NUR-310 Exam Overview PDF

Week 1: Overview of Mental Health Concepts and Therapeutic Communication 1. What is Mental Health? Mental Health: ○ The ability to engage in productive activities, maintain healthy relationships, and adapt to change and adversity. Mental Illness: ○ Signif...

Week 1: Overview of Mental Health Concepts and Therapeutic Communication 1. What is Mental Health? Mental Health: ○ The ability to engage in productive activities, maintain healthy relationships, and adapt to change and adversity. Mental Illness: ○ Significant changes in thinking, emotion, or behavior that cause distress or impair functioning in social, work, or family activities. DSM Criteria for Mental Illness: ○ Defined by significant dysfunction in one or more areas such as work, interpersonal relations, or self-care according to the Diagnostic and Statistical Manual (DSM). 2. Mental Health Continuum Continuum Model: ○ A dynamic range from mental wellness to mental illness. ○ Excelling: No mental illness symptoms, optimal well-being. ○ Thriving: Some stress, but manageable and does not impair daily functioning. ○ Surviving: Problems present, but manageable without distress. ○ Struggling: Significant distress and daily impairment. ○ Crisis: Severe mental illness with major disruptions in functioning. 3. Fight or Flight Response Physiologic Responses to Stress: ○ The body's reaction to perceived threats, originally for physical survival, now also triggered by emotional and psychological stressors. Physical Responses to Stress: ○ Selye’s Definition of Stress: The body's nonspecific response to any demand placed on it, involving the fight-or-flight response. 4. Brain Structures Involved in Stress Response Cerebrum: ○ Divided into four lobes, each with different functions. ○ Frontal Lobes: Control voluntary movement and emotions. ○ Parietal Lobes: Manage sensory input. ○ Temporal Lobes: Handle auditory functions, smell, and emotions. ○ Occipital Lobes: Visual processing.  Diencephalon: ○ Includes the thalamus and hypothalamus, part of the limbic system involved in emotional regulation. 5. The Nervous System Neurotransmitters: ○ Chemicals released by neurons that transmit signals across synapses. They play a key role in mood regulation and are often targeted by psychiatric medications. 6. Anxiety Definition: ○ A feeling of discomfort and apprehension often related to fear of impending danger. It can be adaptive but becomes problematic when it interferes with daily life. Peplau’s Four Levels of Anxiety: ○ Mild Anxiety: Enhanced focus and alertness. ○ Moderate Anxiety: Perceptual field narrows, with physical symptoms like increased heart rate. ○ Severe Anxiety: Greatly diminished perception, confusion, and physical symptoms. ○ Panic Anxiety: Complete disorientation, potential for hallucinations and delusions. 7. Genetics Genotype vs. Phenotype: ○ The genetic makeup of an individual versus the physical expression of those genes. Epigenetics: ○ Environmental influences on gene expression without altering the DNA sequence. Genetic Concordance: ○ Twin Studies: Research comparing identical and fraternal twins to determine genetic vs. environmental contributions to mental health disorders. ○ Lifetime Risk of Schizophrenia: The likelihood of developing schizophrenia based on genetic predisposition, particularly among family members and twins. 8. History of Mental Health Overview: ○ The evolution of mental health care from historical to modern practices, highlighting significant changes in understanding and treatment. 9. Mental Health Care Settings  Outpatient Services: ○ Include primary care, mental health clinics, telehealth, and home-based services for clients with nonacute mental health needs. ○ Key Outpatient Services: Primary care providers, Outpatient mental health clinic, Case management, Home-based services: assertive community treatment, Telehealth, Mobile mental health crisis teams, Day treatment, Family services, Peer services. Inpatient Services: ○ For clients requiring intensive care and supervision, including crisis stabilization, state hospitals, and long-term care facilities. ○ Key Inpatient Services: Crisis stabilization beds, Community-based hospital facilities, State