Chapter 17 Mood Disorders & Suicide Flashcards
Anergia
Lack of energy
“Low periods” tend to be accompanied by…
… anergia, exhaustion, agitation, noise intolerance, & slow thinking processes
Mood
A pervading feeling and sustained emotion
Subjective symptom: Typically not able to be observed
- Based off patient’s report
Influences one’s perception of the world and how one functions
Euthymic Mood
Normal or level mood
Mood Disorder
AKA “Affective Disorders”
Pervasive alterations in emotions that are manifested by depression, mania, or both
Disturbances in regulation of mood, affect, & behavior that go beyond the normal fluctuations in mood that most people experience.
In mood disorders, mood often becomes so intense and persistent that it interferes with social and psychological functioning.
What are the primary mood disorders?
Major depressive disorder & bipolar disorder (BPD)(formerly known as manic-depressive illness)
Major Depressive Disorder (MDD)
Persistent sad mood lasting 2 or more weeks, accompanied by several other symptoms
Onset: usually early adulthood, with recurrences throughout life
Often goes undiagnosed or misdiagnosed
More commonly diagnosed in females
More common in single and divorced individuals
Greater incidence in first-degree relatives
May greatly alter social, family, occupational, and physical functioning
Ranks high among causes of disability
High risk for suicide
Major Depressive Episode
Person experiences a depressed mood or loss of pleasure in nearly all activities that lasts at least 2 WEEKS
Signs & Symptoms:
- Change in eating habits: Unplanned weight gain/loss
- Hypersomnia or Insomnia
- Impaired concentration, decision-making, or problem-solving abilities
- Inability to cope w/ daily life
- Feelings of worthlessness, hopelessness, guilt, or despair
- Thoughts of death &/suicide
- Overwhelming fatigue
- Rumination w/pessimistic thinking w/ no hope for improvement
Result in significant distress or impairment of social, occupational, or other important areas of functioning
Age Disparities & Depressive Disorders
Children with depressive disorders:
- More likely to experience anxiety symptoms
- Less interaction with peers
- Irritable rather than sad mood
Risk of suicide peaks during mid-adolescent years
Suicide is 2nd leading cause of death for those 10-12 years old
Universal screening is recommended for early identification and prevention
Slower treatment response in older adults
Highest suicide rate in people 65 years and older
Considerations for Pediatric Suicide Screening
Predictors of Suicide Attempts: Depressive disorder, being bullied, unsafe home or school environment, emotional trauma
- Alcohol use is a significant predictor in young adults
Children w/ Depression: Difficult to ID & diagnose in certain age groups (behaviors that are considered “age-appropriate” can mask symptoms)
- Can be cranky
- School phobia
- Hyperactivity
- Learning disorders
- Failing grades
- Antisocial behavior
Adolescents w/ Depression May:
- Join gangs
- Abuse substances
- Engage in risky behavior
- Be underachievers
- Drop out of school
Depression in Older Adults
Common among older adults and is markedly increased when they are medically ill
- Older adults that are cranky & argumentative can have depression
Tend to have psychotic features, particularly delusions, more frequently than younger people w/ depression
Suicide among persons older than 65 years is double the rate of suicide of persons younger than 65.
As more people reach older ages, bipolar disorder is no longer a rarity in older adults.
- Majority of individuals in this population with bipolar disorder have symptoms starting earlier in life, whereas individuals w/ a later onset (after age 50) are more rare
Treated for depression with ECT more frequently than younger persons.
- Older adults have increased intolerance of side effects of antidepressant medications and may not be able to tolerate doses high enough to effectively treat the depression.
- ECT produces a more rapid response than medications, which may be desirable if the depression is compromising the medical health of the older adult.
Because the rate of suicide among older adults is high, using treatment that produces the most rapid response becomes even more important
Major Depressive Disorder (MDD) Sign & Symptom Assessment
Depressed mood (e.g., “feels sad, empty, hopeless”; appears tearful; irritable mood)
Anhedonia
Neurovegetative symptoms:
- Change in appetite and unintended significant weight change (loss more common)
- Change in bowel habits, sleep disturbances, and ↓ interest in sexual activity
- Fatigue, tiredness, or loss of energy; insomnia or hypersomnia
Psychomotor agitation (e.g., hand wringing) or retardation (e.g., slow movements)
Feelings of worthlessness or excessive/inappropriate feelings of guilt
Decreased ability to think, concentrate, or make decisions
Recurrent thoughts of death, recurrent suicidal ideation (w/o plan), suicide attempt, or specific plan
Delusions and hallucinations (psychotic depression); about 20%
Anhedonia
Significantly diminished interest or pleasure
MDD Assessment Screening Tools
Lethality assessment
Frequency and dosage of prescribed and over-the-counter medications
Use of herbal substances or culturally related treatments
Use of alcohol, illegal substances, and other mood-altering medications
Psychological tests/standardized screening tools – examples:
- Beck Depression Inventory (BDI)
- Patient Health Questionnaire (PHQ-9)
- Zung Self-Rating Depression Scale
- Hamilton Depression Scale (a clinician rating scale; see Box 17.1 in Videbeck, 2023)
- Columbia Suicide Severity Rating Scale (CSSRS)
MDD Treatment: Acute Phase
Complex & Severe Depression
Primary treatment goal = safety; symptom reduction or remission
Mental health services specialist referral
Crisis resolution (inpatient care or home treatment teams)
Pharmacologic management with careful monitoring and follow-up
Assess and reassess for suicide risk; implement level of observation in concert with level of risk (e.g., suicide precautions, 1:1 observation) – promote safety!
