Exam 3 Flashcards
The painful emotional response to the loss of something or someone significant
Grief
Clients experiencing a painful loss go through some predictable stages:
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
Kubler-Ross Model of Grief
Initially, clients may have difficulty accepting that the loss has really occurred. This is a common first reaction.
Denial
Clients who are grieving often experience strong feelings of ____. They may express ____ toward self, others, or even the lost person.
Anger
During grief, clients may attempt to strike a deal with God or some higher power for an alternative plan. For example, a person may plead, “If you will let me live to see my daughter’s wedding, I’ll accept my cancer diagnosis.”
Bargaining
Of course, clients that are grieving will experience intense feelings of sadness, sorrow, and loss.
Depression
Eventually, most clients come to accept the loss. They utilize coping strategies and become less preoccupied with it. That’s not to say they no longer feel the loss of grieve. They still have ups and downs, but they’ve found new ways to stay connected to the loss as they continue life.
Acceptance
Are the stages of grief set in stone? (Meaning, does everyone experience every stage?)
No, not everyone experiences every stage of grief. Also, it is possible that the stages are not experienced in the order they are listed.
Clients experience the stages of grief. Somatic complaints are common. Some authors say that clients usually achieve some degree of acceptance by 6 months, but each situation is unique and there is no set time limit for grieving.
Normal grief
Occurs when a client experiences the stages of grief before the loss occurs. Sometimes clients are not aware they are experiencing this type of grief since the loss has not yet occured.
Anticipatory grief
Occurs when the grief response may be inhibited, exaggerated, or prolonged. A helpful way to distinguish this from normal grief is that this is often accompanied by feelings of worthlessness or low self-esteem.
Maladaptive grief
Occurs when an individual experiences too many losses at too rapid of a pace. Older adults are especially prone to experiencing this.
Bereavement overload
Two types of mood disorders
Depressive disorders and Bipolar disorders
Depressive disorders
Major depressive disorder, Dysthymia, Premenstrual dysphoric disorder
Bipolar disorders
Bipolar 1, Bipolar 2, Cyclothymia
Clients have a depressed mood and/or loss of interest in pleasurable activities (anhedonia). Clients can feel extreme guilt and feelings of worthlessness. Sleep abnormalities are common. Appetite changes are common. Clients can be incredibly fatigued, making it difficult to get out of bed. Some clients experience psychomotor agitation and irritation. Suicidal thoughts and behaviors can occur.
Major Depressive disorder
Depression subtype- This is a severe version of depression in which a client’s mood is extremely dark and unremitting. Even extremely positive news will not temporarily lift the client’s spirits. Clients often experience early morning awakenings and loss of appetite. Suicidal ideation is common.
Melancholic features
Some clients with depression experience delusions that involve strong feelings of guilt. They may believe they are responsible for someone’s death or a natural catastrophe. Alternatively, they may believe they have a severe illness or that their body is “rotting.” Auditory hallucinations can also occur.
Mood-congruent psychotic features
This is a form of depression that reoccurs seasonally (usually winter). Light therapy is an effective treatment.
Seasonal patterns
This subtype of depression is associated with pregnancy. Some of these clients will develop psychotic features.
Peripartum onset
What are some psychological factors of depression?
-negative beliefs abut the world, themselves, and the future
-cognitive distortions such as all-or-nothing thinking, personalization, mind reading, and discounting positives.
What are some biological factors of depression?
-Deficiencies of serotonin, norepinephrine, and dopamine in the brain
-A medical condition such as hypothyroidism
-Medication use (e.g. alcohol, beta blockers, steroids, withdrawing from a stimulant like cocaine or amphetamine)
Effective treatment options for depression
-Psychotherapy (CBT, group therapy)
-Pharmacotherapy (antidepressants: SSRIs- first-line agents, SNRIs, TCAs, and MAOIs)
-Brain stimulation Therapies (Electroconvulsive therapy, Transcranial magnetic stimulation)
An effective option for clients who are extremely suicidal or have failed numerous other treatments for depression
ECT (Electroconvulsive therapy)
A procedure in which strong magnetic pulses are sent through the skull into the brain (usually the left prefrontal cortex). The evidence for this treatment for depression is not as strong as other options
TMS (Transcranial magnetic stimulation)
Nursing interventions for depression
-SAFETY. Assess for suicidal ideation often and monitor closely.
-Convey empathy and unconditional positive regard
-Teach the stages of grief and explain that these are normal feelings
-Allow clients to express anger and don’t take offence. Physical activity may also be a healthy outlet.
-Explain that crying is okay. Use silence; don’t rush to change the subject
-Encourage clients to seek out spiritual support and a support group
-Teach clients with low self-esteem assertiveness techniques
-Explain that antidepressants can take up to 4 weeks to begin working
Clients with this disorder experience both sides of the mood scale. Mania- feel exuberant, confident, highly creative, endless energy, constantly moving about, little to no need for sleep, pressured speech, dangerous behaviors (drugs, risky sex, reckless spending), highly distractible. Agitated outbursts are common, psychotic delusions nd hallucinations may also occur. Mania usually ends with a crash into deep depression
Bipolar disorder
A less severe version of mania. Clients experience an elevated mood, enhanced creativity, increased energy, and may act intrusively. this by itself does not cause significant impairment
Hypomania
These clients experience mania (and usually depression)
Bipolar 1
These clients experience hypomania and depression
Bipolar 2
Clients that experience 4 or more mood episodes in a 12 month period
rapid cyclers
What are some psychological factors for bipolar disorder?
Stressful life events in childhood seem to increase risk of developing bipolar disorder
What are some biological factors for bipolar disorder?
-Strong genetic basis. Having a first-degree relative with bipolar disorder increases a person’s lifetime risk to 5-10%
-Excessive levels of norepinephrine and dopamine as well as deficient levels of serotonin (even during mania) has been linked to this disorder
-Bipolar depression and regular depression are different in that antidepressants do not usually help with bipolar as it does with unipolar depression.
Effective treatment options for bipolar disorder
-Psychotherapy (CBT, group psychoeducation can help learn coping skills and improve medication adherence)
-Pharmacotherapy (essential to treating bipolar; common medications include lithium, anticonvulsants such as valproate, lamotrigine, and carbamazepine, as well as second generation antipsychotics such as aripiprazole, clozapine, and ziprasidone
-ECT