Chapter 17 Mood Disorders & Suicide Flashcards

1
Q

Anergia

A

Lack of energy

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2
Q

“Low periods” tend to be accompanied by…

A

… anergia, exhaustion, agitation, noise intolerance, & slow thinking processes

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3
Q

Mood

A

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

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4
Q

Euthymic Mood

A

Normal or level mood

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5
Q

Mood Disorder

A

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.

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6
Q

What are the primary mood disorders?

A

Major depressive disorder & bipolar disorder (BPD)(formerly known as manic-depressive illness)

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7
Q

Major Depressive Disorder (MDD)

A

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

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8
Q

Major Depressive Episode

A

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

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9
Q

Age Disparities & Depressive Disorders

A

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

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10
Q

Considerations for Pediatric Suicide Screening

A

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

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11
Q

Depression in Older Adults

A

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

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12
Q

Major Depressive Disorder (MDD) Sign & Symptom Assessment

A

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%

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13
Q

Anhedonia

A

Significantly diminished interest or pleasure

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14
Q

MDD Assessment Screening Tools

A

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)

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15
Q

MDD Treatment: Acute Phase

A

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!

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16
Q

MDD Treatment: Continuation Phase

A

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

17
Q

MDD Treatment: Maintenance Phase

A

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)

18
Q

General Nursing Interventions for MDD

A

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

19
Q

When is bipolar disorder (BD) diagnosed?

A

Diagnosed when a person’s mood fluctuates to extremes of mania and/or depression

20
Q

Mania

A

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

21
Q

Pressured Speech

A

Unrelenting, rapid, often loud talking without pauses

22
Q

Flight-of-Ideas

A

Racing, often unconnected, thoughts

23
Q

Hypomania

A

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)

24
Q

Mixed

A

AKA “Rapid Cycling”

Diagnosed when the person experiences both mania and depression nearly every day for at least 1 week.

25
Q

Bipolar I Disorder

A

1 or more manic or mixed episodes usually accompanied by major depressive episodes

26
Q

Bipolar II DIsorder

A

1 or more major depressive episodes accompanied by at least one hypomanic episode

27
Q

Persistent Depressive (Dysthymic) Disorder

A

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

28
Q

Disruptive Mood Dysregulation Disorder

A

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

29
Q

Cyclothymic Disorder

A

Characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning

30
Q

Substance-Induced Depressive/Bipolar Disorder

A

Characterized by a significant disturbance in mood that is a direct physiological consequence of ingested substances such as alcohol, other drugs, or toxins

31
Q

Fall-Onset Seasonal Affective Disorder (SAD)

A

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

32
Q

Spring-Onset Seasonal Affective Disorder (SAD)

A

Less Common

Symptoms of: Insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall

33
Q

What is the treatment for seasonal affective disorder (SAD)?

A

Light therapy

34
Q

Non-suicidal Self-Injury

A

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

35
Q

Kindling

A

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

36
Q
A