hospital facilities, Transitional or respite facilities, Long-term facilities, Substance use disorder treatment centers, Detoxification, Acute residential treatment. Specialty Care Treatment: ○ Targeted care specific to populations like veterans, pediatric and adolescent care, geriatric care, and forensic care. 10. Disparities in Mental Health Care Social Determinants of Mental Health (SDoMH): ○ Factors like social inequities, education, and poverty that influence mental health outcomes and access to care. 11. Building Therapeutic Relationships Nurse-Patient Relationship: ○ The cornerstone of psychiatric nursing, involving mutual respect and the provision of psychosocial support. Phases of the Therapeutic Relationship: ○ Orientation Phase: Establishes the relationship and sets the tone. ○ Identification Phase: Identifies barriers to wellness. ○ Working Phase: Nurse and client work together toward goals. ○ Termination Phase: Goals are met, and care is transitioned. Maintaining Professional Boundaries: ○ Transference and Countertransference: The unconscious redirection of feelings between nurse and patient that can interfere with treatment goals. ○ Boundaries in the Nurse-Patient Relationship: Warning signs include favoritism, keeping secrets, or spending extra time with a patient, indicating boundary issues that threaten the therapeutic relationship. 12. Communication Strategies - Verbal Open-ended Questions: Encourage patients to share more information. Affirmations: Offer support and encouragement.  Reflections: Confirm understanding of what the patient is conveying. Summaries: Transition or close conversations by restating key points. 13. Motivational Interviewing Steps Engage: Spend most of the time building rapport. Focus: Identify what the patient wants to work on. Evoke: Encourage the patient to talk about reasons for change. Plan: Set realistic, measurable goals. 14. Bias-Free Language Person-First Language: Refer to clients as individuals rather than their disorders, avoiding stigmatizing terms like “normal.” 15. Culturally Sensitive Nursing Care Cultural Formulation Interview (CFI): Assessing cultural factors that influence the patient's health beliefs and practices. Cultural Assessment Example: ○ Application of culturally sensitive care with example scenarios highlighting the importance of understanding cultural differences in patient care. 16. Nursing Process and Clinical Judgment Action Model Six Steps of CJAM: ○ Recognize Cues: Identify relevant patient information. ○ Analyze Cues: Understand the patient’s condition and potential risks based on the cues provided. ○ Prioritize Hypotheses: Rank the most serious or likely explanations for the patient's symptoms. ○ Generate Solutions: Determine desired outcomes and appropriate interventions. ○ Take Action: Implement the chosen interventions. ○ Evaluate Outcomes: Monitor the patient’s progress and determine the effectiveness of the interventions. 17. Therapeutic Communication Techniques: Use reflection, exploring, and clarification to engage the patient in meaningful dialogue and understand their perspective. 18. Policy & Advocacy Projects Advocacy in Mental Health: Engage in policy and advocacy to improve mental health care and address disparities Study Guide: Anxiolytics (Antianxiety) and Antidepressants Anxiolytics (Antianxiety) Drug Class Exemplars: 1. Benzodiazepines: ○ Examples: Alprazolam (Xanax) Clonazepam (Klonopin) - longer half-life Lorazepam (Ativan) Oxazepam (Serax) Diazepam (Valium) - longer half-life Chlordiazepoxide (Librium) - longer half-life Chlorazepate (Tranxene) - longer half-life Temazepam (Restoril) Triazolam (Halcion) Midazolam (Versed) ○ Mechanism of Action: Benzodiazepines enhance the effect of the neurotransmitter GABA by binding to GABA receptor sites, causing an influx of chloride ions into neurons, leading to a major inhibitory effect. This inhibition releases a large amount of dopamine in the limbic system, increasing the potential for physical dependence. ○ Therapeutic Use: Primarily prescribed for treating anxiety, panic attacks, and short-term relief until longer-acting antidepressants take effect. ○ Adverse Effects: Common: Drowsiness, sedation, psychomotor impairment, behavioral disinhibition, and memory loss (especially with Ativan). Serious: Respiratory depression, paradoxical CNS stimulation, and long-term use can lead to dependence. Falls Risk: Increased due to sedation and impaired coordination. Benzodiazepine Toxicity: Treated with flumazenil, which can reverse sedative effects but may induce seizures in clients with seizure history or those taking tricyclic antidepressants. Tapering: Critical to taper off benzodiazepines to prevent withdrawal seizures. 