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79 Cards in this Set
- Front
- Back
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Some drugs that are lethal if overdosed.
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Aspirin, trycyclic antidepressants, Tylenol
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Describe the suicide risk for single men.
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it is twice as high.
Men choose more lethal methods. women attempt more. |
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Describe Religion risk factors of suicide.
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affiliation with religions decreases risk.
Catholics are lowest % protestants and Jews are more prone. |
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What are the socioeconomic risk factors?
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Highest and lowest social classes have higher.
MIddle class has less. |
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What group is the highest among suicides?
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White men older than 80 years are at the greatest risk of all age/gender/race groups
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LIst in order of greatest risk races to lowest in suicide rates?
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Whites are at highest risk for suicide, followed by Native Americans, African
Americans, Hispanic Americans, and Asian Americans. |
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What is the most common Psychiatric Illness among suicides?
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mood disorders are the most common psychiatric illnesses that precede suicide.
Substance-related disorders Schizophrenia Personality disorders Anxiety disorders Severe insomnia is associated with increased risk of suicide Use of alcohol and barbiturates Psychosis with command hallucinations Affliction with a chronic painful or disabling illness Family history of suicide Homosexual individuals have a higher risk of suicide than heterosexuals |
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Patients that have commited suicide. What % has attempted?
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50%
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Define the acronym UNSAFE which is used for risk factors.
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– U nconnected—no support; sense of not belonging or being a burden
– N onadherence—unmanaged mental illness or co-occurring disorders – S tigma/shame related to past attempts or suicidal behavior – A buse history drug and/or alcohol misuse; prior attempt – F amily history of suicide or suicide attempts – E xacerbations—worsened mental illness, hospitalizations |
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Define the acronym SAFER which is used for protective factors.
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– S elf-help skills
– A dherence to treatment plan – F amily and community support – E ducation about risk factors, warning signs, and triggers for suicide – R ecovery and resilience |
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List the Psychological predisposing factors for suicide:
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Anger turned inward
Hopelessness Desperation and guilt History of aggression and violence Shame and humiliation Developmental stressors Predisposing Factors: Theories of Suicide (cont’d) Biological theories Genetics Possible genetic predisposition Neurochemical factors Serotonin deficiency |
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Describe the Assessment portion of Nurses with suicide
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Demographics
Age Gender Ethnicity Martial status Socioeconomic status Occupation Lethality and availability of method Religion Family history of suicide Presenting symptoms/medical-psychiatric diagnosis Suicidal ideas or acts Seriousness of intent Plan Means Verbal and behavioral clues Interpersonal support system Analysis of the suicidal crisis The precipitating stressor Relevant history Life-stage issues Psychiatric/medical/family history Coping strategies |
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Describe Nursing Process: Diagnosis/Outcome Identification
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Risk for suicide
Risk for self-directed violence Hopelessness |
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What is highest priority in Suicide?
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safety!
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list the Guidelines for treatment of the suicidal client on an outpatient basis
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Do not leave the person alone
Establish a no-suicide contract with the client Enlist the help of family or friends Schedule frequent appointments Establish rapport and promote a trusting relationship Be direct and talk matter-of-factly about suicide Discuss the current crisis situation in the client’s life Identify areas of self-control Give antidepressant medications |
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List Crisis counseling interventions with the suicidal client
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Focus on the current crisis and how it can be alleviated
Note client’s reactivity to the crisis and how it can be changed Work toward restoration of the client’s self-worth, status, morale, and control Introduce alternatives to suicide Rehearse more positive ways of thinking Identify experiences and actions that affirm self-worth and self-efficacy Encourage movement toward the new reality Be available for ongoing therapeutic support and growth |
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List the most important things a family should do for a suicidal client?
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Take any hint of suicide seriously
Do not keep secrets Be a good listener Express to the client feelings of personal worth Know about suicide intervention resources Restrict access to firearms or other means of self-harm Acknowledge and accept the person’s feelings Provide a feeling of hopefulness Do not leave him or her alone Show love and encouragement Seek professional help Remove children from the home Do not judge or show anger toward the person, or provoke guilt in him or her |
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List the Interventions with family and friends of suicide victims
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Encourage the person to talk about the suicide
Discourage blaming and scapegoating Listen to feelings of guilt and self-persecution Talk about personal relationships with the victim Recognize differences in styles of grieving Assist with development of adaptive coping strategies Identify resources that provide support ` |
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What % of Suicides are attempted by patients with a diagnosed mental illness?