MDD Treatment: Continuation Phase
Moderate depression, increased ability to function
Primary treatment goal = relapse prevention of current episode
Antidepressant medications – promote medication adherence
Combine and augment medications (e.g., add lithium, an antipsychotic, or another antidepressant)
High-intensity psychosocial interventions and psychoeducation
Counseling
Short-term psychodynamic psychotherapy
Assess for suicide risk and intervene accordingly –
promote safety!
Mental health services specialist referral
MDD Treatment: Maintenance Phase
Mild to moderate depression, remission of symptoms
Primary treatment goal = prevent future depressive episodes
Treat co-existing anxiety
Promote sleep hygiene
Active monitoring
Low-intensity psychosocial interventions
Group CBT
Antidepressant medications for some patients (e.g., high risk for recurrence)
General Nursing Interventions for MDD
Promote safety
Provide for physical needs; promote self-care, personal hygiene, and sleep hygiene
Encourage food and fluid intake and physical activity
Plan patient activities when their energy level is at its peak
Actively initiate communication with patient; document all observations and conversations
Encourage patient to write down and talk about feelings; listen attentively
Provide a structured routine; urge socialization and joining group activities
Promote sleep and rest
Stress management and relaxation techniques; positive coping skills
When is bipolar disorder (BD) diagnosed?
Diagnosed when a person’s mood fluctuates to extremes of mania and/or depression
Mania
A distinct period during which mood is abnormally and persistently elevated, expansive, or irritable
Typically lasts ~1 week (unless the person is hospitalized and treated sooner), but it may be longer for some individuals
Signs & Symptoms:
- Inflated self-esteem or grandiosity
- Decreased sleep
- Excessive & pressured speech
- Flight-of-ideas
- Distractibility
- Increased activity or psychomotor agitation
- Excessive involvement in pleasure-seeking or risk-taking activities w/ high potential for painful consequences
Mood: May be excessively cheerful, enthusiastic, and expansive, or the person may be irritable, especially when they are told no or have to follow rules.
- Person often denies any problems, placing the blame on others for any difficulties they experience.
- Some people also exhibit delusions and hallucinations during a manic episode
Pressured Speech
Unrelenting, rapid, often loud talking without pauses
Flight-of-Ideas
Racing, often unconnected, thoughts
Hypomania
A period of abnormally and persistently elevated, expansive, or irritable mood and some other milder symptoms of mania
Key Difference: Does not impair the person’s ability to function (in fact, they may be quite productive), and there are no psychotic features (delusions and hallucinations)
Mixed
AKA “Rapid Cycling”
Diagnosed when the person experiences both mania and depression nearly every day for at least 1 week.
Bipolar I Disorder
1 or more manic or mixed episodes usually accompanied by major depressive episodes
Bipolar II DIsorder
1 or more major depressive episodes accompanied by at least one hypomanic episode
Persistent Depressive (Dysthymic) Disorder
A chronic, persistent mood disturbance characterized by symptoms such as:
- Insomnia
- Loss of appetite
- Decreased energy
- Low self-esteem
- Difficulty concentrating
- Feelings of sadness and hopelessness that are milder than those of depression
Disruptive Mood Dysregulation Disorder
A 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
Cyclothymic Disorder
Characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning
Substance-Induced Depressive/Bipolar Disorder
Characterized by a significant disturbance in mood that is a direct physiological consequence of ingested substances such as alcohol, other drugs, or toxins
Fall-Onset Seasonal Affective Disorder (SAD)
AKA “Winter Depression”
People experience:
- Increased sleep, appetite, and carbohydrate cravings
- Weight gain
- Interpersonal conflict
- Irritability
- Heaviness in the extremities beginning in late autumn and abating in spring and summer
Spring-Onset Seasonal Affective Disorder (SAD)
Less Common
Symptoms of: Insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall
What is the treatment for seasonal affective disorder (SAD)?
Light therapy
Non-suicidal Self-Injury
Involves deliberate, intentional cutting, burning, scraping, hitting, or interference with wound healing.
Some persons who engage in self-injury report reasons of alleviation of negative emotions, self-punishment, seeking attention, or escaping a situation or responsibility.
Others report the influence of peers or the need to “fit in” as contributing factors
Kindling
The process by which seizure activity in a specific area of the brain is initially stimulated by reaching a threshold of the cumulative effects of stress, low amounts of electric impulses, or chemicals such as cocaine that sensitize nerve cells and pathways
