Mental health Exam 2 notes PDF

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Mental health Exam 2 notes. Chapter 17: the suicidal client    

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Suicide is not a diagnosis or a disorder, it is a behavior Second leading cause of death in age 10-34  Fourth leading cause of death in 35-54  Eight leading cause of death in ages 55-64 Suicide risk factors  Identified as factors that have statistically been corelated with a higher incidence of suicide Warning signs  Which safe identified as factor suggestion more immediate concern

Risk Factors for suicide  Marital status  Single, never married, divorced men!  Gender  Male succeed more than women in suicide  Women are more likely to over dose, while men take more lethal force by shooting themselves.!!!!!!!***  Age  15-24  70 percent of all suicides are among white males, but white males over the age of 80 are at the greatest risk of all.  Religion  Men and women who are associated with religion are less likely to commit suicide.  Socioeconomic status  Suicide rates are higher among physicians, artists, dentist, law enforcement officers, lawyers and insurance agents.

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Ethnicity

 White Other risk factor: mental illness, after discharge from a psychiatric hospitalization, antidepressants. Use of alcohol and especially in combination with barbiturates. Studies show that there are high risk of suicide among, gay men, lesbians, and transgenders. Someone who has attempted suicide before is at a higher risk of committing it again than someone who has just thought about it the first time. psychiatric illness and severe insomnia having attempting suicide loss of a loved one through death or separation lack of employment

Predisposing factors: Theories of suicide  Psychological theories  Anger turned inward - like self-hatred  Hopelessness and symptoms of depression  History of aggression and violence  Shame and humiliation  Sociological Theories  Durkheim’s Theory  Egoistic suicide – This is when they feel separated from society. This individual does not feel part of any group like family or church.  Altruistic suicide - opposite to egoistic suicide. This individual in part of “All” the group and is willing to sacrifice himself for it. (Think of aluarbar bombing)  Anomic suicide – this is like when you are no longer in a part of a group like(Like: a divorce, loss of job). Scared of being without the group you use to be in. (Amno longer in the group)  The three-step theory  Pain- phycological pain  Connectedness – it prevents suicide from happening until that connectedness feeling is gone, then suicide ideation comes back.  When the feelings of suicide comes, the person can only do it if they have the capacity to. Biological theories  Genetics – Diminished serotonin has something to do with depression and suicidal behavior.  Neurological factors – Deficiency of serotonin Assessment  It is important for nurses to identify and distinguish idea(thoughts), plans(Intentions) and attempts (Behavior). IS PATH WARM ( Signs of suicidal risk) MUST KNOW!!  Ideation: Has suicide ideas that are current and active, especially with an identified plan  Substance abuse: Has current and/or excessive use of alcohol or other mood-altering drugs  Purposelessness: Expresses thoughts that there is no reason to continue living  Anger: Expresses uncontrolled anger or feelings of rage  Trapped: Expresses the belief that there is no way out of the current situation

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Hopelessness: Expresses lack of hope and perceives little chance of positive change  Withdrawal: Expresses desire to withdraw from others or has begun withdrawing  Anxiety: Expresses anxiety, agitation, and/or changes in sleep patterns  Recklessness: Engages in reckless or risky activities with little thought of consequences  Mood: Expresses dramatic mood shifts Assessments  Identify and distinguish ideas (thoughts), plans (intentions) attempts (behavior)

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symptoms: seriousness of intent, plan, means, verbal and behavioral cues

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analysis of the suicidal crisis

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he precipitating stressor, relevant history, life stage issues

Planning/Implementation

do not leave the person alone(Never), suicide contract with the client, be direct and talk matter of factly about suicide. Ask them directly if they ever thought of harming themselves, create a safe environment for clients, encourage clients to verbalize their feelings. Family and friend teaching

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Take any hint of suicide seriously

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Do not keep secrets

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Be a good listener

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Express feelings of personal worth to the client

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Restrict access to firearms or other means of self-harm

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Acknowledge and accept the person's feelings

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Provide feeling of hopefulness

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Do not leave him or her alone

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Show love and encouragement

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Seek professional help

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Remove children from home

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Do not judge or show anger toward the person or provoke guile in him or her

Chapter 25: Depressive Disorders!!!!**** KNOW DISORDERS 

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Depression is an alteration in mood that is expressed by feelings of sadness, despair, and pessimism, more common in women

Types of depressive disorder

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Major depressive disorder MDD 

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No maniac behavior in past

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No association of substance abuse or medical condition

To be diagnose the degree of severity symptoms mild, moderate, severe, psychotic catatonic or melancholic feature

Persistent depressive disorder 

Characteristics of Dysthymia (persistent mild depression)

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Symptoms: sad , or down in the dumps, no psychotic episodes**.

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The Important thing to notice is chronically depress mood (children show irritable mood) most of the day for at least 2 years****

Premenstrual Dysphoric Disorder 

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Depressed mood or loss of interest or pleasure in usual activities impaired social and occupational functioning that has existed for at least 2 weeks ***

Symptoms: depressed mood, excessive anxiety, mood swings, and decreased interest in activities during the week prior to menses***(before having their period),

Substance induced depressive disorder 

Occur as a result of physiological effects of a substance/medication.

