Mood Disorders Flashcards
(44 cards)
Grief
The painful emotional response to the loss of something or someone significant.
Kübler-Ross Model of Grief
Denial , Anger, Bargaining, Depression, Acceptance
Denial
Initially, clients may have difficulty accepting that the loss has really occurred. Denial is a common first reaction
Anger
Clients who are grieving often experience strong feelings of anger. They may express anger toward themselves, others, or even the lost person.
Bargaining
During grief, clients may attempt to strike a deal with God or some higher power for an alternative plan. For example, a person may plead, “If you will let me live to see my daughter’s wedding, I’ll accept my cancer diagnosis.”
Depression
Of course, clients that are grieving will experience intense feelings of sadness, sorrow, and loss.
Acceptance
Eventually, most clients come to accept the loss. They utilize coping strategies and become less preoccupied with it. That’s not to say they no longer feel the loss or still grieve; they still have ups and downs. But they’ve found new ways to stay connected to the loss as they continue life.
Types of Grief
Normal grief , Anticipatory grief ,Complicated or Maladaptive grief, Bereavement overload
Normal grief
Clients experience the stages of grief (denial, anger, bargaining, etc.). Somatic complaints are common (e.g., headaches, nausea, fatigue, sleep difficulties). Some authors say that clients usually achieve some degree of acceptance within six months. Keep in mind, each situation is unique and there is no set time limit for grieving. Remember, anger is a normal emotion during grief.
Anticipatory grief
Occurs when a client experiences the stages of grief before the loss occurs (e.g., when a loved one is in hospice care). Sometimes clients are not aware they are experiencing this type of grief since the loss has not yet occurred.
Complicated or Maladaptive grief
Occurs when the grief response may be inhibited, exaggerated, or prolonged. A helpful way to distinguish normal grief from maladaptive grief is that the latter is often accompanied by feelings of worthlessness or low-self esteem. Another key indicator is difficulty carrying out normal activities.
Bereavement overload
Occurs when an individual experiences too many losses at too rapid of a pace. Older adults are especially prone to experiencing this.
Practical Advice
- Don’t speak; be present - When someone is suffering, we feel the urge to say something to make the pain go away. We use clichés like, “Something good will come from this.” The statements often minimize the pain someone is feeling and are usually offensive. Instead of speaking, it’s better to simply be present. People that are grieving usually won’t remember what you say (unless it’s offensive). However, they won’t ever forget that you were present.
- Listen- Clients who are grieving are likely to express strong, negative emotions. Be a good listener. Don’t philosophize about why the tragedy happened or what it means. Let the people suffering express their thoughts and emotions—including negative ones.
- Take action - We often say to people, “Let me know if there is something I can do to help you.” This well-intended statement is not very helpful. It puts an additional burden on the person that is suffering. They have to ask you for a favor. They have to worry if they are being too burdensome, a bother, etc. It’s much better to take action. Do something thoughtful for the person that is suffering.
- Express compassion and care - If you must say something, simply express compassion and care. For example, you might say, “I am so sorry that this happened. I care deeply for you.”
Major Mood Disorders
- Depressive disorders
- Bipolar disorders.
Nursing Diagnoses
Complicated grieving, imbalanced nutrition: less than body requirements, impaired social interaction, insomnia, low self-esteem, powerlessness, risk for injury, risk for suicide, risk for violence: self-directed or other-directed, self-care deficit (hygiene, grooming), social isolation/impaired social interaction, and spiritual distress.
Major Depressive Disorder
Clients have a depressed mood and/or loss of interest in pleasurable activities (anhedonia). Clients can feel extreme guilt and feelings of worthlessness. Sleep abnormalities are common (increased or decreased). Appetite changes are common (increased or decreased). Clients can be incredibly fatigued, making it difficult to climb out of bed. Some, however, experience psychomotor agitation and irritation. In some cases, suicidal thoughts and behaviors can occur.
Depression Subtypes
Melancholic features
Mood-congruent psychotic features
Seasonal pattern
Melancholic features
This is a severe version of depression in which a client’s mood is extremely dark and unremitting. Even extremely positive news will not temporarily lift the client’s spirits. Clients often experience early morning awakenings and loss of appetite. Suicidal ideation is common.
Mood-congruent psychotic features
Some clients with depression experience delusions that involve strong feelings of guilt. They may believe they are responsible for someone’s death or a natural catastrophe. Alternatively, they may believe they have a severe illness or that their body is “rotting.” Auditory hallucinations can also occur.
Seasonal pattern
This is a form of depression that reoccurs seasonally (usually seasonally). Light therapy is an effective treatment.
Peripartum onset
This subtype of depression is associated with pregnancy. Some of these clients will develop psychotic features.
Epidemiology (Major Depressive Disorder)
Depression is often called the “common cold” of mental disorders. The lifetime prevalence of depression is about 17%. It’s nearly twice as common in women. Depression can occur at any age, but it is less common in older adults. A common problem is relapsing. The chance of relapsing after one episode is 50%. After two episodes, the relapse rate is 80%
Psychological Factors (Major Depressive Disorder)
Cognitive-behavioral theorists note that depressed clients have a similar pattern of thinking: negative beliefs about the world, themselves, and the future. In addition, depressed clients exhibit several cognitive distortions (e.g., all-or-nothing thinking, personalization, mind reading, discounting positives).
Biological Factors (Major Depressive Disorder)
Depression may be related to deficiencies of serotonin, norepinephrine, and dopamine in the brain. We also know that depression is sometimes caused by a general medical condition (e.g., hypothyroidism) or medication use (e.g., alcohol, beta-blockers, steroids, withdrawal from a stimulant like cocaine or amphetamine).