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95%
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Epidemiological Factors of Suicide.
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More than 34,000 persons in the United States end their lives each year by suicide
Suicide is the – 3rd leading cause of death among Americans 15 to 24 years of age – 4th leading cause of death for ages 25 to 44 – 8th leading cause of death for ages 45 to 64 |
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Pathological depression occurs when?
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adaptation is ineffective.
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Epidemiology of Depression
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• One of the leading causes of disability in the United States
• During their lifetime, 21% of women and 13% of men will become clinically depressed • Gender differences • Incidence of depression is higher in women than in men by about 2 to 1 • Age • Ages 10 through middle age: women experience more depression • Ages 44 to 65: the difference lessens • After age 65: women tend to be more depressed • Gender stereotypes and social roles • Gender socialization • Female characteristics of helplessness, passivity, emotionality are associated with depression and lower self-esteem • Social class: • Higher rates of depression in lower socioeconomic classes |
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Epidemiology of Depression (culture)
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• Race and Culture: No consistent relationship between race and mood disorder has been reported.
• Depression is more prevalent in whites than blacks • Depression is more severe and disabling in blacks • Blacks are less likely to receive treatment than whites • Overdiagnosis of schizophrenia, underdiagnosis of mood disorders • Marital status: • Marriage has been found to have a positive effect on mental health • Single and divorced people more likely to experience depression than married people • Effects of age also affect these results • Seasonality: • Peak occurrences of mood disorders in the spring and fall (Seasonal Affective Disorder) • Suicides also peak in the spring and fall, with the highest number being in the spring • Proposed theories: • Temperature and barometric pressure • Sociodemographic variables • Biochemical variables |
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List the symptoms of Major Depressive Disorder:
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• Characterized by depressed mood most of the time
• Loss of interest or pleasure in usual activities (anhedonia) • Changes in sleep and eating • Psychomotor agitation or retardation • Fatigue or loss of energy • Feelings of worthlessness or guilt • Poor concentration or indecisiveness • Recurrent suicidal ideation or thoughts of death • No history of manic behavior • Social and occupational functioning impaired for at least two weeks • Cannot be attributed to use of substances or a general medical condition • Symptoms are not related to bereavement |
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Describe Dysthmic disorder. (lightest)
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• Sad or “down in the dumps”
• No evidence of psychotic symptoms • Essential feature is a chronically depressed mood for • Most of the day • More days than not • For at least 2 years • Early onset (before age 21) • Late onset (age 21 or older) |
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Describe Premenstrual Dysphoric Disorder
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Depressed mood
Anxiety Mood swings Decreased interest in activities Symptoms begin during week prior to menses and subside shortly after onset of menstruation |
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Describe Minor Depressive Disorder
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• Does not meet the diagnostic criteria for Major Depressive Disorder
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List the diagnoses Post-psychotic Depressive Disorder of Schizophrenia
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occurs during the residual phase of schizophrenia
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List the symptoms of Major Depressive Episode
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superimposed on the active phase of a psychotic disorder
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When a physician cannot determine if depression is primary
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could be due to medical condition or substance induced.
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What is the Patho of Neuroendocrine Disorders.
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• Failure within the hypothalamic-pituitary-adrenocortical axis
• Hyper-secretion of cortisol (stress hormone) • Diminished release of thyroid-stimulating hormone (TSH) |
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List • Physiological influences that influence depression.
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• Medication side effects
• Anxiolytics, antipsychotics, sedative-hypnotics • Steroids: prednisone, cortisone • Hormones: estrogen, progesterone • Analgesics and anti-inflammatory drugs • Antihypertensives: propranolol, reserpine • Acne medication: Accutane • Antibacterial, antifungal, antineoplastics, antiulcer drugs |
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List Neurological disorders that influence depression.
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• CVA
• Brain tumor • Alzheimer’s, Parkinson’s, Huntington’s • Multiple sclerosis |
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LIst Electrolyte disturbances than can influence depression.