2. Buspirone (Buspar): ○ Mechanism of Action: Partial serotonin receptor agonist and weak dopamine receptor antagonist. Does not affect GABA receptors.  The onset of action is up to 2 weeks, making it unsuitable for PRN (as needed) use. ○ Therapeutic Use: Commonly prescribed for chronic anxiety, especially where long-term management is needed without the risk of dependence. ○ Adverse Effects: Dizziness, headaches, nausea, nervousness, and dysphoria (at high doses). ○ Advantages: Does not cause sedation or dependence, making it a safer long-term option compared to benzodiazepines. 3. Beta-Blockers: ○ Examples: Propranolol (Inderal) Atenolol (Tenormin) ○ Mechanism of Action: Beta-blockers work by blocking the effects of adrenaline (epinephrine) on the body's beta receptors, which helps to control physical symptoms of anxiety such as palpitations and tremors. ○ Therapeutic Use: Often used for situational anxiety, such as performance anxiety. ○ Adverse Effects: Propranolol: Light-headedness, sleepiness, short-term memory loss, slow pulse, lethargy, insomnia, diarrhea, cold hands and feet, numbness/tingling in extremities. Atenolol: Cold extremities, dizziness, tiredness, potential for bradycardia (heart rate below 50 bpm), depression, nightmares. ○ Cautions: Avoid in chronic lung disease, asthma, diabetes, and certain heart diseases. Abrupt withdrawal can cause severe hypertension. 4. Hydroxyzine (Atarax, Vistaril): ○ Mechanism of Action: Antihistamine with sedative properties. ○ Therapeutic Use: Used as a short-term treatment for anxiety, especially when sedation is beneficial. ○ Adverse Effects: Drowsiness, dizziness, blurred vision, constipation, dry mouth. Teaching Points: Benzodiazepines: ○ Emphasize the potential for dependence and the importance of tapering to avoid withdrawal seizures. ○ Be aware of next-day sedation and the risk of falls.  ○ Inform clients about paradoxical responses. ○ Educate on signs of toxicity and the role of flumazenil. Buspirone: ○ Explain the delay in therapeutic effects, requiring consistent use for several weeks. ○ Discuss common side effects like dizziness and headaches. Beta-Blockers: ○ Educate on avoiding abrupt discontinuation and potential side effects related to heart rate and blood pressure. Hydroxyzine: ○ Advise on sedative effects and potential for dizziness or blurred vision. Antidepressants Drug Class Exemplars: 1. Selective Serotonin Reuptake Inhibitors (SSRIs): ○ Examples: Fluoxetine (Prozac) Sertraline (Zoloft) Citalopram (Celexa) Escitalopram (Lexapro) ○ Mechanism of Action: SSRIs selectively block the reuptake of serotonin at presynaptic receptors, increasing serotonin levels in the brain. ○ Therapeutic Use: Commonly used for depression, anxiety disorders, and OCD. ○ Adverse Effects: Nausea, agitation, sexual dysfunction, dry mouth, GI issues, somnolence (due to anticholinergic properties). 2. Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): ○ Examples: Duloxetine (Cymbalta) Venlafaxine (Effexor) ○ Mechanism of Action: SNRIs block the reuptake of both serotonin and norepinephrine at presynaptic receptors. ○ Therapeutic Use: Used for depression, anxiety disorders, and neuropathic pain. ○ Adverse Effects: Similar to SSRIs, including nausea, agitation, sexual dysfunction. Unique: Appetite suppression. 3. Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs):  ○ Example: Bupropion (Wellbutrin) ○ Mechanism of Action: NDRIs inhibit the reuptake of norepinephrine and dopamine. ○ Therapeutic Use: Used for depression, seasonal affective disorder, and as a smoking cessation aid. ○ Adverse Effects: Insomnia, dry mouth, GI issues. 