Mood Disorders: Exam 3 Flashcards
Grief is the painful emotional response to the ___________ of something or someone significant.
Loss
Initially, clients may have difficulty accepting that the loss has really occurred. Denial is a common first reaction.
Denial
Clients who are grieving often experience strong feelings of anger. They may express anger 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 or grieve. They still have ups and downs. But they’ve found new ways to stay connected to the loss as they continue life.
Acceptance
What are the stages in KÜBLER-ROSS MODEL OF GRIEF?
Denial
Anger
Bargaining
Depression
Acceptance
What are the types of grief?
Normal grief
Anticipatory grief
Maladaptive grief
Bereavement Overload
Clients experience the stages of grief (denial, anger, bargaining, etc.). Somatic complaints are common (e.g., headaches, nausea, fatigue, sleep difficulties). Some authors say that clients usually achieve some degree of acceptance by six months. Keep in mind, 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 (e.g., when a loved one is in hospice care). Sometimes clients are not aware they are experiencing this type of grief since the loss has not yet occurred.
Anticipatory Grief
Occurs when the grief response may be inhibited, exaggerated, or prolonged. A helpful way to distinguish normal grief from maladaptive grief is that the latter is often accompanied by feelings of ___________________ or low self-esteem.
Worthlessness
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
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 (increased or decreased). Appetite changes are common (increased or decreased). Clients can be incredibly fatigued, making it difficult to climb out of bed. Some, however, experience psychomotor agitation and irritation. In some cases, suicidal thoughts and behaviors can occur.
Major Depressive Disorder
What are the depression sub-types?
Melancholic features
Mood-congruent psychotic features
Seasonal pattern
Peripartum onset
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 ______________ and loss of appetite. _______________ ideation is common.
Awakenings
Suicidal
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 ____________ ). Light therapy is an effective treatment.
Winter
Seasonal Patterns
This subtype of depression is associated with pregnancy. Some of these clients will develop __________ features.
Psychotic
Peripartum Onset
Depression is often called the “common _________ ” of mental disorders. The lifetime prevalence of depression is about 17%. It’s nearly twice as common in _________ . Depression can occur at any age, but it is less common in older adults.
A common problem is relapsing. The chance of relapsing after one episode is _____ %. After two episodes, the relapse rate is ______ %.
Cold
Women
50%
80%
What is the etiology for Major Depressive Disorder?
Psychological Factors
Cognitive-behavioral theorists note that depressed clients have a similar pattern of thinking: negative beliefs about the world, themselves, and the future. In addition, depressed clients exhibit several cognitive distortions (e.g., all-or-nothing thinking, personalization, mind reading, discounting positives).
Biological Factors
Depression may be related to deficiencies of serotonin, norepinephrine, and dopamine in the brain.
Sometimes depression is caused by a general medical condition (e.g., hypothyroidism) or medication use (e.g., alcohol, beta blockers, steroids, withdrawing from a stimulant like cocaine or amphetamine).
What are the effective treatments for Major Depressive Disorder?
Psychotherapy
Effective psychotherapy includes CBT and group therapy.
Pharmacotherapy
Antidepressants (SSRIs, SNRIs, TCAs, MAOIs) are commonly used. SSRIs are usually the first-line agents since their side effects are milder.
Brain Stimulation Therapies
Electroconvulsive therapy (ECT) is an effective option for clients who are extremely suicidal or have failed numerous other treatments. The evidence supporting ECT for these clients is strong.
Transcranial magnetic stimulations (TMS) is another option. TMS, as the name suggests, is procedure in which strong magnetic pulses are sent through the skull into the brain—usually the left prefrontal cortex. Unfortunately, the evidence for TMS is not strong.
Nursing Interventions:
Safety is always the top priority. Depressed clients might be suicidal. Assess for suicidal ideation often and monitor closely.
Convey ____________ 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 offense. Physical activity (e.g., jogging, hitting a punching bag, etc.) may also be a healthy outlet.
Explain that crying is OK. 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 _______ weeks to begin working.
Empathy
Four
Mania can feel extremely pleasurable. Clients may feel exuberant, extremely confident, and highly creative. They seem to have endless energy, are always moving about, and may feel little or no need for sleep. They are high on life. Their thoughts race (flight of ideas) and their speech is “pressured.” It may be difficult to get a word in while talking to them. Dangerous behaviors are common (e.g., drugs, risky sex, reckless spending). They are highly distractible and may begin massive projects that they cannot complete (e.g., a simple plan to paint a bedroom may morph into a whole house renovation). Not all is cheery; agitated outbursts are common. Psychotic delusions (usually grandiose) and hallucinations (usually auditory) may also occur. Manic episodes usually end with a crash into deep depression.
Hypomania is a less severe version of mania. Clients experience an elevated mood, enhanced creativity, increased energy, and may act intrusively. Hypomania by itself does not cause significant impairment.
Bipolar Disorder
These clients experience __________ (and usually depression). What type of bipolar disorder is this?
Mania
Bipolar 1
