Exam 3 Depression Flashcards
What are protectice factors for depression?
Responsible for others
pregnancy
reliigous beliefs
sasifaction with life
social support
health care alliance
sobriety
resilience
future orianted thinking
effectove coping skills
What assessment tools do we use for suicide?
- Columbia Suicide Severity Rating Scale
- sad persons (sex, age, depressed, previous attempts, ethanol abuser, rational thinking loss, social support lacking, organized plan, no spouse, sickness)
Acute risk of suicide is characterized by what acronym?
IS PATH WARM
- Ideation
- Substance Abuse
- Purposelessness
- Anxiety
- Trapped
- Hopelessness
- Withdrawal
- Anger
- Recklessness
- Mood
What is a safety plan?
A template that goes over things such as warning sings, coping strategies, people/social distractions, social support (people I can ask), professional agencies for crisis contact, safe environment
What do we do with a safety plan?
We as the nurse develop it with the patient, they can take it home, put it on their fridge, and use the numbers to get help if they have suicidal thoughts
When would a patient need 1:1 observation? (criteria)
*Patient is currently verbalizing a clear intent to harm self
*Patient is unwilling to make a no-harm contract (or not convincingly contracts for safety)
*Patient shows no insight into existing problems
*Patient has poor impulse control
*Patient has already attempted suicide in recent past by lethal method
Three important questions to assess lethality (suicide related)
1.Is there a specific plan with details?
2.How lethal is the proposed method?
3.Is there access to the planned method?
Higher risk examples of lethality (suicide)
- Using gun
- jumping off high place
- hanging
- poisoning with carbon monoxide
Lower risk examples of lethality (suicide)
- Cutting wrists
- Inhaling natural gas
- Overdose with nonprescription drugs
What is the Six Step Approach for Recovery for self harm (ex. cutting, burning)
- Limit setting for safety
- Developing self esteem
- Discovery of motive/role
- Learning that it can be controlled
- Replacing self injury with coping skills
- Entering maintenance phase
Non-Suicidal Self Injury may include what actions
cutting, burning, biting, skin picking, hitting and interfering with healing
Non-Suicidal Self Injury may last
at least a year and happen repeatedly
What is SAD PERSONS used for?
suicide risk assessment
What ISPATHWARM
mnemonic for warning signs
Most people with Non-Suicidal Self Injury do not seek
professional help
Intent of Non-Suicidal Self Injury is to
alleviate psychiatric pain/punish self/get attention
13%-23% of people with Non-Suicidal Self Injury are what age group?
adolescents
Non-Suicidal Self Injury is a global problem that declines after age
29
Non-Suicidal Self Injury is comorbid with
What disorders?
- depression
- anxiety
- eating disorders
- substance use disorders
In the “real world” we assess daily for risk- and do what?
determine how SAFE our environment is
In NONPSYCHIATRIC settings, ____ is the norm
1:1 observation
With grieving consider
cultural variances
Problems arise when grieving is
prolonged, impairs functioning, causes distress
Kubler-Ross 5 Stages
- Denial
- Anger
- Bargaining
- Depression
- Acceptance:
- Rarely that neat/linear
- And not any given specific time frame
What are Horowitz’s Stages of Loss and Adaptation (ATI)
- Outcry
- Denial and Intrusion
- Working Through
- Completion
Worden: 4 Tasks of Mourning (ATI)
- Accepting the reality of loss
- Processing the pain of grief
- Adjusting to a world without the lost loved one
- Creating an enduring connection while debarring on new life
(usually takes about a year-varies by person)
What factors affect grief?
- Current stage of development
- Support
- Significance of loss
- Culture/ethnicity
- Prior experience with loss
- Socioeconomic status
- Spiritual beliefs
What are Risks for Maladaptive Grieivng
related to death
- Dependence of deceased
- Unexpected death- young age or by socially unacceptable means (suicide/murder)
- Inadequate coping skills
- Lack of support
- Preexisting mental health concerns
What are factors of Maladaptive Grief (delayed or inhibited)?
- Extended denial phase
- Does not go through stages
What are factors of Maladaptive Grief (distorted/exaggerated)
- Extended anger phase
- Impairs function
-Clinical depression
What are factor of Maladaptive Grief (Chronic/Prolonged)
Varies
- Impacts ADLs
- Not accept reality of loss
Nursing interventions for depression?
Allow time
*Educate
*Open & Therapeutic communication
*Assess for ineffective coping
*Referral/groups
*Debriefing
*Protect from abandonment & isolation
*Support grieving families
What are risk factors for depression?
Gender (higher in women)
Prior episode of depression
Family History
Stressful life event
Current substance abuse
Medical illness
Few social supports
What are s/s of major depressive disorder?
Recurrent thoughts of suicide
Decrease/increase in appetite
Inability to concentrate
Difficulty in making decisions
Feeling worthless and self-blame
Decreased energy
Disturbed sleep
(must have 5 or more for at least 2 weeks)
What are s/s of persistent depressive disorder
Poor appetite or overeating
Insomnia or hypersomnia
Low energy/fatigue
Low self-esteem
Poor concentration
Feelings of hopelessness
Lasts at least 2 years or more
What are s/s of disruptive mood dysregulation syndrome?
Introduced in 2013 in response to excessive number of
children being diagnosed with BIPOLAR
Constant and severe irritability and anger in ages 6-18 years
old
Temper tantrums out of proportion with situation 3x week
Impacts at home, school and with peers
What is premenstrual dysphoric disorder?
- ast week before onset of period in women
- Mood swings, irritability, depression, anxiety,
feelings of being overwhelmed, difficulty
concentrating - Lack of energy, overeating, insomnia or
hypersomnia, aching, bloating, weight gain
How do we treat premenstrual dysphoric disoder?
Regular aerobic exercise,
complex
carbohydrates,
sleep,
acupuncture,
light therapy,
relaxation therapy
What is the first line treatment for depression?
SSRIs
What are possible AE of SSRIs
nausea, vomiting, diarrhea, headache,
nervousness, anxiety, light-headedness, and loss of libido
* Possible lethal reaction: Serotonin Syndrome
What is postpartum depression?
Usually begins within the first few months
after delivery.
What is season affective disorder?
Related to decreased melatonin production
* Treated with Light Therapy
* 30-45 minutes daily
What is the special concern for men with trazadone?
priapism
What is the risk with tryciclic antidepressants?
ot recommended for SUICIDE risk patients (10-day supply can be lethal)
What are common side effects of triclinic antidepressants
dry mouth, constipation, blurred vision, urinary retention,
dizziness, and urinary retention
What disorder is most likely to interpret neutral expressions as angry?
DMDD
What assessment tools do we use for depression?
- Beck
- Hamilton D
- Mental Status Exam