4. Tricyclic Antidepressants (TCAs): ○ Example: Amitriptyline ○ Mechanism of Action: Block the reuptake of serotonin and norepinephrine in presynaptic receptors, increasing their availability. ○ Therapeutic Use: Used to treat major depressive disorder, anxiety disorders, and chronic pain. ○ Adverse Effects: Anticholinergic effects: Dry mouth, constipation. Risk for orthostatic hypotension. Over time, clients may develop a tolerance to these effects. 5. Monoamine Oxidase Inhibitors (MAOIs): ○ Example: Phenelzine (Nardil) ○ Mechanism of Action: Inhibit the enzyme monoamine oxidase, which breaks down neurotransmitters like serotonin, norepinephrine, and dopamine. ○ Therapeutic Use: Used for treatment-resistant depression and anxiety. ○ Adverse Effects: Weight gain, daytime sedation, sexual dysfunction, insomnia. ○ Cautions: Interacts with many medications and foods containing tyramine (e.g., cheese, smoked fish, aged meat, chocolate, beer, soy sauce). These interactions can lead to hypertensive crises, which are life-threatening. General Teaching Points for Antidepressants: Adherence: Consistent medication use is critical, as full effects may take several weeks. Side Effects: Common side effects include dry mouth, GI issues, and somnolence due to anticholinergic properties. Patients should be educated on how to manage these. Dietary Restrictions: For MAOIs, strict dietary adherence is necessary to avoid life-threatening hypertensive crises.  Risk of Discontinuation Syndrome: Warn against abruptly stopping medication to avoid withdrawal symptoms. Week 3: Ethical, Legal, and Safety ANA Nursing Code of Ethics: 1. The nurse practices with compassion and respect for the inherent dignity, worth and unique attributes of every person. 2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. 3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient Client Rights: What rights does a BH patient have? 1. The right to humane treatment and care (medical and dental care) 2. The right to vote 3. The rights related to granting, forfeiture, or denial of a driver’s license 4. The right to due process of law, including the right to press legal charges against another person 5. Informed consent and the right to refuse treatment 6. Confidentiality 7. A written plan of care/treatment that includes discharge follow-up, as well as participation in the care plan and review of that plan 8. Communication with people outside the mental health facility, including family members, attorneys, and other health care professionals 9. Provision of adequate interpretive services if needed 10. Care provided with respect, dignity, and without discrimination 11. Freedom from harm related to physical or pharmacological restraint, seclusion, and any physical or mental abuse or neglect 12. A psychiatric advance directive that includes the client’s treatment preferences in the event that an involuntary admission is necessary 13. Provision of care with the least restrictive interventions necessary to meet the client’s needs without allowing them to be a threat to themselves or others Nursing Ethics: 1. Beneficence- The quality of doing good; can be described as charity 2. Fidelity- Loyalty and faithfulness to the client and to one’s duty 3. Autonomy- The client’s right to make their own decisions. However, the client must accept the consequences of those decisions. The client must also respect the decisions of others. 4. Veracity- Honesty when dealing with a client 5. Justice- Fair and equal treatment for all Types of admission:  1. Voluntary: Option to leave, Competent to make decisions, Legal guardian can admit 2. Involuntary: Can be done by anyone, Risk of harm to self or other, provider must evaluate. Limited to 60 days, 2 providers required 3. Informal: This is the least restrictive form of admission for treatment. The client does not pose a substantial threat to self or others. The client is free to leave the hospital at any time, even against medical advice. 