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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
asking questions to explore ambivalence
reasons to die vs. reasons to live
26
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
27
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
28
another name for mood disorder
affective disorder
29
mood disorders
pervasive alterations in emotions manifested by depression, mania, or both, that interferes with life and causes long term sadness, agitation, or elation
30
how long do sx have to last to be considered major depressive disorder
at least two weeks
31
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
32
depression manifestations based on age and development
school phobia, hyperactivity, learning disorders. etc.
33
depression may manifest in ___________ complaints in which cultures?
somatic complaints cultures that avoid verbalizing emotion
34
what cultural group are at an increased risk for depression if in a non-supportive psychosocial environment
LGBTQ
35
Biological theory for depression and mood disorders
genetic neurochemical dysfunction; decrease in serotonin, norepinephrine, acetylcholine, and dopamine neuroendocrine dysfunction (hormones)
36
psychodynamic theories for depression and mood disorders
freud: self-deprecation Jacobsen: superego over powerless ego Beck: cognitive theory
37
triad
negative self-deprecating view of self, pessimistic view of the world, belief that negative reinforcement will continue
38
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
39
7 cognitive distortions
all or nothing thinking filtering overgeneralization jumping to conclusions catastrophizing shoulds global labeling
40
all or nothing thinking
thinking in black and white, reducing complex outcomes
41
filtering
take negative details and magnifying them, while filtering out the positive aspects
42
overgeneralization
using a bad outcome as evidence that nothing will ever go right again
43
jumping to conclusions
thinking we know what other people are feeling and why they act the way they do
44
catastrophizing
expecting disaster to always strike
45
should's
list of ironclad rules about how we/other people should behave
46
global labeling
generalizing one or two qualities into global judgement
47
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
48
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
49
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)
50
anhedonia
reduced ability to experience pleasure
51
interventions for patients with MDD
safety! (suicide precautions if needed) break up tasks for ADLs therapeutic communication to encourage tx
52
non-pharmacological treatment approaches for MDD
electroconvulsive therapy (ECT) psychotherapy (combined with meds)
53
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
54
what types of therapy are utilized with MDD
interpersonal therapy behavioral therapy cognitive therapy
55
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
56
fluoxetine side effects
headache, anxiety, sedation, tremor, sexual dysfunction, constipation, nausea, diarrhea, weight loss
57
nursing implications for fluoxetine
administer in AM (if nervous) or PM (if drowsy) monitor for hyponatremia encourage adequate fluids report sexual dysfunction to provider
58
sertraline side effects
dizziness, sedation, headache, insomnia, sexual dysfunction, diarrhea, dry mouth and throat, n/v, sweating
59
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
60
paroxetine side effects
dizziness, sedation, headache, insomnia, weakness, fatigue, constipation, dry mouth and throat, n/v diarrhea, sweating
61
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)
62
hyperpyrexia
temp over 106.7 F due to changes in the hypothalamus
63
symptoms of serotonin syndrome
SHIVERS Shivering Hyperreflexia and myoclonus increased temperature Vital sign instability Encephalopathy Restlessness Sweating
64
myoclonus
sudden involuntary twitching or jerking of a muscle or muscle group
65
tx of serotonin syndrome
tx symptomatically ex. cooling blankets, blood pressure meds, muscle relaxers for rigidity, oxygen, IV fluids, serotonin-blocking agents
66
Tricyclic Antidepressants
increase levels of norepinephrine and serotonin take 14 days before noticing an effect, 6 weeks for full effect
67
who cannot take antidepressants
pts with liver impairment, glaucoma, or urinary obstructions
68
do not combine tricyclic antidepressants with what other substances
St. Johns Wart, oral contraceptives, or benzos
69
examples of tricyclic antidepressants
amitriptyline, doxepin, desipramine, imipramine, amoxapine
70
MAOIs
rarely used due to side effects and interactions with other drugs; if taken with tyramine containing foods can cause hypertensive crisis
71
examples of MAOIs
isocarboxazid, phenelzine, tranylcyromine
72
symptoms of hypertensive crisis
headache, n/v, extreme hypertension, restlessness, dilated pupils, fever, motor agitation
73
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

NUR 215: Mental Health (11 decks)

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