Affective Disorders Student PDF

Module 16: Affective Disorders Part 2: Depression, Suicide, and Non-suicidal Self-Injury Ashley H. Barnes, DNP, RN, CNE NURS 1112 Fall 2024  Depressive Disorders Disruptive Mood Persistent Depressive Premenstrual Dysphoric D...

Module 16: Affective Disorders Part 2: Depression, Suicide, and Non-suicidal Self-Injury Ashley H. Barnes, DNP, RN, CNE NURS 1112 Fall 2024  Depressive Disorders Disruptive Mood Persistent Depressive Premenstrual Dysphoric Dysregulation Disorder Disorder Disorder Constant and severe Low-level depressive Symptom cluster in last irritability and anger feelings through most of week prior to onset of a Temper tantrums out of each day, for the majority woman’s period; include proportion to the situation of days Mood swings, at least 3 times per week At least 2 years in irritability, depression, Exhibits symptoms in at adults anxiety, feeling least two settings: home, At least 1 year in overwhelmed, and school, and with peers children/ adolescents difficulty concentrating Must have two or more of Symptoms decrease the following: significantly or disappear Decreased appetite or with the onset of overeating, insomnia or menstruation hypersomnia, low energy, poor self-esteem, difficulty thinking, and hopelessness SAMPLE FOOTER TEXT 2 Depressive Disorders Substance/Medication- Depressive Disorder d/t Major Depressive Disorder induced Depressive another Medical Condition Disorder Person does not experience Depressive disorder Five (or more) of the depressive symptoms in associated with another following in 2-week period the absence of drug or medical condition Weight and appetite alcohol use or withdrawal CVA, Parkinson’s changes Symptoms appear within 1 Huntington’s, Sleep disturbances month of use Alzheimer’s, TBI, Fatigue Meds that provoke: Cushing’s disease, Worthlessness or guilt Antivirals hypothyroidism, Loss of ability to Cardiovascular arthritis, back pain, concentrate Retionoic acid metabolic conditions, Recurrent thoughts of Antidepressants HIV, diabetes, infection, death Anticonvulsants cancer, and Psychomotor agitation Antimigraine autoimmune problems PLUS—at least one Antipsychotics symptom is also either Depressed mood or Loss of interest or SAMPLE FOOTER TEXT pleasure (anhedonia)3 Pathophysiology  Genetic (first-degree family members)  Biochemical  Stressful life events  Hormonal  Inflammatory  Diathesis-stress model  Interplay between genetic and biological  Cognitive SAMPLE FOOTER TEXT 4 Assessment  Assessment of suicidality  Self-assessment  Appearance  Behavior/Affect: Anergia  Mood: Depressed mood and anhedonia  Emotions: Anxiety; feelings of worthlessness, hopelessness, guilt, anger, helplessness  Thoughts/Perceptions: delusions and/or hallucinations  Comorbidity: chronic pain (sometimes) SAMPLE FOOTER TEXT 6  ”You said you were depressed. Tell me what that is like for you”  “When you feel depressed, what sort of thoughts do you have?”  ”Have you had thoughts about ending your life?”  “Do you have a plan?”  “Do you have the means to carry out your plan?”  “Is there anything that would prevent you from carrying out your plan?” SAMPLE FOOTER TEXT 7 Diagnosis  Risk for suicide  Chronic low self-esteem  BeckDepression  Imbalanced nutrition  Constipation Inventory  Disturbed sleep pattern  Hamilton  Ineffective coping Depression  Disabled family coping Scale  PHQ-9 SAMPLE FOOTER TEXT 8 Implementation Three Phases Communication when Withdrawn  Acute phase (6 to 12 weeks)  Make observations  Reduction of depressive symptoms  Simple, concrete words and restoration of psychosocial and  Allow time to respond work function  Listen for covert messages  Continuation phase (4 to 9 months)   Avoid platitudes Prevention of relapse  Maintenance phase (1 year or more) SAMPLE FOOTER TEXT 9 Implementation  Counseling  Coping skills  Health Teaching  Health Promotion  Self-care activities  Teamwork and Safety  Constantly assessing for suicide  Light Therapy  Exercise SAMPLE FOOTER TEXT 10 Brain Stimulation Therapies Electroconvulsive Therapy (ECT) Induction of seizures Repetitive transcranial magnetic stimulation (rTMS) Use of MRI strength magnetic pulses to stimulate the focal areas Vagus Nerve Stimulation (VNS) Potentially boosts the level of transmitters, improving mood Deep Brain Stimulation (DBS) Implanted electrodes surgically placed in 1 2 / 0 8 / 2 0the 24 areas that are underactive SAMPLE FOOTER TEXT 11 Medications SSRIs SNRIs TCA MAOI NaSS SARIS NDRI A SAMPLE FOOTER TEXT 12 SAMPLE FOOTER TEXT 13 SAMPLE FOOTER TEXT 14 Suicide & Non-suicidal Self- Injury SAMPLE FOOTER TEXT 15 SAMPLE FOOTER TEXT 16 Terms to know Suicidal ideation: Thinking about killing oneself Suicide attempt: Engaging in potentially self-injurious behavior with the intention of death Suicide: Intentional act of killing oneself by any means Nonsuicidal self-injury: Intentional damage to one’s own body tissue, without conscious suicidal intent, and for purposes not socially or culturally sanctioned SAMPLE FOOTER TEXT 17   Genetics  Family tendency Risk Factors  Neurohormonal Mental Illness Depressive Disorder  Low serotonin Substance Abuse Psychosis  Environmental Increased Risk  Cultural Anxiety Disorders Personality disorders  Social Eating disorders Trauma-related disorders SAMPLE FOOTER TEXT 18 Assessment SAMPLE FOOTER TEXT 19 Assessment (Cont)  Verbal and nonverbal clues  Overt statements  Covert statements/nonverbal cues  Lethality of suicide plan  History of attempts  Family history  Sudden switch from sad to happy mood  Social supports SAMPLE FOOTER TEXT 20 Nursing Diagnosis  Risk for suicide  Self-care deficit  Impaired sleep  Impaired nutritional intake  Anxiety SAMPLE FOOTER TEXT 21 Interventions Prevention Interventions  Improved mental health services  Safety  Activities that provide support,  Therapeutic alliance information, and education  Creation of safety plan  Prevention curriculum in K-12; higher  Medications & CAM education education  Coping skills and stress management  QPR: Question, Persuade, Refer  Case Management  Milieu therapy SAMPLE FOOTER TEXT 22 Safety, Safety, Safety  Use (and count) plastic utensils.  No private room; keep door open at all times.  Jump-proof and hang-proof bathrooms.  Lock doors to non-patient areas.  Monitor for and remove potentially harmful gifts.  In patient’s presence, assess belongings and search patient for harmful objects.  Ensure that patients do not bring or leave harmful objects. SAMPLE FOOTER TEXT 23 Treatments  Biological treatments  Pharmacotherapy for comorbid disorders  Brain stimulation therapy to decrease ideation  Psychological therapies  Advanced practice roles SAMPLE FOOTER TEXT 24 Non-suicidal Self-Injury SAMPLE FOOTER TEXT 25 Patho/Risk Factors  Comorbidity  Major Depressive Disorder  Anxiety  Eating disorders  Substance Abuse Disorders  Risk Factors  Biological factors  Cognitive factors  Environmental factors  Societal factors SAMPLE FOOTER TEXT 26 Assessment Diagnosis Planning  Importance of empathy  Risk for self-mutilation  Limit setting for safety  Look for triggers  Self-mutilation  Developing self-esteem  Discovery of motive and its role  Discovering self-control  Replacement with coping skills  Entering maintenance phase SAMPLE FOOTER TEXT 27 Implementation Treatment  Caring for injuries  Biological Treatment   Pharmacotherapy Establishing therapeutic alliance  Comorbidities  Teaching coping skills  Psychological Therapies  Promoting reflective dialogue  Advanced Practice Roles SAMPLE FOOTER TEXT 28