4. Temporary emergency admission: The client is admitted for emergent mental health care due to the inability to make decisions regarding care. The medical health care provider can initiate the admission which is then evaluated by a mental health care provider. The length of the temporary admission varies by the client’s need and state laws but often is not to exceed 15 days. Seclusion and Restraints: 1. Can be physical or chemical 2. Last resort available 3. Must be ordered by the provider 4. Time Limits- 17 and above: up to 4 hours before another order 5. Children 9-17: 2 hours before another order 6. Children under 9: 1 hour before another order 7. Someone has to sit with them at all times to ensure patient safety 8. Drink, eat, bathroom 9. Must manage patient needs 10. DOCUMENTATION!!!! Justify why you took this action Torts: The medical issues of the patients have to be addressed! 1. Intentional Torts: actions that damage client property or violate client rights: False Imprisonment, Assault- causing someone to fear harm, Battery- causing physical harm 2. Unintentional Torts: are a result of failing to meet the duty of care: 3. Negligence: Failing to provide adequate care in a personal or professional situation when one has an obligation to do so 4. Malpractice: A type of professional negligence consisting of five elements: 5. Breach of duty- Not meeting the standards of care 6. Cause in fact and Proximate cause- “Did injury occur as a result of action taken by the nurses, or lack of action? Did the nurse foresee injury as a cause of their action or inaction?” 7. Damages- Loss of earnings, property, or causing pain and suffering 8. Duty- Understanding that specific knowledge and skills are needed for specialty nursing, like psychiatry. Therapeutic Relationship 1. Orientation Phase: 2. Introduction, Confidentiality, Testing the Relationship Working Phase: Problem-solving andClient self-esteem Resolution Summarize goals Make plans for the future Termination Study Guide: Anxiety, Somatic, and Dissociative Disorders 1. Anxiety Disorders Introduction to Anxiety: Definition: Anxiety is a feeling of discomfort, apprehension, or dread related to the anticipation of danger, often nonspecific or unknown. While it is a necessary force for survival, it becomes pathological when fears and anxieties are excessive and interfere with social, occupational, or other areas of functioning. Types of Anxiety Disorders: 1. Panic Disorder: ○ Characteristics: Recurrent, unpredictable panic attacks manifested by intense apprehension, fear, or terror, often associated with physical discomfort like chest pain, palpitations, or dizziness. ○ Symptoms: Sweating, trembling, shortness of breath, chest pain, nausea, dizziness, depersonalization, and fear of losing control or dying. 2. Generalized Anxiety Disorder (GAD): ○ Characteristics: Chronic, unrealistic, and excessive anxiety and worry occurring more days than not for at least 6 months. Symptoms include muscle tension, restlessness, and difficulty concentrating. 3. Separation Anxiety Disorder: ○ Characteristics: Excessive fear or anxiety concerning separation from those to whom the individual is attached. It can lead to nightmares and reluctance to leave the attachment figure. 4. Selective Mutism: ○ Characteristics: Consistent failure to speak in specific social situations despite speaking in other situations. It affects academic or social achievement and interferes with regular communication. 5. Phobias: ○ Agoraphobia: Fear of being in places where escape might be difficult or help unavailable, such as open spaces, public transportation, or crowded places. ○ Social Anxiety Disorder: Excessive fear of social situations where the individual may be embarrassed or negatively evaluated. ○ Specific Phobias: Fear of specific objects or situations, such as animals, natural environments, blood-injection-injury, or situational types. 6. Obsessive-Compulsive Disorder (OCD): ○ Characteristics: Presence of recurrent obsessions (intrusive thoughts) and compulsions (repetitive behaviors) that are time-consuming and cause distress or impairment. 7. Body Dysmorphic Disorder:  ○ Characteristics: Exaggerated belief that the body is deformed or defective in some way. Common concerns include facial flaws, excessive facial hair, or body shape. 8. Trichotillomania (Hair-Pulling Disorder): ○ Characteristics: Recurrent pulling out of one’s own hair, resulting in noticeable hair loss. The behavior is preceded by tension and followed by a sense of relief. 