16 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Patients with depression often exhibit anhedonia.

17 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Anhedonia refers to the loss of any sense of pleasure from activities that a person formerly enjoyed. This is a manifestation of depression.

18 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Major Depressive Disorder and Nursing Process Application (cont.) Data analysis/nursing diagnoses Outcome identification –Free from self-injury –Improved mood and energy –Return to previous functional level –Medication compliance

19 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Major Depressive Disorder and Nursing Process Application (cont.) Intervention –Providing for safety (suicide precautions) –Promoting therapeutic relationship –Promoting ADLs, physical care –Using therapeutic communication –Managing medications –Patient, family teaching Evaluation

20 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bipolar Disorder Extreme mood fluctuations from mania to depression (see Figure 17.1) Second only to major depression as cause of worldwide disability Onset usually in late teens, 20s, or 30s Manic episodes begin suddenly, last from a few weeks to several months

21 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment Psychopharmacology –Antimanic agent: lithium –Anticonvulsant agent used as mood stabilizer (see Table 17.6) –Agents helpful in reducing manic behavior, protecting against bipolar depressive cycles Psychotherapy useful in mildly depressive or normal portion of bipolar cycle –Not useful during manic stages

22 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bipolar Disorder and Nursing Process Application Assessment –History –General appearance, behavior (pressured speech, flamboyancy, sexually suggestive) –Mood, affect (euphoric, grandiose) –Thought process, content (circumstantiality, tangentiality) –Sensorium, intellectual processes (disoriented to time)

23 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bipolar Disorder and Nursing Process Application (cont.) Assessment (cont.) –Judgment, insight –Self-concept (exaggerated) –Roles, relationships (labile emotions) –Physiologic, self-care considerations Data analysis/nursing diagnoses Outcome identification –Free from injury—med compliance –Meet basic needs and self-care –Socially appropriate behavior

24 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following would be most appropriate for the treatment of mania associated with bipolar disorder? –A. Lithium –B. Fluoxetine –C. Citalopram –D. Venlafaxine

25 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Lithium Rationale: Lithium is an antimanic agent, which would be most appropriate for treating a manic patient with bipolar disorder. –Fluoxetine, citalopram, and venlafaxine are antidepressants.

26 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bipolar Disorder and Nursing Process Application (cont.) Intervention –Providing for safety –Meeting physiologic needs –Providing therapeutic communication –Promoting appropriate behaviors –Managing medications (see Tables 17.6 and 17.7) –Providing patient, family teaching Evaluation

27 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Suicide Intentional act of killing oneself Suicidal ideation: thinking about killing oneself Warning signs: risk for suicide (see Box 17.4)

28 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Suicide (cont.) Assessment: –Previous suicide attempts (first 2 years after— highest risk period, especially first 3 months); relative who committed suicide –Warnings of suicidal intent (see Box 17.4); risky behavior –Lethality assessment Data analysis/nursing diagnoses

29 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Suicide (cont.) Outcome identification –Safety, free from self-harm Intervention –Authoritative role –Safe environment: suicide precautions; no suicide/no self-harm contract –Support system list

30 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Suicide (cont.) Family response –Suicide as ultimate rejection of family, friends –Families react with guilt, shame, anger

31 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Suicide (cont.) Nurse’s response –Need for unconditional positive regard for person –Avoidance of patient blame –Nonjudgmental approach, tone –Belief that one person can make a difference in another’s life –Possible devastation of staff if patient commits suicide

32 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal and Ethical Considerations Assisted suicide as topic of national legal, ethical debate (Oregon, the first state to adopt assisted suicide into law) Nurse often cares for terminally or chronically ill people with poor quality of life. Nurse’s role to provide supportive care for patients, family as they work through decision-making process

33 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? When dealing with a patient who is suicidal, the nurse needs to assume a dependent role.

34 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: When dealing with a patient who is suicidal, the nurse must take an authoritative role.

35 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Elder Considerations Depression common among the elderly; marked increase when elders are medically ill –Psychotic features common –Increased intolerance to medications –ECT more commonly used for treatment; more rapid response Suicide increased among elderly

36 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Community-Based Care Nurses as first health-care professionals to recognize behaviors consistent with mood disorders Successful treatment of depression in community by psychiatrists, psychiatric advanced practice nurses, primary care physicians

37 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Community-Based Care (cont.) Bipolar disorder: referral to psychiatrist or psychiatric advanced practice nurse for treatment

38 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Health Promotion Education to address stressors contributing to depressive illness Efforts to improve primary care treatment of depression Prevention and early detection, treatment for adolescents

39 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Health Promotion (cont.) Screening for early detection of risk factors –Family strife –Parental alcoholism or mental illness –History of fighting –Access to weapons in the home

40 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Awareness Issues Importance of dealing with own feelings about suicide Frustration possible when working with depressed or manic patients Exhaustion possible when working with manic patients Journaling to help deal with feelings; talking with colleagues often helpful


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