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• Excessive sodium bicarbonate or calcium
• Deficits in magnesium and sodium • Increased or decreased potassium |
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List Hormonal Disorders that influence depression.
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• Dysfunction of adrenal cortex: Addison’s (chronic renal insufficiencey), Cushing’s (exposed to high levels of the hormone cortisol)
• Thyroid abnormalities |
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List Psychosocial circumstances that cause Depression.
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Learning theory
• Learned helplessness: Repeated failure to control life, leading to feelings of helplessness and dependence on others and a possible predisposition to depression. Psychoanalytical theory • Melancholia – mourning a loss • Anger turned inward • Object loss theory • Loss of significant other (mother) during first 6 months of life through abandonment or separation • Early loss or trauma may predispose client to lifelong periods of depression • Reaction to loss in adult life may be more severe after early childhood losses Cognitive theory: Views underlying cause of depression as cognitive rather than affective Three cognitive distortions that serve as the basis for depression: Negative expectations of the environment Negative expectations of the self Negative expectations of the future Transactional Model of Stress/Adaptation It is most likely that depressive disorder is caused by a combination of factors: Genetic: family history of depression, biochemical alterations Past Experiences: anger, failure, loss, cognitive problems Existing Conditions: poor coping skills, lack of support system, neuroendocrine disturbances, medication side effects, other physiological conditions Cognitive appraisal: threat to self-esteem or loss of self-esteem |
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List Childhood Depression Symptoms
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• Under age 3: feeding problems, tantrums, lack of playfulness and emotional expressiveness
• Ages 3 to 5: accident proneness, phobias, excessive self-reproach • Ages 6 to 8: physical complaints, aggressive behavior, clinging behavior • Ages 9 to 12: morbid thoughts and excessive worrying • Usually is precipitated by a loss • Use of antidepressants is controversial – black box warning about suicidal tendencies • Focus of therapy: • Alleviate symptoms and strengthen coping skills • Parental and family therapy |
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List Adolescent Depression symptoms
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Symptoms include
Anger, aggressiveness Running away Delinquency Social withdrawal Sexual acting out Substance abuse Restlessness; apathy Loss of self-esteem Sleeping and eating changes Psychosomatic complaints |
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Diagnostically diagnosing Adolescent depression
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Best clue that differentiates depression from normal stormy adolescent behavior:
A visible manifestation of behavioral change that lasts for several weeks Most common precipitant to adolescent suicide: perception of abandonment by parents or close peer relationship Treatments: antidepressants and psychosocial therapies Use of antidepressants is controversial – black box warning about suicidal tendencies |
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Describe Postpartum depression
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May last for a few weeks to several months
Symptoms include Depressed mood Fatigue Irritability Loss of appetite Sleep disturbances Loss of libido Concern about ability to care for infant Treatments: antidepressants and psychosocial therapies Associated with hormonal changes, tryptophan metabolism, or cell alterations |
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Geriatric Depression
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Bereavement overload from many losses: health, income, family, friends, independence
High percentage of suicides among elderly, especially white males over 85 years old Symptoms of depression are often confused with symptoms of dementia Treatment Antidepressant medication Electroconvulsive therapy Psychosocial therapies |
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list the symptoms of Transient depression
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Symptoms at this level of the continuum are not necessarily dysfunctional
Symptoms are relieved quickly without intervention Affective: The “blues” Behavioral: Some crying Cognitive: Some difficulty getting mind off one’s disappointment Physiological: Feeling tired and listless |
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List the Symptoms of Mild depression
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Symptoms of mild depression are identified by clinicians as similar to those associated with normal grieving
Affective: Anger, anxiety, sadness, hopelessness Behavioral: Tearfulness, regression, withdrawal Cognitive: Preoccupied with loss Physiological: Anorexia, insomnia, psychosomatic complaints |
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list symptoms of Moderate depression
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Symptoms equivalent to those associated with dysthymic disorder
Affective: Helplessness, powerlessness, low self-esteem, anhedonia Behavioral: Slowed physical movements, slumped posture, limited verbalization Cognitive: Retarded thinking processes, difficulty with concentration Physiological: Anorexia or overeating, sleep disturbance, headaches |
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List of symptoms for Severe depression
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Includes symptoms of major depressive disorder or bipolar depression
