Psychology of Emotional Responses

Emotional Responses

• Emotional responses can be maladaptive and lead to mood disorders
• Loss can take up to 3 years to process

Mood Disorders

• A group of disorders that involve a disturbance in emotion, cognition, and behavior
• Exist when emotional responses are exaggerated, prolonged, or interfere with normal functioning
• Include depression, mania, and bipolar disorders

Stages of Dying/Grief

• D - Denial (initial response to protect the self from anxiety)
• A - Anger (individual feels they are victims of incompetence or a vengeful God)
• B - Bargaining (the person tries to exhibit good behavior to please God)
• D - Depression (occurs when the reality of loss or impending loss cannot be ignored)
• A - Acceptance (occurs when the person has come to peace with themselves and others)

Grief

• Normal response to a loss (death of significant other, divorce, illness, hospitalization, etc.)
• Acute grieving occurs up to 3 months after a significant loss
• Resolution of grief occurs when the grieving person can remember comfortably and realistically, both the pleasures and pains of the loss

Depression

• Emotional state manifested by sadness, discouragement, decreased self-esteem, helplessness, and increased risk for suicide
• Can be classified into:
  • Major Depression (unipolar major depression)
  • Postpartum Onset (postpartum blues, postpartum depression, postpartum psychosis)
  • Dysthymia (chronically sad or depressed mood)
  • Bipolar Disorders (bipolar manic, bipolar depressed, bipolar mixed)

Suicidal Behavior

• Involves thoughts of taking one's own life
• Can be classified into:
  • Suicidal threat (accompanied by behavioral changes)
  • Suicidal gesture (self-destructive act that does not cause serious injury)
  • Suicidal attempt (self-destructive act with the potential outcome of death)
• Nursing interventions include:
  • Assessing and evaluating suicidal risk
  • Suspecting suicidal ideation in depressed clients
  • Inquiring directly about suicidal ideations
  • Conveying concern and a sense of understanding
  • Evaluating client's access to means of suicide

Postpartum Onset

• Postpartum blues: lasts 1-4 days, occurs in 50-80% of women, and is treated with reassurance and time
• Postpartum depression: occurs from 2 weeks to 12 months after delivery, has a rate of 10-15%, and is treated with therapy and support
• Postpartum psychosis: occurs in the first month after delivery, has a low incidence, and is treated with medication and hospitalization

Bipolar Disorders

• Classified into:
  • Bipolar I (one or more manic episodes or mixed episodes)
  • Bipolar II (one or more major depressive episodes accompanied by at least one hypomanic episode)
  • Cyclothymia (circular or cyclic type of bipolar disorder)
  • Bipolar disorder NOS (not otherwise specified)
• Symptoms include:
  • Euphoric mood
  • Exaggerated sense of self-esteem
  • Increased energy
  • Decreased need for sleep
  • Increased talkativeness
  • Distractibility
  • Increased goal-directed activity

Seasonal Affective Disorder (SAD)

• Occurs in fall and winter months
• Associated with loss of sunlight
• Disappears during spring and summer
• Common symptoms include:
  • Loss of energy
  • Hypersomnia
  • Overeating with carbohydrate craving
  • Weight gain
  • Lethargy and fatigue

Nursing Implications

• For Depressive Disorders:
  • Facilitate adequate nutrition
  • Promote sleep
  • Assist with hygiene and grooming
  • Promote daily activity and rest
• For Bipolar Disorders:
  • Promote adequate nutrition
  • Reduce stimulation
  • Promote rest
  • Enhance relaxation
  • Administer lithium carbonate or other medications as prescribed
• For Suicidal Behaviors:
  • Evaluate client's degree of suicidal risk
  • Take warning signs seriously
  • Remove dangerous and potentially lethal materials or objects
  • Place the client in a safe, protective environment
  • Monitor closely and consistently