suicide, depression and mood disorders Flashcards
suicide
intentional act of ending one’s life; may be preceded by suicidal ideation
suicide attempt
willful, self-inflicted, life-threatening attempts that have not led to death
suicidal ideation
process of thinking about killing oneself
warning signs of suicide
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
biggest predictor of suicide
previous suicide attempt
risk factors of suicide
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;
Freuds theory of suicide
murderous attach on the internalized person
Menninger’s theory of suicide
individuals who commit suicide experience, revenge, depression, and guilt
Shneidman’s theory of suicide
first theorist to view suicide as a solution to an unbearable psychological pain and isolation; saw self-destructive behaviors as sub-intended suicide
neurobiology of suicide
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
health risk factors for suicide
terminal, chronic, or painful medical conditions
traumatic brain injuries
environmental risk factors for suicide
access to means, prolonged stress, exposure to suicide
historical risk factors for suicide
previous attempts and adverse childhood events
protective factors of suicide
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
interventions for suicidal patients
assess risk and presence of a plan, safety contract, remain nonjudgmental, implement suicide precautions to maintain safety
how to assess risk and presence of a plan
be direct with questions
complete lethality assessment: how detailed? how lethal?
examples of extremely lethal suicide plans
guns, hanging, carbon monoxide, car crashes
examples of low risk suicidal plans
slashing wrists and ingesting pill
ways to remain nonjudgmental
avoid blaming the patient
tone and approach demonstrate positivity and support
how to perform suicidal inquiry
ask specific questions about thoughts, plans, behaviors and intent
asking questions about suicidal ideation
how often? how intense? how long do they last?
in the past 48 hours, past month, and worst ever
asking questions about suicide plan
timing? location? lethality? availability? preparatory acts?
asking questions about behaviors
past attempts? aborted attempts? rehearsals (tying noose, loading gun), non-suicidal self-injurious behaviors
asking questions about suicidal intent
extent to which the patient
1. expects to carry out the plan
2. believes the plan/act to be lethal vs. self-injurious
asking questions to explore ambivalence
reasons to die vs. reasons to live
behavioral cues pointing to suicide
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
categories in the modified sad persons scale
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
another name for mood disorder
affective disorder
mood disorders
pervasive alterations in emotions manifested by depression, mania, or both, that interferes with life and causes long term sadness, agitation, or elation
how long do sx have to last to be considered major depressive disorder
at least two weeks
three disorders related to major depressive disorder
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
depression manifestations based on age and development
school phobia, hyperactivity, learning disorders. etc.
depression may manifest in ___________ complaints
in which cultures?
somatic complaints
cultures that avoid verbalizing emotion
what cultural group are at an increased risk for depression if in a non-supportive psychosocial environment
LGBTQ
Biological theory for depression and mood disorders
genetic
neurochemical dysfunction; decrease in serotonin, norepinephrine, acetylcholine, and dopamine
neuroendocrine dysfunction (hormones)
psychodynamic theories for depression and mood disorders
freud: self-deprecation
Jacobsen: superego over powerless ego
Beck: cognitive theory
triad
negative self-deprecating view of self, pessimistic view of the world, belief that negative reinforcement will continue
what does cognitive behavioral therapy (CBT) work on?
identifying and testing negative/distorted cognitive views
develop alternative thinking patterns by challenging the cognitive distortions
rehearsing new cognitive and behavioral response
7 cognitive distortions
all or nothing thinking
filtering
overgeneralization
jumping to conclusions
catastrophizing
shoulds
global labeling
all or nothing thinking
thinking in black and white, reducing complex outcomes
filtering
take negative details and magnifying them, while filtering out the positive aspects
overgeneralization
using a bad outcome as evidence that nothing will ever go right again
jumping to conclusions
thinking we know what other people are feeling and why they act the way they do
catastrophizing
expecting disaster to always strike
should’s
list of ironclad rules about how we/other people should behave
global labeling
generalizing one or two qualities into global judgement
sx of major depressive disorder
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
risk factors for major depressive disorder
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
Assessing patients with major depressive disorder (MDD)
mood/affect (anhedonia)
thought process/content (rumination, suicide)
intellectual (impaired memory/cognitive thinking)
may use depression rating scales (zung, beck, hamilton)
anhedonia
reduced ability to experience pleasure
interventions for patients with MDD
safety! (suicide precautions if needed)
break up tasks for ADLs
therapeutic communication to encourage tx
non-pharmacological treatment approaches for MDD
electroconvulsive therapy (ECT)
psychotherapy (combined with meds)
what is electroconvulsive therapy; how long does it last
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
what types of therapy are utilized with MDD
interpersonal therapy
behavioral therapy
cognitive therapy
SSRIs
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
fluoxetine side effects
headache, anxiety, sedation, tremor, sexual dysfunction, constipation, nausea, diarrhea, weight loss
nursing implications for fluoxetine
administer in AM (if nervous) or PM (if drowsy)
monitor for hyponatremia
encourage adequate fluids
report sexual dysfunction to provider
sertraline side effects
dizziness, sedation, headache, insomnia, sexual dysfunction, diarrhea, dry mouth and throat, n/v, sweating
nursing implications for sertraline
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
paroxetine side effects
dizziness, sedation, headache, insomnia, weakness, fatigue, constipation, dry mouth and throat, n/v diarrhea, sweating
serotonin syndrome
can occur if SSRIs are mixed with MAOIs or if SSRI dose is too high; potentially fatal if untreated (from hyperpyrexia and cardiovascular shock)
hyperpyrexia
temp over 106.7 F due to changes in the hypothalamus
symptoms of serotonin syndrome
SHIVERS
Shivering
Hyperreflexia and myoclonus
increased temperature
Vital sign instability
Encephalopathy
Restlessness
Sweating
myoclonus
sudden involuntary twitching or jerking of a muscle or muscle group
tx of serotonin syndrome
tx symptomatically
ex. cooling blankets, blood pressure meds, muscle relaxers for rigidity, oxygen, IV fluids, serotonin-blocking agents
Tricyclic Antidepressants
increase levels of norepinephrine and serotonin
take 14 days before noticing an effect, 6 weeks for full effect
who cannot take antidepressants
pts with liver impairment, glaucoma, or urinary obstructions
do not combine tricyclic antidepressants with what other substances
St. Johns Wart, oral contraceptives, or benzos
examples of tricyclic antidepressants
amitriptyline, doxepin, desipramine, imipramine, amoxapine
MAOIs
rarely used due to side effects and interactions with other drugs; if taken with tyramine containing foods can cause hypertensive crisis
examples of MAOIs
isocarboxazid, phenelzine, tranylcyromine
symptoms of hypertensive crisis
headache, n/v, extreme hypertension, restlessness, dilated pupils, fever, motor agitation
examples of foods containing tyramine
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
