MOOD DISORDERS Flashcards
(15 cards)
the key causative factors which have been identified for depression
- feeling blue to very severe, where there is extraordinary sadness
- dejection and an inability to take pleasure in activities.
- grief is part of normal human functioning and is not a disease state.
- feeling low
- feeling hopeless
- fatigue
- decreased or increased sleep
- decreased or increased appetite
Summarise the key causative factors which have been identified for bipolar disorder
- cycling between depression and normal mood, and mania
- bipolar 1 disorder is defined by one or manic or mixed episodes.
- bipolar 2 disorder is characterised by hypomania and a depressive episode.
- a mixed episode is where features of mania and depression such as agitation, anxiety, fatigue, or irritability occur simultaneously or in short succession.
Complete the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) criteria for Major Depressive Disorder. Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either:
1 Depressed mood
2 Loss of interest or pleasure
3 higher rates of suicide
4 chronic pain
5 poorer health
6. irritability
7. substance use
8 trouble sleeping
9 confusion or attention problems
Today you are working with John. You ask him how he is feeling. He reports that he feels like he will never get better, and he doesn’t see the point of going on. He appears withdrawn and mildly irritated and is struggling with getting out of bed.
Q3.4 Identify three nursing interventions that you could use to help John with his mood and to manage his day. Explain the rationale for these interventions:
intervention: Be genuine and honest with clients. Accept them for who they are (both negative and positive aspects).
- Depressed people have chronically low self esteem
- Genuine acceptance by others is a first step to recovery
Today you are working with John. You ask him how he is feeling. He reports that he feels like he will never get better, and he doesn’t see the point of going on. He appears withdrawn and mildly irritated and is struggling with getting out of bed.
Q3.4 Identify three nursing interventions that you could use to help John with his mood and to manage his day. Explain the rationale for these interventions:
intervention: Treat anger and negative thinking as symptoms of the illness, not as personally targeted at the nurse
- Depressed people are often negative and angry
- By identifying that negativity and anger are aspects of the illness, the nurse can encourage the client to move on from these issues to express more appropriate emotions
Today you are working with John. You ask him how he is feeling. He reports that he feels like he will never get better, and he doesn’t see the point of going on. He appears withdrawn and mildly irritated and is struggling with getting out of bed.
Q3.4 Identify three nursing interventions that you could use to help John with his mood and to manage his day. Explain the rationale for these interventions:
intervention: Identify and evolve clients in activities where they can enjoy success
- It is important for clients to feel good about themselves
- By involving clients in activities that they can accomplish, they may begin to improve their sense of self-worth
Bipolar disorder
Q3.5 Complete the DSM-5 criteria for a manic disorder
A a distinct period of abnormally and persistently elevated expensive, or irritable mood and abnormally and persistently increased goal directed activity or energy lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary.
B during the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms are present to a significant degree and represent a noticeable change from usual behaviour
1 inflated self-esteem or grandiosity
2 Decreased need for sleep
3 more talkative than usual or pressure to keep talking
4 flight of ideas or subjective experience that thoughts are racing
5 Distractibility (i.e attention to easily drawn to unimportant or irrelevant external stimuli.
6 increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7 excessive involvement in activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments.
D. The episode is not due to a substance or medical condition.
Identify three appropriate nursing interventions and rationale for these when working with someone experiencing an acute episode of mania.
intervention: Speak in a calm, supportive tone
- Using this tone of voice encourages the client to respond positively, not defensively
- A clear, calm tone discourages the clients need to engage in power struggles
Identify three appropriate nursing interventions and rationale for these when working with someone experiencing an acute episode of mania
intervention: Give firm, simple directions and comments. Limit setting may be required
- Using this tone of voice encourages the client to respond positively, not defensively
- A clear, calm tone discourages the clients need to engage in power struggles
- Clients with mania have flight of ideas and pressure of speech and are easily distracted
- The nurse needs to take control of the situation by politely firmly interrupting excessively talkative clients. This is particularly important when the nurse is leading a group and the manic client is disrupting others
Identify three appropriate nursing interventions and rationale for these when working with someone experiencing an acute episode of mania.
intervention: Never reinforce hallucinations, delusions or irritable beliefs
Reinforce reality and redirect the conversation
- The same polices apply to clients with mania as to depressed clients
- It is not appropriate to agree with the clients perceptual abnormalities. Equally, arguing that they do not exist serves little purpose.
- The nurse should state their perception of the situation
- The nurse should state that there is a discrepancy between what is perceived by the client and what is perceived by the nurse
- The nurse should then steer the conversation to discussing real people and real events
Why do people find it difficult to talk about suicide?
People often experience stigma around mental illnesses such as depression and often feel like they will be judged or rejected by loved ones if they speak up about their depression, therefore this can prevent them from getting help
What should be included in a risk analysis plan?
- Risk assessment seeks to gather information that may influence the potential of adverse events happening, linking and contextualising past information with current circumstances.
- Risk formulation requires that risk factors are identified, with collaborative predictions or follow-up; unescorted leave from impatient stays previously perceived to be too risky; pharmacology – free trials as a result of severe side effects; non-admission following presentation in crisis team visit at home
What are the dynamic risk factors associated with suicide risk?
Dynamic risk factors
- Mental state and/or internal risk factors:
- Substance abuse/dependence, especially alcohol misuse/abuse
- Current diagnosis of personality disorder, especially antisocial and borderline personality disorders, impulsivity
- Active symptoms of mental illness (comorbid depression or psychotic disorder and impaired rational thinking, command hallucinations) with suicidal/self-harm/arm to others ideation with plan and intent
- Poor response/compliance with treatment
- Situational and/or external risk factors:
- Isolation (geographic and social) and poor social supports
- Recent losses such as job, bereavement, separation or divorce with associated access to children issues
- Recent suicide of friend, family member or public figure
- Recent experience of adversity or stressful event such as admission or discharge from mental health inpatient unit
- Access to means and opportunity for suicide/self-harm/harm to others
- Unauthorised leave or failure to return from leave
What are the protective risk factors associated with suicide risk?
- Previous help-seeking behaviour
- Strong, dependable social supports, good relationships (friends, family-significant others)
- positive engagement with services, therapeutic alliance evident, compliance with treatment, awareness of early warning signs, concerns about effect of suicide on others
- Stable employment and accommodation
- Prolonged abstinence from substances
What are some questions you would ask someone you suspect or know is experiencing suicidal ideation?
- You’ve told me a bit of what’s been happening
- Does it seem unbearable sometimes?
- Have you had thoughts of hurting yourself?
- Have you ever tried to hurt yourself?
- do you ever have thoughts of hurting someone else?
- Have you ever had to protect yourself from others?
