W2_Suicide_MDD

Question 1

SAD PERSONS NO HOPE
(16 Points)
???

Answer 1

S- Sex (M)
A - Age (≥ 65)
D – Depression

P – Previous Attempt
E – Ethanol Use
R – Rational Thinking Loss
S – Social Support Lacking
O – Organized Plan
N – No Spouse
S – Sickness

N – No Meaning in Life
O – Overt change in Physical/ emotional state

H – Hostile Interpersonal environment
O – Out of Hospital
P – Pre-disposing Personality
E – Excuses for Dying

Question 2

How to use SAD PERSONS NO HOPE?

Answer 2

SAD PERSONS NO HOPE
(16 Points)

0-5 (Discharge)
6-8 (Psych Consult)
> 8 (Urgent admission)

The score must be used in conjunction with
Clinical Assessment/ judgement.
Clinical Assessment/ judgement should always comes first.

Score high/ low does not override clinical assessment.

Question 3

DSM V Diagnostic Criteria for MDD

Answer 3

5 or more of the following over 2 weeks:

1. Depressed mood most of the day, for most days
2. Diminished interest and pleasure on activities
3. Significant weight loss
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Diminished ability to think or concentrate
9. Recurrent thoughts if death, suicidal ideation or suicide attempt
   - Significant distress, or social and
   - occupational dysfunction
   - Not due to substance abuse or a general medical condition
   - Not explained by any other psychiatric conditions
   - No manic or hypomanic episode

Question 4

Cultural Considerations for MDD

Answer 4

1. Masking of depression
2. Somatic complaints
3. Expression of symptoms (more so for elderly)
4. Stigmatization

Question 5

List the 3 different categories of Mood Disorders

Answer 5

1) Bipolar Disorder I, II
2) MDD
3) Persistent Depressive Disorders
(seldom seen in RL, patients are functional & separate criteria used for them)

Question 6

Treatment for Depression

(Bio-psycho- social)

Answer 6

Biological
Medications
Anti-depressants
Hypnotics
Electroconvulsive therapy

Psychological
CBT, Interpersonal Psychotherapy; Supportive therapy

Social
Practical help
Psychoeducation
Family education
Job counselling
Liaison with appropriate agencies

Question 7

If the doctor prescribe Monoamine Oxidase inhibitors, what are your main concerns for the patient?

Answer 7

Avoid tyramine rich food.
Such as soybean, fermented beans, red wine, cheese etc.

Avoid flu medications containing ephedrine or pseudoephedrine etc.
(such as 2nd gen antihistamines, Zyrtec, Telfast etc.)

Question 8

If the doctor prescribed Tricyclic Anti-depressants instead of MAOIs and SSRIs, what are some of the nursing considerations?

Answer 8

Side effects of TCA such as sedation, orthostatic hypotension, anticholinergic side effects.

Observe if patient swallow the medication.

TCA can be toxic if there’s overdose! (e.g. Amitriptyline and Dothiepin)

Question 9

Doctor prescribed SSRI for the patient, what are some of the considerations?
- Indications for SSRI?
- Side effects?

Answer 9

Better tolerated than TCAs
Safe for elderly
Do not cause problems with postural hypotension, altered cognition, narrow angle glaucoma or urinary retention

Less sedating and fewer anti– cholinergic and cardio-toxic side effects than TCAs

Safer in overdose compared to TCAs
Less likely to cause switch to mania than TCAs
Less pro-convulsant effect than with TCAs, but significant interactions can occur between certain SSRIs and some anti- epileptic medications

**Fluoxetine, Paroxetine and Fluvoxamine can produce substantial inhibition of some hepatic cytochrome P450 enzymes – higher risk of drug interactions.
**

Question 10

Doctor prescribed Fluoxetine for the patient.
What is the drug class? What are some of the considerations?

Answer 10

Fluoxetine is a SSRI.

More concerned for patients takeing Fluoxetine at night, as it allows the patients to stay awake at night.
Fluvoxamine can be sedating.

SSRI can cause patients to have GI issues such as constipation and loose stools.

Question 11

Nursing interventions for Suicidal patients

Answer 11

What matters is the person’s subjective intentions and expectations, irrespective of the medical seriousness.

1) Therapeutic communication (TNPR)
2) Need for unconditional positive regard for person (Positive Regard)
3) Avoidance of client blame/ guilt (Don’t Blame)
4) Non-judgmental approach (Don’t Judge)

Belief that one person can make a difference in another’s life
(To give the patient HOPE!)

• Depending on patient’s condition and severity
• Some wards does practice non-obtrusive observation (can be done individually or in a group)
  (can be done in graduated stages)
• Being very alert and very observant is very important in Mental Health Nursing care