Psychiatric Nursing: Depression, Suicide Risk, and Bipolar Disorders

What are the classifications of Major Depression?

Mild, moderate, or severe; with psychotic features; postpartum onset; seasonal affective disorder; dysthymic disorder; premenstrual dysphoric disorder; substance-induced depressive disorder.

What does the acronym SIGECAPS stand for in relation to Major Depression?

Sleep, Interest, Guilt, Energy, Concentration/Cognition, Appetite, Psychomotor, Suicidality.

What is Cognitive Behavioral Therapy (CBT)?

A nonpharmacologic treatment that involves meeting with a trained therapist to empower the client to change behavior by changing thinking.

What is Electroconvulsive Therapy (ECT)?

A treatment for severe depression that induces brief seizures through electrical current, usually administered under general anesthesia.

What is Transcranial Magnetic Stimulation (TMS)?

A non-invasive procedure that uses magnetic pulses to stimulate focal areas of the cerebral cortex without the use of anesthesia.

What is the purpose of light therapy?

To treat seasonal affective disorder by exposing clients to bright light to compensate for lack of sunshine.

What are the pre-ECT preparations?

Benzodiazepines should be discontinued; the client must be NPO for 6 to 8 hours prior; and a rapid-acting general anesthetic and muscle-paralyzing agent are administered.

What is the SAD PERSONS scale used for?

To assess suicide risk factors by scoring points for each factor present, helping to determine the appropriate level of care.

What score on the SAD PERSONS scale indicates a need for hospitalization?

A score of 7 to 10.

What are some individual risk factors for suicide?

Previous attempts at self-harm, mental illness, lack of social support, legal and financial problems, risky behaviors, job loss, serious medical illness, substance use.

What relationship factors increase suicide risk?

History of abuse or neglect, being bullied, family history of suicide, personal relationship problems, sexual violence.

What community factors can contribute to suicide risk?

Barriers to health care access, cultural beliefs about suicide, community clusters of suicides, stigma around mental illness, access to lethal means.

What are immediate warning signs of suicide?

Stating a desire to die, feelings of hopelessness, feeling trapped, unbearable physical/emotional pain, feeling like a burden.

What are some behavioral warning signs of suicide?

Withdrawing from social interactions, giving away possessions, bidding goodbye, engaging in risky behavior, obsessively thinking about death.

What is the significance of memory loss in ECT?

One major side effect of Electroconvulsive Therapy is memory loss.

What is the role of the nurse in ECT?

To monitor the client's status and respond to any emergencies during the procedure.

What is the importance of structure and schedule in managing depression?

Having a structured schedule can help improve mood and provide stability for individuals with depression.

What is the effect of alcohol on depression?

Alcohol is a depressant substance that can exacerbate depressive symptoms.

What should clients do if they have suicidal thoughts?

They should report their thoughts to a nurse or mental health professional immediately.

What is the significance of St John's wort in depression treatment?

It is an alternative therapy that should not be taken with SSRIs due to potential interactions.

What is the goal of ECT?

To reset the wiring in the brain for patients with severe depression after other treatments have failed.

What are common signs of suicidal ideation?

Complaining about feeling great guilt or shame, increasing use of drugs or alcohol, behaving anxious or agitated, changing eating or sleeping habits, displaying rage or talking about seeking revenge.

What does the acronym IS PATH WARM stand for in suicide risk assessment?

I - Ideation, S - Substance Abuse, P - Purposelessness, A - Anxiety, T - Trapped, H - Hopelessness, W - Withdrawal, A - Anger, R - Recklessness, M - Mood changes.

What characterizes Bipolar Disorder?

Episodes of depression and mania, with symptoms of mania including overactivity, overeating, overspending, not sleeping, and talking very quickly.

What cultural considerations should be taken into account for clients with mental illness?

Cultural attitudes toward mental illness, reluctance to disclose struggles, and fears of losing jobs, custody of children, or relationships.

What was the prevalence of bipolar disorder in U.S. adults in 2019?

Estimated at 2.8%, with a similar breakdown among genders.

What does the acronym DIGFAST represent in assessing mania?

D - Distracted, I - Indiscretions, G - Grandiose, F - Flight of ideas, A - Activity, S - Sleep, T - Talkative.

What are some risk factors for Bipolar Disorders?

Strong familial connections, with relatives showing both depression and bipolar disorder.

What are some diagnostic tools for depression?

Beck Depression Inventory, PHQ-9, Hamilton Depression Scale, Geriatric Depression Scale, Altman Self-Rating Mania Scale.

What classes of medications are used to treat depressive disorders?

SSRIs, SNRIs, TCAs, MAOIs, SGAs, mood stabilizers, and anticonvulsants.

What is the nurse's role in ensuring client safety during acute situations?

Prioritize client safety, especially if no caregiver is available to provide a thorough history.

What should nurses teach clients regarding their disorder?

Specific education about the disorder, general physical health practices, and reducing stigma in communities.

What cues should nurses recognize to identify clients needing help?

Lack of energy or motivation, inability to carry out daily activities, and speech patterns indicating distress.

What are the first steps in the nursing process for clients with mood disorders?

Safety first, followed by analyzing cues and prioritizing hypotheses.

What considerations should be made during the planning phase for clients with mood disorders?

Rest, nutrition, suicide precautions, and referrals to community mental health services.

What actions should nurses take during the implementation phase for clients with depression?

Create a structured plan encouraging participation in activities and monitor for suicidality.

What actions should nurses take during the implementation phase for clients with mania?

Ensure structured plans for rest and nutrition, and provide high-calorie foods.

What safety measures should be taken for inpatient clients?

Assess for suicidality, monitor for harmful objects, and provide one-to-one surveillance if necessary.

What should nurses do if a client expresses suicidal ideation?

Therapeutically ask about the ideation, explore these thoughts, and assess for lethality.

What are the short-term outcomes to evaluate in clients with mood disorders?

Presence or absence of suicidal ideations, ability to care for self, and mood stability.

What are the long-term outcomes to evaluate in clients with mood disorders?

Adherence to medication, lack of suicidality, and functionality in relationships and life.

What is the importance of communication in nursing care for clients with mental health issues?

To assure clients that disclosure of symptoms will not lead to rejection, bias, or stigma.

What dietary considerations should be made for clients on MAOIs?

Avoid tyramine-rich foods like aged cheeses and cured meats to prevent hypertension.

What is the significance of the Hamilton Depression Scale?

It is a tool used to assess the severity of depression, with versions containing 17 or 21 items.

What role does case management play for clients with chronic depression?

It coordinates medication management and psychotherapy.

What should be monitored in clients experiencing mania?

Ensure they receive adequate nutrition and rest, and monitor for excessive activity.

What is a common behavioral sign of depression in clients?

Inability to carry out activities of daily living.

What is a key aspect of the nursing process in managing mood disorders?

Continuous assessment and adjustment of care based on the client's changing needs.