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NUR 215: Mental Health > suicide, depression and mood disorders > Flashcards

suicide, depression and mood disorders Flashcards

1
Q

suicide

A

intentional act of ending one’s life; may be preceded by suicidal ideation

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2
Q

suicide attempt

A

willful, self-inflicted, life-threatening attempts that have not led to death

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3
Q

suicidal ideation

A

process of thinking about killing oneself

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4
Q

warning signs of suicide

A

usually give direct or indirect signals to others about intent to harm themselves; making statements about dying or ending it all, giving away possessions, withdraws from social activities or stops making future plans, become better or happy

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5
Q

biggest predictor of suicide

A

previous suicide attempt

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6
Q

risk factors of suicide

A

relative or close friend who committed suicide, depression or mood disorder, increased risk among elderly patients over age 65, being a minority or experiencing discrimination;

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7
Q

Freuds theory of suicide

A

murderous attach on the internalized person

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8
Q

Menninger’s theory of suicide

A

individuals who commit suicide experience, revenge, depression, and guilt

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9
Q

Shneidman’s theory of suicide

A

first theorist to view suicide as a solution to an unbearable psychological pain and isolation; saw self-destructive behaviors as sub-intended suicide

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10
Q

neurobiology of suicide

A

low level of 5-HIAA are associated with impulsive, suicide-like violence which affects serotonin functioning, can be used to predict future attempts/completed suicide

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11
Q

health risk factors for suicide

A

terminal, chronic, or painful medical conditions
traumatic brain injuries

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12
Q

environmental risk factors for suicide

A

access to means, prolonged stress, exposure to suicide

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13
Q

historical risk factors for suicide

A

previous attempts and adverse childhood events

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14
Q

protective factors of suicide

A

may not counteract significant acute risk; internal: ability to cope with stress, religious beliefs, frustration tolerance
external: responsibility to children or pets, positive therapeutic relationships, social support system

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15
Q

interventions for suicidal patients

A

assess risk and presence of a plan, safety contract, remain nonjudgmental, implement suicide precautions to maintain safety

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16
Q

how to assess risk and presence of a plan

A

be direct with questions
complete lethality assessment: how detailed? how lethal?

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17
Q

examples of extremely lethal suicide plans

A

guns, hanging, carbon monoxide, car crashes

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18
Q

examples of low risk suicidal plans

A

slashing wrists and ingesting pill

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19
Q

ways to remain nonjudgmental

A

avoid blaming the patient
tone and approach demonstrate positivity and support

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20
Q

how to perform suicidal inquiry

A

ask specific questions about thoughts, plans, behaviors and intent

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21
Q

asking questions about suicidal ideation

A

how often? how intense? how long do they last?
in the past 48 hours, past month, and worst ever

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22
Q

asking questions about suicide plan

A

timing? location? lethality? availability? preparatory acts?

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23
Q

asking questions about behaviors

A

past attempts? aborted attempts? rehearsals (tying noose, loading gun), non-suicidal self-injurious behaviors

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24
Q

asking questions about suicidal intent

A

extent to which the patient
1. expects to carry out the plan
2. believes the plan/act to be lethal vs. self-injurious

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25
Q

asking questions to explore ambivalence

A

reasons to die vs. reasons to live

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26
Q

behavioral cues pointing to suicide

A

giving away prized possessions, writing farewell notes, making out a will, putting personal affairs in order, having global insomnia, exhibiting a sudden and unwanted improvement in mood after being depressed or withdrawn, neglecting personal hygiene

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27
Q

categories in the modified sad persons scale

A

sex, age, depression. previous attempts or psychiatric care, excessive alcohol or drug use, rational thinking loss, separated, organized, no social support, available lethal plan, stated future intent

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28
Q

another name for mood disorder

A

affective disorder

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29
Q

mood disorders

A

pervasive alterations in emotions manifested by depression, mania, or both, that interferes with life and causes long term sadness, agitation, or elation

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30
Q

how long do sx have to last to be considered major depressive disorder

A

at least two weeks

31
Q

three disorders related to major depressive disorder

A

dysthymic disorder (milder form of depression)
seasonal affective disorder: winter onset or spring onset, treated with light therapy
postpartum depression/premenstrual dysphoric disorder: r/t to pregnancy, hormone changes, birth

32
Q

depression manifestations based on age and development

A

school phobia, hyperactivity, learning disorders. etc.

33
Q

depression may manifest in ___________ complaints
in which cultures?

A

somatic complaints
cultures that avoid verbalizing emotion

34
Q

what cultural group are at an increased risk for depression if in a non-supportive psychosocial environment

A

LGBTQ

35
Q

Biological theory for depression and mood disorders

A

genetic
neurochemical dysfunction; decrease in serotonin, norepinephrine, acetylcholine, and dopamine
neuroendocrine dysfunction (hormones)

36
Q

psychodynamic theories for depression and mood disorders

A

freud: self-deprecation
Jacobsen: superego over powerless ego
Beck: cognitive theory

37
Q

triad

A

negative self-deprecating view of self, pessimistic view of the world, belief that negative reinforcement will continue

38
Q

what does cognitive behavioral therapy (CBT) work on?