9. Hoarding Disorder: ○ Characteristics: Persistent difficulty discarding possessions, regardless of their value, often accompanied by the excessive acquisition of items. 2. Somatic Disorders Introduction to Somatic Symptom and Related Disorders: Definition: Characterized by physical symptoms that suggest a medical disease but cannot be explained by any organic pathology. Types of Somatic Disorders: 1. Somatic Symptom Disorder: ○ Characteristics: Multiple, medically unexplained physical symptoms that are associated with psychosocial distress. The individual devotes excessive time and energy to worrying about these symptoms. 2. Illness Anxiety Disorder: ○ Characteristics: Preoccupation with having or acquiring a serious illness despite the absence of significant medical findings. The fear is disproportionate to the actual physical symptoms. 3. Conversion Disorder (Functional Neurological Symptom Disorder): ○ Characteristics: Loss or alteration of physical function (e.g., paralysis, blindness) without any medical explanation, often precipitated by psychological stress. 4. Factitious Disorder (Munchausen Syndrome): ○ Characteristics: Deliberate feigning of physical or psychological symptoms to assume the sick role and receive medical attention. 3. Dissociative Disorders Introduction to Dissociative Disorders: Definition: Involves disruptions in the normal integration of consciousness, memory, identity, or perception of the environment. Types of Dissociative Disorders: 1. Dissociative Amnesia: ○ Characteristics: Inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. 2. Dissociative Identity Disorder (DID): ○ Characteristics: Presence of two or more distinct personality states within an individual, with the transition between personalities often triggered by stress. 3. Depersonalization-Derealization Disorder: ○ Characteristics: Persistent or recurrent experiences of feeling detached from one’s own body or mental processes (depersonalization) and/or feeling detached from one’s surroundings (derealization). 4. Treatment and Management Non-Pharmacologic Treatments: Cognitive Behavioral Therapy (CBT): Focuses on changing maladaptive thought patterns and behaviors. Exposure Therapy: Gradual exposure to the feared object or situation to reduce avoidance. Support Groups: Provide peer support and shared experiences in managing anxiety. Complementary-Integrative Approaches: Include relaxation techniques, mindfulness meditation, and lifestyle management (healthy diet, exercise, avoiding excessive caffeine). Pharmacologic Treatments: Antidepressants: ○ SSRIs: First-line treatment for anxiety and depressive disorders (e.g., Sertraline, Fluoxetine). Anxiolytics: ○ Benzodiazepines: Effective for acute anxiety but have a high potential for dependence (e.g., Alprazolam, Lorazepam). ○ Buspirone: Non-sedative anxiolytic, effective for GAD with no risk of dependence. ○ Antihistamines: Hydroxyzine can be used for short-term anxiety relief. Beta Blockers: ○ Propranolol: Used for performance anxiety by reducing physical symptoms like palpitations. 5. Nursing Process: Planning and Implementation For Anxiety Disorders: Interventions: Stay with the patient during panic attacks, maintain a calm approach, reduce stimuli, and use simple communication. Teach patients to recognize signs of escalating anxiety and use coping strategies. For Somatic and Dissociative Disorders: Interventions: Focus on relieving discomfort from physical symptoms and helping patients develop coping strategies. For dissociative disorders, aim to restore normal thought processes and manage stress without dissociation. Study Guide: Depression and Suicide 2. Types of Depressive Disorders 1. Major Depressive Disorder (MDD): ○ Characteristics: Persistent depressed mood or loss of interest/pleasure in activities. ○ Symptoms: Changes in appetite or weight, insomnia/hypersomnia, fatigue, feelings of worthlessness, difficulty concentrating, suicidal thoughts. 2. Seasonal Affective Disorder (SAD): ○ Characteristics: Depressive symptoms that occur during specific seasons, often in winter due to reduced sunlight. 3. Persistent Depressive Disorder (Dysthymia): ○ Characteristics: Chronic depressed mood for most of the day, more days than not, for at least 2 years. 