Affective: Feelings of total despair, worthlessness, flat affect, anhedonia Behavioral: Psychomotor retardation, curled-up position, absence of communication, poor hygiene and grooming Cognitive: Difficulty concentrating Possible delusional thinking, with delusions of persecution and somatic delusions Self-blame Confusion Suicidal thoughts Physiological: A general slow-down of the entire body, changes in eating and sleeping, psychosomatic symptoms |
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List the Nursing Diagnoses
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Risk for self-harm or risk for suicide related to
Depressed mood Feelings of worthlessness Misinterpretations of reality Self-care deficit related to depressed mood Imbalanced nutrition less than body requirements related to depressed mood Insomnia related to depressed mood Disturbed thought processes related to Withdrawal into self Impaired cognition fostering negative perception of self or environment Psychotic symptoms Powerlessness related to Complicated grieving process Lifestyle of helplessness Low self-esteem related to Learned helplessness Feelings of abandonment by significant others Impaired cognition fostering negative view of self Complicated grieving related to Real or perceived loss Bereavement overload Spiritual distress related to complicated grieving process Maintaining client safety Ensuring that basic needs related to nutrition, elimination, activity, rest, and personal hygiene are met Encouraging the client to take medication as ordered Promoting increase in self-esteem Assisting client to define and test reality Encouraging client acceptance of the psychiatric diagnosis Encouraging appropriate interaction with others Encouraging client self-control and control over life situation Assistance in confronting anger that has been turned inward on the self Helping client to reach out for spiritual support of choice Assisting client through grief process Encouraging the client to continue medication after discharge keep all outpatient follow-up appointments Has self-harm to the client been avoided? Has suicidal ideation subsided? Does the client know where to seek assistance outside the hospital when suicidal thoughts occur? Does the client have follow-up care established? Does the client agree to keep appointments and take medications as ordered? Is the client’s family aware of arrangements for follow-up care? Is the client making plans for the future? Is the client able to verbalize positive aspects about self, past accomplishments, and future prospects? Can the client identify areas of life situation over which he or she has control? Does the client set realistic goals? Risk for self-harm or risk for suicide related to Depressed mood Feelings of worthlessness Misinterpretations of reality Self-care deficit related to depressed mood Imbalanced nutrition less than body requirements related to depressed mood Insomnia related to depressed mood Disturbed thought processes related to Withdrawal into self Impaired cognition fostering negative perception of self or environment Psychotic symptoms Powerlessness related to Complicated grieving process Lifestyle of helplessness Low self-esteem related to Learned helplessness Feelings of abandonment by significant others Impaired cognition fostering negative view of self Complicated grieving related to Real or perceived loss Bereavement overload Spiritual distress related to complicated grieving process Interventions focus on: Maintaining client safety Ensuring that basic needs related to nutrition, elimination, activity, rest, and personal hygiene are met Encouraging the client to take medication as ordered Promoting increase in self-esteem Assisting client to define and test reality Encouraging client acceptance of the psychiatric diagnosis Encouraging appropriate interaction with others Encouraging client self-control and control over life situation Assistance in confronting anger that has been turned inward on the self Helping client to reach out for spiritual support of choice Assisting client through grief process Encouraging the client to continue medication after discharge keep all outpatient follow-up appointments Has self-harm to the client been avoided? Has suicidal ideation subsided? Does the client know where to seek assistance outside the hospital when suicidal thoughts occur? Does the client have follow-up care established? Does the client agree to keep appointments and take medications as ordered? Is the client’s family aware of arrangements for follow-up care? Is the client making plans for the future? Is the client able to verbalize positive aspects about self, past accomplishments, and future prospects? Can the client identify areas of life situation over which he or she has control? Does the client set realistic goals? The most effective approach is a combination of psychotherapy and pharmacology Individual Psychotherapy: focus on client’s current interpersonal relationships Group Therapy: after the acute illness has passed, provides peer support, may be a self-help group Family Therapy: focus on restoring adaptive family functioning Cognitive Therapy: focus on identifying dysfunctional ways of thinking and behaving, changing automatic thoughts Electroconvulsive Therapy: induction of a seizure, generally used after antidepressant medications have failed Transcranial Magnetic Stimulation: stimulation of neurons in the brain using very short pulses of magnetic energy Light Therapy: especially effective with Seasonal Affective Disorder (SAD), helps decrease overproduction of melatonin Antidepressants: used to treat dysthymic disorders, major depressive disorder, depression associated with other conditions, anxiety disorders, bulimia nervosa, and premenstrual dysphoric disorder. |
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Define Bi-Polar Disorder
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• It is characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy.
