October 5, 2022

I have assigned each of you a topic for your ppt presentation. It should be at least a minimum of 10 slides. Make sure you include an explanation of the diagnoses, signs/symptoms, nursi

I have assigned each of you a topic for your ppt presentation.

Due Date: Next Tuesday 10/11/22.

It should be at least a minimum of 10 slides. Make sure you include an explanation of the diagnoses, signs/symptoms, nursing assessment, interventions/treatments and nursing diagnoses. Your are more than welcome to add more information if you would like. I have Power Point

If you have any questions please let me know.

Please keep an eye out there are two types the disorder and depression

Chapter 17: Mood Disorders and Suicide

Mood Disorders #1

Mood disorders/affective disorders

Pervasive alterations in emotions manifested by depression or mania or both

Interference with life; long-term sadness, agitation, or elation

Individuals with mood disorders throughout history

Until the mid-1950s, no treatment available for serious depression or mania.

Mood Disorders #2

Most common psychiatric diagnosis associated with suicide

Depression is one of the most important risk factors.

Categories of Mood Disorders

Major depressive episode

Lasts at least 2 weeks

Bipolar disorder

Bipolar I, bipolar II

Related disorders

Dysthymic disorder

Cyclothymic disorder

Substance-induced depressive or bipolar disorder

Seasonal affective disorder

Postpartum blues, depression, psychosis, premenstrual dysphoric disorder

Nonsuicidal self-injury

Etiology #1

Biologic theories

Genetic theories

Neurochemical theories: serotonin, norepinephrine, possibly acetylcholine and dopamine

Neuroendocrine influences: hormones

Etiology #2

Psychodynamic theories

Self-deprecation

Ideal ego

Mania as defense against underlying depression

Depression as reaction to life experience

Rejecting or unloving parents

Cognitive distortions

Cultural Considerations

Other behaviors considered age appropriate can mask depression

Children: school phobia, hyperactivity, learning disorders, failing grades, antisocial behaviors

Adolescents: substance abuse, gangs, risky behaviors, dropping out of school

Adults: substance abuse, eating disorders, compulsive behaviors

Somatic complaints

Major manifestation among cultures that avoid verbalizing emotions

1. Question #1

Is the following statement true or false?

Depression is most commonly associated with suicide.

1. Answer to Question #1

True

Rationale: Depression is considered the most common diagnosis that results in suicide.

Major Depressive Disorder

Untreated episode of depression can last weeks, months, or years.

Most clear in about 6 months

50% to 60% will suffer recurrence.

Approximately 20% will develop a chronic form of depression.

Some people with severe depression have psychotic features.

Psychopharmacology

Selective serotonin reuptake inhibitors (see Table 17.1)

Tricyclic antidepressants (see Table 17.2)

Atypical antidepressants (see Table 17.3)

MAOI antidepressants (see Table 17.4)

Hypertensive crisis

Serotonin syndrome

Other Medical Treatments and Psychotherapy

Electroconvulsive therapy (ECT)

Psychotherapy (combined with medications)

Interpersonal therapy: relationship difficulties

Behavior therapy: positive reinforcement of interactions

Cognitive therapy: focus on cognitive distortions (see Table 17.5)

Investigational treatments: transcranial magnetic stimulation (TMS)

Major Depressive Disorder and Nursing Process Application #1

Assessment

History

General appearance and motor behavior (psychomotor retardation, latency of response, psychomotor agitation)

Mood and affect (anhedonia)

Thought process and content (rumination, thoughts of suicide)

Sensorium and intellectual processes (impaired memory)

Major Depressive Disorder and Nursing Process Application #2

Assessment—(cont.)

Judgment and insight (impaired judgment)

Self-concept (feelings of worthlessness)

Roles and relationships (the more severe the depression, the greater the difficulty)

Physiological and self-care considerations

Depression rating scales

Self-rating scales: Zung Self-Rating Depression Scale and Beck Depression Inventory

Clinician rating scale: Hamilton Rating Scale for Depression (see Box 17.1)

2. Question #2

Is the following statement true or false?

Clients with depression often exhibit anhedonia.

2. Answer to Question #2

True

Rationale: Anhedonia refers to the loss of any sense of pleasure from activities that a person formerly enjoyed. This is a manifestation of depression.