A

identifying and testing negative/distorted cognitive views
develop alternative thinking patterns by challenging the cognitive distortions
rehearsing new cognitive and behavioral response

39
Q

7 cognitive distortions

A

all or nothing thinking
filtering
overgeneralization
jumping to conclusions
catastrophizing
shoulds
global labeling

40
Q

all or nothing thinking

A

thinking in black and white, reducing complex outcomes

41
Q

filtering

A

take negative details and magnifying them, while filtering out the positive aspects

42
Q

overgeneralization

A

using a bad outcome as evidence that nothing will ever go right again

43
Q

jumping to conclusions

A

thinking we know what other people are feeling and why they act the way they do

44
Q

catastrophizing

A

expecting disaster to always strike

45
Q

should’s

A

list of ironclad rules about how we/other people should behave

46
Q

global labeling

A

generalizing one or two qualities into global judgement

47
Q

sx of major depressive disorder

A

sleep disturbance
interest diminished in pleasurable activities
guilt feelings (and worthlessness)
energy decreased
concentration diminished (indecisive)
appetite changes
psychomotor slowing or agitation
suicidal thoughts/behaviors

sx last at least two weeks

48
Q

risk factors for major depressive disorder

A

more common in women than men
greater incidence if seen in first degree relatives
increased risk with age in men, but decreased risk in women with age
highest rates among single, divorced people

49
Q

Assessing patients with major depressive disorder (MDD)

A

mood/affect (anhedonia)
thought process/content (rumination, suicide)
intellectual (impaired memory/cognitive thinking)
may use depression rating scales (zung, beck, hamilton)

50
Q

anhedonia

A

reduced ability to experience pleasure

51
Q

interventions for patients with MDD

A

safety! (suicide precautions if needed)
break up tasks for ADLs
therapeutic communication to encourage tx

52
Q

non-pharmacological treatment approaches for MDD

A

electroconvulsive therapy (ECT)
psychotherapy (combined with meds)

53
Q

what is electroconvulsive therapy; how long does it last

A

delivery of electrical impulses to the brain to induce a controlled seizure

typically 6-15 total treatments, given 3x a week for 2-5 weeks

54
Q

what types of therapy are utilized with MDD

A

interpersonal therapy
behavioral therapy
cognitive therapy

55
Q

SSRIs

A

block the reuptake of serotonin increasing serotonin levels in the synapse. very effective with minimal side effects, symptoms generally decrease when starting (10 days until you start to see the effects)

ex. fluoxetine, sertraline, paroxetine, citalopram, escitalopram

56
Q

fluoxetine side effects

A

headache, anxiety, sedation, tremor, sexual dysfunction, constipation, nausea, diarrhea, weight loss

57
Q

nursing implications for fluoxetine

A

administer in AM (if nervous) or PM (if drowsy)
monitor for hyponatremia
encourage adequate fluids
report sexual dysfunction to provider

58
Q

sertraline side effects

A

dizziness, sedation, headache, insomnia, sexual dysfunction, diarrhea, dry mouth and throat, n/v, sweating

59
Q

nursing implications for sertraline

A

administer in PM if patient is drowsy
encourage use of sugar free beverages or hard candy
drink adequate fluids
monitor for hypernatremia
report sexual dysfunction to provider

60
Q

paroxetine side effects

A

dizziness, sedation, headache, insomnia, weakness, fatigue, constipation, dry mouth and throat, n/v diarrhea, sweating

61
Q

serotonin syndrome

A

can occur if SSRIs are mixed with MAOIs or if SSRI dose is too high; potentially fatal if untreated (from hyperpyrexia and cardiovascular shock)

62
Q

hyperpyrexia

A

temp over 106.7 F due to changes in the hypothalamus

63
Q

symptoms of serotonin syndrome

A

SHIVERS
Shivering
Hyperreflexia and myoclonus
increased temperature
Vital sign instability
Encephalopathy
Restlessness
Sweating

64
Q

myoclonus

A

sudden involuntary twitching or jerking of a muscle or muscle group

65
Q

tx of serotonin syndrome

A

tx symptomatically
ex. cooling blankets, blood pressure meds, muscle relaxers for rigidity, oxygen, IV fluids, serotonin-blocking agents

66
Q

Tricyclic Antidepressants

A

increase levels of norepinephrine and serotonin
take 14 days before noticing an effect, 6 weeks for full effect

67
Q

who cannot take antidepressants

A

pts with liver impairment, glaucoma, or urinary obstructions

68
Q

do not combine tricyclic antidepressants with what other substances

A

St. Johns Wart, oral contraceptives, or benzos

69
Q

examples of tricyclic antidepressants

A

amitriptyline, doxepin, desipramine, imipramine, amoxapine

70
Q

MAOIs

A

rarely used due to side effects and interactions with other drugs; if taken with tyramine containing foods can cause hypertensive crisis

71
Q

examples of MAOIs

A

isocarboxazid, phenelzine, tranylcyromine

72
Q

symptoms of hypertensive crisis

A

headache, n/v, extreme hypertension, restlessness, dilated pupils, fever, motor agitation

73
Q

examples of foods containing tyramine

A

mature or aged cheese or dishes made with cheese such as lasagna or pizza. all cheese is considered aged cheese except cottage cheese, cream cheese, ricotta cheese and processed cheese slices

aged meats

NUR 215: Mental Health (11 decks)

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