• Delusions or hallucinations may or may not be part of clinical picture. • Onset of symptoms may reflect a seasonal pattern. • Mania is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking. • Mania can occur as a biological (organic) disorder, or as a response to substance use or a general medical condition. • A somewhat milder form of mania is called hypomania. |
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Define Detur the High
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Distractibility
Talkativeness Reckless behavior Hyposomnia Ideas that Race Grandiosoity Hypersexuality |
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Describe Epidemiology of Bipolar Disorder
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Epidemiology
• Bipolar disorder affects approximately 5.7 million American adults. • Gender incidence roughly equal: ratio of women to men about 1.2 to 1 • Average age at onset is the early 20s. • Occurs more often in the higher socioeconomic classes. • Sixth leading cause of disability in the middle age group. |
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Describe • Bipolar I disorder
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• Is experiencing, or has experienced, a full syndrome of manic or mixed symptoms
• May also have experienced episodes of depression |
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Describe • Bipolar II disorder
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• Characterized by bouts of major depression with episodic occurrence of hypomania
• Has never met criteria for full manic episode |
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Describe • Bipolar disorder, mixed
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• Symptoms include rapidly alternating moods (sadness, irritability, euphoria) accompanied by symptoms associated with both depression and mania
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Define • Cyclothymic disorder
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• Chronic mood disturbance
• At least 2-year duration • Numerous episodes of hypomania and depressed mood of insufficient severity to meet the criteria for either bipolar I or II disorder • Other bipolar disorders • Bipolar disorder due to a general medical condition • Substance-induced bipolar disorder |
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LIst the biological theories of Bipolar Disorder
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• Strong hereditary implications
• Biochemical influences: possible excess of norepinephrine and dopamine |
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Describe the Physiological Influences of Bipolar Disorder
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Brain lesions
• Medication side effects |
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List the psychosocial theories of Bipolar disorder
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• Credibility of psychosocial theories has declined in recent years.
• Bipolar disorder is viewed as a disease of the brain. • Transactional model • Bipolar disorder most likely results from an interaction between genetic, biological, and psychosocial determinants. |
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Information regarding Childhood Bipolar
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• Lifetime prevalence of pediatric and adolescent bipolar disorders is estimated at about 1%.
• Diagnosis is difficult. • Guidelines for diagnosis and treatment have been developed by the Child and Adolescent Bipolar Foundation (CABF). • The CABF recommends the use of FIND (frequency, intensity, number, and duration) in making a diagnosis of bipolar disorder in children and adolescents. |
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Define FIND by the CABF
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the Child and Adolescent Bipolar Foundation (CABF).