4. Premenstrual Dysphoric Disorder (PMDD): ○ Characteristics: Severe mood swings, anxiety, and depression occurring in the week before menstruation, improving shortly after the onset of menstruation. 5. Substance-Induced Depressive Disorder: ○ Characteristics: Depression related to intoxication or withdrawal from substances like alcohol, amphetamines, or opioids. 3. Diagnosis of Depressive Disorders Key Symptoms: ○ Depressed or irritable mood. ○ Loss of interest or pleasure in activities. ○ Significant weight/appetite change.  ○ Sleep disturbances (insomnia or hypersomnia). ○ Psychomotor agitation or retardation. ○ Fatigue or loss of energy. ○ Feelings of worthlessness or guilt. ○ Difficulty concentrating or indecisiveness. ○ Recurrent thoughts of death or suicidal ideation. Differentiating Factors: ○ MDD: Persistent and long-term. ○ SAD: Linked to seasonal changes. ○ Persistent Depressive Disorder: Chronic, typically starting in childhood. ○ PMDD: Tied to menstrual cycles. ○ Substance-Induced: Related to substance use/withdrawal. 4. Risk Factors for Depression Female gender (twice the risk of males). Family history of depressive disorders. Lack of social support. Poor coping abilities. Life or environmental stressors. Substance use/abuse. Medical disorders and other mental health conditions. 5. Etiology of Depression Genetic Factors: Increased risk if a close family member has MDD. Neurotransmitter Deficiency: Dysregulation of serotonin, dopamine, and norepinephrine. Endocrine Interactions: Involvement of the HPA axis. Immune System Interactions: Role of cytokines. Freudian Theory: Self-rejection and low self-esteem due to lack of love in childhood. Cognitive Theory: Irrational beliefs and negative distortions. Environmental Factors: Adverse or traumatic life events. 6. Current Research Smartphone Addiction and Depression: Correlation between female gender, smartphone addiction, loneliness, and depression in adolescents. Tai Chi: Effective in reducing anxiety but not depression among U.S. veterans. 7. Cultural Effects on Depression Different cultures express depression differently: ○ Middle Eastern: "Problems of the heart." ○ Hopi Native Americans: "Heartbroken." ○ West Indies: "Running amok" or "zar." ○ Asians: Complaints of weakness, fatigue, or "imbalance." 8. Comorbidity Depression often co-occurs with other psychiatric and medical disorders like stroke, cancer, cardiovascular disorders, anxiety, substance abuse, and psychosis. 9. Family Response to Depression Families may experience frustration, guilt, or anger. Depression can lead to financial hardship and may increase the risk of abuse, especially toward women. 10. Treatment Modalities Medications: SSRIs: ○ Examples: Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro). SNRIs: ○ Examples: Duloxetine (Cymbalta), Venlafaxine (Effexor). NDRIs: ○ Example: Bupropion (Wellbutrin). Tricyclics: ○ Example: Amitriptyline. MAOIs: ○ Example: Phenelzine (Nardil). Therapy: Cognitive Behavioral Therapy (CBT): Focuses on changing negative thought patterns.  Dialectical Behavioral Therapy (DBT): Emphasizes acceptance of emotions and situations. Other Treatments: ○ Light therapy. ○ Transcranial Magnetic Stimulation (TMS). ○ Electroconvulsive Therapy (ECT). ○ Herbal Remedies: St. John’s Wort, SAMe. 11. Nursing Assessment for Depression Physical Health: Assess appetite, weight changes, sleep patterns, and fatigue. Medications and Substance Use: Review current medications and any substance use. Psychosocial: Evaluate mood/affect, cognition/memory, and thought content. 12. Suicide Awareness and Prevention Language: Use non-judgmental language, such as "died by suicide" instead of "committed suicide." Statistics: ○ Suicide is the 2nd leading cause of death for ages 10-14 and the 3rd for ages 15-24. ○ 79% of people who die by suicide are male. ○ 46% of people who die by suicide have a mental health condition. ○ 59% of youth with depression receive no treatment. Groups at Risk: High school students, LGBTQIA+ individuals, Native Hawaiian or Native American populations. Interventions: Ask directly about suicide, instill hope, reduce access to dangerous objects, and understand that "safety contracts" are not evidence-based.