Major Depressive Disorder and Nursing Process Application #3

Data analysis/nursing diagnoses

Outcome identification

Free from self-injury

Independently carry out activities of daily living

Balance of rest, sleep, and activity

Evaluate self-attributes realistically

Socializing

Return to occupation or school activities

Medication compliance

Verbalize symptoms of recurrence

Major Depressive Disorder and Nursing Process Application #4

Intervention

Providing for safety (suicide precautions)

Promoting a therapeutic relationship

Promoting ADLs and physical care

Using therapeutic communication

Managing medications

Client and family teaching

Evaluation

Bipolar Disorder

Extreme mood swings: episodes of mania and depression (see Figure 17.1)

Second only to major depression as cause of worldwide disability

Lifetime risk is at least 1.2%, risk of completed suicide for 15%

Occurs almost equally among men and women

More common in highly educated people

Treatment

Psychopharmacology

Lithium

Anticonvulsant drugs (see Table 17.6)

Psychotherapy

Useful in mildly depressive or normal portion of bipolar cycle

Not useful during manic stages

Bipolar Disorder and Nursing Process Application #1

Assessment

History

General appearance and motor behavior (clothes reflecting elevated mood)

Mood and affect (periods of euphoria, grandiosity)

Thought process and content (circumstantiality, tangentiality)

Sensorium and intellectual processes (disoriented to time)

Bipolar Disorder and Nursing Process Application #2

Assessment—(cont.)

Judgment and insight

Self-concept (exaggerated self-esteem)

Roles and relationships (in manic phase can rarely fulfill role responsibilities)

Physiological and self-care considerations

Data analysis/nursing diagnoses

Outcome identification, examples:

No injury to self or others

Balance of rest, sleep, and activity

Socially appropriate behavior

3. Question #3

Which would be most appropriate for the treatment of mania associated with bipolar disorder?

A. Lithium

B. Fluoxetine

C. Citalopram

D. Venlafaxine

3. Answer to Question #3

A. Lithium

Rationale: Lithium is an antimanic agent, which would be most appropriate for treating a manic client with bipolar disorder.

Fluoxetine, citalopram, and venlafaxine are antidepressants.

Bipolar Disorder and Nursing Process Application #3

Intervention

Providing for safety

Meeting physiological needs

Providing therapeutic communication

Promoting appropriate behaviors

Managing medications

Providing client and family teaching

Evaluation

Suicide #1

Intentional act of killing oneself

Men commit approximately 72% of suicides.

Suicidal ideation: thinking about killing oneself

Warning signs: risk for suicide (for myths and facts, see Box 17.2)

Suicide involves ambivalence.

Suicide #2

Assessment

Previous suicide attempts (the first 2 years after is the highest risk period, especially the first 3 months); relative who committed suicide

Warnings of suicidal intent

Risky behavior

Lethality assessment

Suicide #3

Outcome identification examples

Safe from harming self and others

No-suicide contract

List of positive attributes

Intervention

Using an authoritative role

Providing a safe environment

Creating a support system list

Suicide #4

Family response

Suicide as ultimate rejection of family and friends

Families react with guilt, shame, and anger.

Families can disintegrate.

Suicide #5

Nurse’s response

Need for unconditional positive regard for person

Avoidance of client blame

Nonjudgmental approach, tone

Belief that one person can make a difference in another’s life

Possible devastation of staff if client commits suicide

Legal and Ethical Considerations

Assisted suicide is a as topic of national legal and ethical debate.

Oregon was the first state to adopt assisted suicide into law.

Nurse often cares for terminally or chronically ill people with poor quality of life.

Nurse’s role is to provide supportive care for clients and family as they work through decision-making process.

4. Question #4

Is the following statement true or false?

When dealing with a client who is suicidal, the nurse needs to assume a dependent role.

4. Answer to Question #4

False

Rationale: When dealing with a client who is suicidal, the nurse must take an authoritative role.

Elder Considerations

Depression common among the elderly; marked increase when elders are medically ill

Psychotic features more frequent than in younger people with depression

Increased intolerance of side effects of medications

ECT more commonly used for treatment; more rapid response

Suicide increased among elderly

Community-Based Care

Nurses as first health care professionals to recognize behaviors consistent with mood disorders

Documenting and reporting behaviors helps clients get treatment.

Successful treatment of depression in community by psychiatrists, psychiatric advanced practice nurses, and primary care physicians

Mental Health Promotion #1

Education to address stressors contributing to depressive illness

Efforts to improve primary care treatment of depression

Prevention and early detection, treatment for adolescents

Mental Health Promotion #2

Screening for early detection of risk factors

Family strife

Parental alcoholism or mental illness

History of fighting

Access to weapons in the home

Self-Awareness Issues

Importance of dealing with own feelings about suicide

Frustration possible when working with depressed or manic clients

Exhaustion possible when working with manic clients

Journaling to help deal with feelings

Talking with colleagues is often helpful.

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I have assigned each of you a topic for your ppt presentation. It should be at least a minimum of 10 slides. Make sure you include an explanation of the diagnoses, signs/symptoms, nursi

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