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If you remove the substance and they go to therapy, they can overcome it.

depressive disorder associated with another medical condition 

occur as a result of a physiological effect of a medical condition***

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Depression in 3 year old or less: Tantrums, lack of playfullness

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Depression in 3-5: regression. Like starts peeing on themselves

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Depression in ages 6 to 8: cling to parents

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Depression in 9 to 12: excessive worrying and poor self esteem.

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Depression in Senescence (Elderly): 

Common with bereavement overload(When a lot of people they know die)

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Symptoms may be confused with neurocognitive disorder

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Treatment: Electroconvulsive therapy, anti depressant meds, psychosocial therapy.

Postpartum Depression: 

This depression is after a woman delivers they feel depressed and sometimes don’t want to face the baby and isn’t really worried about the baby. (Babyblues) 

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Symptoms: Fatigue, irritability; Loss of appetite, sleep disturbance; Loss of libido, concerns of not being able to care for the infant.

Transient Depression: is they type of depression or behavior we see(Transient) through every day to day living. This type of depression subsides quickly.  Affective: Sadness, dejection, feeling downhearted, having the blues  Behavioral: Some crying possible  Cognitive: Some difficulty getting mind off of one’s disappointment  Physiological: Feeling tired and listless

Mild Depression : Symptoms at the mild level of depression are like those associated with uncomplicated grieving. Alterations at the mild level include the following:  Affective: Denial of feelings, anger, anxiety, guilt, helplessness, hopelessness, sadness, despondency  Behavioral: Tearfulness, regression, restlessness, agitation, withdrawal  Cognitive: Preoccupation with the loss, self-blame, ambivalence, blaming others  Physiological: Anorexia or overeating, insomnia or hypersomnia, headache, backache, chest pain, or other symptoms associated with the loss of a significant other  Moderate Depression : Dysthymia (also called persistent depressive disorder) is an example of moderate depression and represents a more problematic disturbance, which, according to the DSM-5, is characterized by symptoms that are enduring for at least 2 years (APA, 2013). Symptoms associated with this disorder include the following: ■Affective: Feelings of sadness, dejection, helplessness, powerlessness, hopelessness; gloomy and pessimistic outlook; low self-esteem; difficulty experiencing plea- sure in activities ■Behavioral: Sluggish physical movements (i.e., psychomotor retardation); slumped posture; slowed speech; limited verbalizations, possibly consisting of ruminations about life’s failures or regrets; social isolation with a focus on the self; increased use of substances possible; self-destructive behavior possible; decreased interest in personal hygiene and grooming ■Cognitive: Slowed thinking processes; difficulty concentrating and directing attention; obsessive and repetitive thoughts, generally portraying pessimism and negativism; verbalizations and behavior reflecting suicidal ideation ■Physiological: Anorexia or overeating; insomnia or hypersomnia; sleep disturbances; amenorrhea; decreased libido; headaches; backaches; chest pain; abdominal pain; low energy level; fatigue and listless- ness; feeling best early in the morning and continually worse as the day progresses (possibly related to the diurnal variation in the level of neurotransmitters that affect mood and level of activity) 1. Severe Depression : Severe depression (also called major depressive disorder) is characterized by an intensification of the symptoms described for moderate depression (see Box 25–2). Symptoms at the severe level of depression include the following:

■Affective:

Feelings of total despair, hopelessness, and worthlessness; flat (unchanging) affect, appeaing devoid of emotional tone; prevalent feelings of nothingness and emptiness; apathy; loneliness; sadness; inability to feel pleasure. ■Behavioral: Psychomotor retardation so severe that physical movement may literally come to a standstill, or psychomotor behavior manifested by rapid, agitated, purposeless movements; slumped posture; sitting in a curled-up position; walking slowly and rigidly; virtually nonexistent communication (when verbalizations do occur, they may reflect delusional thinking); no personal hygiene and grooming; social isolation is common, with virtually no inclination toward interaction with others ■Cognitive: Prevalent delusional thinking, with delusions of persecution and somatic delusions being most common; confusion, indecisiveness, and an inability to concentrate; hallucinations reflecting misinterpretations of the environment; excessive self-deprecation, self-blame, and thoughts of suicide NOTE: Because of the low energy level and slow thought processes, the individual may be unable to follow through on suicidal ideas. However, the desire is strong at this level. ■Physiological: A general slowdown of the entire body, reflected in sluggish digestion, constipation, and urinary retention; amenorrhea; impotence; diminished libido; anorexia; weight loss or weight gain associated with appetite changes; changes in sleep patterns, including difficulty falling asleep and awakening very early in the morning; feeling worse early in the morning and somewhat better as the day progresses (as with moderate depression, this may reflect the diurnal variation in the level of neurotransmitters that affect mood and activity)

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Interventions

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Create a safe environment for the client. Remove all potentially harmful objects from client’s access (sharp objects, straps, belts, ties, glass items, alcohol). Supervise closely during meals and medication administration. Perform room searches as deemed necessary.