• FIND • Frequency: symptoms occur most days in a week • Intensity: symptoms are severe enough to cause extreme disturbance • Number: symptoms occur 3 or 4 times a day • Duration: symptoms occur 4 or more hours a day |
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Childhood depression describe symptons
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• Euphoric/expansive mood: extremely happy, silly, or giddy
• Irritable mood: hostility and rage, often over trivial matters • Grandiosity: believes abilities to be better than everyone else’s • Decreased need for sleep: may sleep for only 4 or 5 hours per night and wake up feeling rested • Pressured speech: loud, intrusive, difficult to interrupt • Racing thoughts: rapid change of topics • Distractibility: unable to focus on school lessons • Increase in goal-directed activity/psychomotor agitation: activities become obsessive; increased psychomotor agitation • Excessive involvement in pleasurable or risky activities: exhibits behavior that has an erotic, pleasure-seeking quality about it • Psychosis: may experience hallucinations and delusions • Suicidality: may exhibit suicidal behavior during a depressed or mixed episode or when psychotic |
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List the Psychopharmacology treatments for Adolescent and childhood Bi-Polar
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• Psychopharmacology
• Lithium • Divalproex • Carbamazepine • Atypical antipsychotics |
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List the Family interventions for children and Adolescent Bi-Pilor
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• Psychoeducation about bipolar disorder
• Communication training • Problem-solving skills training • ADHD is the most common comorbid condition. • ADHD agents may exacerbate mania and should be administered only after bipolar symptoms have been controlled. |
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Nursing Assessment Stage 1-Hypomania
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Symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization
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Nursing Assessment Stage 2-Acute mania
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Marked impairment in functioning of mood, cognition and perception, and activity and behavior; usually requires hospitalization
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Nursing Assessment Stage 3-Delirious Mania
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A grave form of the disorder, characterized by severe clouding of consciousness and representing an intensification of the symptoms associated with acute mania; the condition is rare since the advent of antipsychotic medication
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Nursing Diagnosis
• Risk for injury related to |
• Extreme hyperactivity, increased agitation, and lack of control over purposeless and potentially injurious movements
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• Risk for violence: self-directed or other-directed related to
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• Manic excitement
• Delusional thinking • Hallucinations • Impulsivity |
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• Disturbed thought processes related to
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• Biochemical alterations in the brain, evidenced by delusions of grandeur and persecution and inaccurate interpretation of the environment
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• Disturbed sensory perception related to
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• Biochemical alterations in the brain and to possible sleep deprivation, evidenced by auditory and visual hallucinations
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• Imbalanced nutrition less than body requirements related to
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• Refusal or inability to sit still long enough to eat, evidenced by loss of weight, amenorrhea
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• Impaired social interaction related to
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• Egocentric and narcissistic behavior
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• Insomnia related to
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• Excessive hyperactivity and agitation
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Criteria for Measuring Outcomes
• The client |
Exhibits no evidence of physical injury
• Has not harmed self or others • Is no longer exhibiting signs of physical agitation • Eats a well-balanced diet with snacks to prevent weight loss and maintain nutritional status • Verbalizes an accurate interpretation of the environment • Verbalizes that hallucinatory activity has ceased and demonstrates no outward behavior indicating hallucinations • Accepts responsibility for own behaviors • Does not manipulate others for gratification of own needs • Interacts appropriately with others |
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When evaluating the client what are you looking for?
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• Evaluation of the effectiveness of the nursing interventions is measured by fulfillment of the outcome criteria.
• Has the client avoided personal injury? • Has violence to client or others been prevented? • Has agitation subsided? • Have nutritional status and weight been stabilized? • Have delusions and hallucinations ceased? • Is the client able to make decisions about own self-care? • Is behavior socially acceptable? • Is the client able to sleep 6 to 8 hours per night and awaken feeling rested? • Does the client understand the importance of maintenance medication therapy? |
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LIst the treatment modalities of Bipolar Disorder?
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• Individual psychotherapy
• Group therapy • Family therapy • Cognitive therapy • Electroconvulsive therapy |
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Discuss the • The recovery model
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• A concept of healing and transformation enabling a person with mental illness to live a meaningful life in the community while striving to achieve his or her full potential.
• A shift in the paradigm of care of persons with serious mental illness from the traditional medical psychiatric treatment toward the concept of recovery. • Components of the recovery model • Self-direction • Individualized and person-centered • Empowerment • Holistic • Non-linear • Strengths-based • Peer support • Respect • Responsibility • Hope • The recovery model integrates • Services provided by professionals • Services provided by consumers • Services provided in collaboration |
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In order to diagnose Major Depressive Disorder the client must have 5 of what for at least 2 weeks?
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• Sleep disturbance (increased or decreased)
• Interest reduced (not enjoying anything) • Guilt sensation and worthlessness • Energy loss and fatigue • Concentration problems • Appetite problem (increased or decreased) • Psychomotor agitation or retardation • Suicidality |
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Echopraxia
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is the involuntary repetition or imitation of the observed movements of another. It is closely related to echolalia, the involuntary repetition of another's speech.
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Echolalia
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the involuntary repetition of another's speech.
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Cholinergic transmission in mania and depression?
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excessive in depression and inadequate in mania.
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