Adaptive functions of emotions Social communication Physiological arousal Subjective awareness Psychodynamic defense
Adaptive emotional responses Implies an openness and awareness of feelings An example is an uncomplicated grief reaction
Maladaptive emotional responses A detachment or denial of one’s feelings Suppression of emotions and a delayed grief reaction are examples of a maladaptive response Mania and depression are other examples.
Grief Is the subjective state that follows loss Two types of pathological grief reactions are: delayed grief reaction and distorted grief reaction (depression)
Lifetime Risk for Depression For women 20-30% risk For men 7-12% risk Depression often occurs along with other medical and psychiatric illnesses
Bipolar Disorders A depressive episode with previous or current manic episodes. Mania is an elevated or irritable mood.
Depression Behaviors may vary. Key element here is change in assessing behavior A change in usual behavior patterns The most common behaviors are depressive mood, anxiety, and somatic complaints.
Risk Factors for depression Prior episodes of depression Fhx Prior suicidal attempts Female gender Age at onset < 40 years old Medical comorbidity Personal hx of sexual abuse Substance abuse
Postpartum blues Are brief episodes lasting 1-4 days that occur in 50- 80 % of women within 1-5 days of delivery. Postpartum depression occurs from 2-12 months after delivery, risk is 10- 15%. Postpartum psychosis- low incidence, onset 2-3 days post delivery.
Seasonal Affective Disorder (SAD) Depression that comes with shortened hours of daylight in winter and fall and disappears during spring and summer.
Potential for suicide 15% of severely depressed patients commit suicide 25-50% of patients with bipolar disorder attempt suicide at least once.
Predisposing Factors of depression Genetics in the case of recurrent depression and bipolar disorder. Aggression turned inward theory (Freud)-anger turned inward Object loss theory -ruptured tie between mother and child Personality organization theory- poor self-concept cognitive model-related to disturbed thinking Helplessness/hopelessness model- no control over outcomes in life Behavioral model- person affects environment with reinforcement variable
Biological Model Mood disorders result from dysregulation in neurotransmitter systems, particularly serotonin. (5-HT) And from mechanisms that control hormonal balance (cortisol, GH, and prolactin) and biological rhythms.
Precipitating stressors and mood disorders Loss of attachment (death) Life events ( physical and sexual abuse) Role strain (gender related work& home) Physiological changes (meds and illnesses)
Coping Mechanisms Mourning and bereavement; Mourning begins with introjection-directing your feelings toward the mental image of a loved one. This serves as a buffering mechanism.
NANDA Diagnoses Dysfunctional grieving Hopelessness Powerlessness Spiritual distress Risk for suicide Risk for self directed violence
Nursing outcome Patient will be emotionally responsive and return to a pre-illness level of functioning
Planning care Reduction and removal of maladaptive emotional responses Restoration of the patient’s occupational and psychosocial functioning
Planning care cont. Improvement in the patient’s quality of life Minimization of the likelihood of relapse and recurrence
3 Phases of Treatment Acute treatment- goal is to eliminate symptoms (6-12 weeks) Continuation treatment- goal is to prevent relapse ( the return of symptoms) and to promote recovery (4-9 months) Maintenance treatment-goal is to prevent recurrence- a new episode of illness (1 or more years)
Nursing Interventions address: Environmental issues- highest priority should be given to the potential for suicide. Nurse-patient issues-supportive companionship Physiological treatments-(meds, ECT,sleep deprivation, & phototherapy) Expressing feelings-encourage expression of hope Cognitive strategies-help patient explore their feelings, increase positive thinking by reviewing strengths.
Nursing Interventions address: Behavioral changes- give reinforcement to accomplishing positive activities, occupational and recreational activities. Also encourage movement and physical exercise. Social skills model effective social behaviors to increase self-esteem Mental health education for patient and the family to increase family functioning and decrease symptomatology.
Mental Health Education cont. Communicate that mood disorders are a medical illness, not a character defect Recovery is the rule, not the exception Mood disorders are treatable illnesses Goal of intervention is not just to get better, but to get and stay completely well.