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Assess frequently for the presence and lethality risk of suicidal ideation. The intensity of suicide ideation can change over the course of hours or days, so it is important to assess subjective and objective data to evaluate current risk. Discussion of suicidal feelings with a trusted individual provides some relief to the client.

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Convey an attitude of unconditional acceptance of the client as a worthwhile individual. (See Chapter 17 for more detailed information about relevant assessment and intervention strategies.)

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Encourage the client to actively participate in establishing a safety plan. (See Chapter 17 for guidelines on establishing safety plans). Suicidal clients are often very ambivalent about their feelings. Discussion of strategies for maintaining safety with a trusted individual may provide assistance before the client experiences a crisis situation.

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Maintain close observation of the client. Depending on level of suicide precaution, provide one- to-one contact, constant visual observation, or checks at least every 15 minutes conducted at irregular intervals. Place the client in a room close to the nurse’s station; do not assign to a private room. Accompany the client to off-ward activities if attendance is indicated and, if necessary, to the bath- room. Close observation is necessary to ensure that the client does not harm self in any way. Being alert for suicidal and escape attempts facilitates being able to prevent or interrupt harmful behavior.

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Maintain special care in administration of medications. This prevents saving up to overdose or dis- carding and not taking.

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Make rounds at frequent, irregularintervals(espe- cially at night, toward early morning, at change of shift, or other predictably busy times for staff). This prevents staff surveillance from becoming

 predictable. Awareness of client’s location is impor- tant, especially when staff is busy, unavailable, or less observable.  Encourage verbalizations of honest feelings. Through exploration and discussion, help the client identify symbols of hope in his or her life.  Encourage the client to express angry feelings within appropriate limits. Provide a safe method of hostility release. Help the client identify the true source of anger and work on adaptive coping skills for use outside the treatment setting. De- pression and suicidal behaviors may be viewed as anger turned inward on the self. If this anger can be verbalized in a nonthreatening environment, the client may be able to eventually resolve these feelings.  Identify community resources that the client may use as a support system and from whom he or she may request help if feeling suicidal once discharged from the hospital. Having a concrete plan for seek- ing assistance during a crisis may discourage or pre- vent self-destructive behaviors.

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Orient the client to reality, as required. Point out sensory misperceptions or misinterpretations of the environment. Take care not to belittle the client’s fears or indicate disapproval of verbal expressions. ■Most importantly, spend time with client. This pro- vides a feeling of safety and security while also con- veying the message, “I want to spend time with you because I think you are a worthwhile person.”

Ask the client directly, “Have you thought about killing your- self?” or “Have you thought about harming yourself in any way?” “If so, what do you plan to do? Do you have the means to carry out this plan?” “How strong are your intentions to die?” The risk of suicide is greatly increased if the client has developed a plan, has strong intentions, and especially if means exist for the client to execute the plan.

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Be direct. Talk openly and matter-of-factly about suicide. Listen actively and encourage expression of feelings, including anger. Accept the client’s feelings in a nonjudgmental manner.

Treatments 

Phase I – patient is assessed and given information regarding their depression

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Phase II – Focus on helping the client resolve complicated grief reactions

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Phase III - this is the end of the therapeutic alliance is terminated

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GROUP THERAPY -

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Family therapy

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Cognitive therapy

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ECT

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TMS – Transcranial Magnetic Stimulation 

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This uses short magnetic energy to stimulate the nerve cells in a local part of the brain. Similar to ECT just THERE IS NO SEIZURES

Vagul Nerve and deep brain stimulation Light therapy - READ(pg 522) 

The light therapy is administered by a 10,000-lux light box, which contains white fluorescent light tubes covered with a plastic screen that blocks ultraviolet rays.

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The individual sits in front of the box with eyes open (although one should not look directly into the light).

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Therapy usually begins with 10- to 15-minute sessions and gradually progresses to 30 to 45 minutes.

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The mechanism of action is believed to be related to retinal stimulation, which triggers a reduction of melatonin and an increase in serotonin in the brain

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Side effects appear to be dosage related and include headache, eyestrain, nausea, irritability, photophobia (eye sensitivity to light), or insomnia agitation, but these are usually mild and short-lived

Psychopharmacology pg 522

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Antidepressant medication is generally considered first line treatment for severe clinical depression and is used in the treatment of other depressive disorders 

Tricyclic , tetracylic, MAOIs, SSRIs

All antidepressants carry an FDA black- box warning for suicide As antidepressant drugs take effect and mood begins to lift, the individual may have increased energy with which to implement a suicide plan. Suicide potential often in- creases as level of depression decreases. The nurse should be particularly alert to sudden lifts in mood.

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Sertraline- sometimes it takes a few weeks for the medication to bring about an improvement in symptoms.

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Education for a client taking MAOI should include Tyramine – restricted diet, prohibitive concurrent use of over the counter medication without physician notification. They cant have tyramine because he can dramatically increase Blood Pressure. Avoid foods like; avocado, cheese, chicken. BUT yogurt is okay to have.

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Light Therapy (Know)! 

Light therapy has demonstrated effectiveness that is comparable to antidepressants

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Light therapy should be used regularly until the season changes

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Side effects such as headache, nausea, or agitation, when they occur are usually mild and transi...