NURS 3121 Mental Health Nursing: Communication & Therapeutic Relationships, Depression & Mood Disorders, Suicide Assessment

Flashcards covering key vocabulary terms related to therapeutic communication, therapeutic relationships, challenges in these relationships, phases of therapeutic relationships, therapeutic and non-therapeutic communication techniques, major depressive disorder (MDD), bipolar disorder, and suicide assessment and interventions from the NURS 3121 Mental Health Nursing lecture.

Therapeutic Relationships

Relationships that facilitate communication of thoughts and feelings, assist with problem-solving, help clients examine alternatives to unsuccessful behaviors, and promote self-care and independence. They are patient-centric with clear boundaries.

Transference

A challenge in therapeutic relationships where a client unconsciously displaces emotional reactions, feelings, and attitudes from past significant relationships onto the nurse.

Countertransference

A challenge in therapeutic relationships where the nurse unconsciously displaces emotional reactions, feelings, and attitudes from past significant relationships onto the client.

Boundaries (Therapeutic Relationships)

Clear limits and expectations in therapeutic relationships covering physical space, personal space, social interactions, and defining the roles and needs of the nurse versus the patient. It’s important to keep the same boundaries for all patients to make it easiest to not cross them.

Pre-Orientation Phase

The phase of the therapeutic relationship where the nurse prepares for the encounter with the client, often by reviewing chart information, self-assessing personal feelings, and anticipating concerns.

Orientation Phase

The phase of the therapeutic relationship where the nurse and client meet and establish trust, define the purpose of the relationship, identify preliminary goals, and clarify roles. Termination is included in this - you express the limits of the relationship. 

Working Phase

The phase of the therapeutic relationship where identified problems are addressed, and solutions are explored and implemented. New coping mechanisms and behavioral changes are encouraged. Can be especially difficult for students in mental health rotations - you have to be a certain level of confrontational. 

Termination Phase

The final phase of the therapeutic relationship where goals are reviewed, the client becomes more independent in self-care, and the relationship concludes.

Active Listening

A therapeutic communication technique that involves fully concentrating on and understanding what the client is communicating, both verbally and non-verbally.

False Reassurance

A non-therapeutic communication technique that dismisses the client's feelings and concerns, often using phrases like 'I wouldn’t worry about…' or 'I’m sure things will turn out.'

Advising / Giving advice

• A non-therapeutic communication technique where the nurse tells the client what to do, such as 'Have you tried writing a letter to her to say how you feel?'

• a way to suggest things without giving advice —> “so i’ve talked to patients in the past that have dealt with something similar, that have tried such and such. i don’t know about you, but it worked for them.” 

• when you’ve exhausted all options and still can’t think of a solution, that’s when you focus on how it’s making them feel and try to deal with that aspect of things. 

Defending (Non-therapeutic Technique)

A non-therapeutic communication technique where the nurse attempts to protect someone or something from verbal attack, conveying that the client has no right to express negative feelings, e.g., 'The doctor only has your best interest in mind.'

Belittling feelings

A non-therapeutic communication technique that dismisses or minimizes the client's expressed emotions, making them feel like their feelings are unimportant, e.g., 'We all get a little depressed sometimes.'

Denying feelings

A non-therapeutic communication technique that invalidates the client's feelings by stating they aren't true, e.g., 'That can’t be true, I’m sure your husband loves you very much.'

Multiple questions (Non-therapeutic Technique)

A non-therapeutic communication technique involving asking several questions in quick succession, overwhelming the client and making it difficult for them to respond effectively.

Not tracking / Changing the subject

A non-therapeutic communication technique where the nurse introduces an unrelated topic while the client is discussing an important issue, indicating a lack of interest or discomfort with the topic.

Diathesis Stress Model

A psychological theory that explains how a disorder may develop from a genetic or biological predisposition (diathesis) co-occurring with environmental stress or trauma.

Diathesis

Within the Diathesis Stress Model, this refers to a biological predisposition to a particular mental health disorder.

Stress (Diathesis Stress Model)

Within the Diathesis Stress Model, this refers to environmental stress or trauma that, when combined with a diathesis, can lead to significant dysfunction in mental functioning.

Major Depressive Disorder (MDD)

A mood disorder characterized by depressed mood, emotional, cognitive, physical, and behavioral symptoms, leading to impaired functioning.

Etiology of MDD (Biological Factors)

Includes genetic predispositions, biochemical imbalances, and hormone regulation issues.

Etiology of MDD (Psychological Factors)

Includes cognitive theory (negative thought patterns) and learned helplessness (belief that one cannot control outcomes). There are also environmental factors.

Suicidality in MDD

Major Depressive Disorder significantly increases the lifetime prevalence of suicidal thought (~45%), plan (~20%), and attempt (~15%) compared to the general population.

With psychotic features (MDD specifier)

A specifier for Major Depressive Disorder indicating the presence of hallucinations or delusions during a depressive episode.

Premenstrual Dysphoric Disorder (PMDD)

A specifier or distinct depressive disorder subtype characterized by severe mood irritability, dysphoria, and other symptoms that occur during the premenstrual phase.

Persistent Depressive Disorder (PDD)

A specifier or distinct depressive disorder subtype referring to a chronic form of depression (formerly dysthymia) where symptoms have lasted for at least two years.

Mental Status Assessment

A structured assessment used to evaluate a client's current mental state, including appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, and insight.

Beck Depression Inventory (BDI)

A self-report questionnaire used to measure the severity of depression in adolescents and adults.

Hamilton Depression Scale (HAM-D)

A clinician-rated questionnaire used to assess the severity of depression, particularly in individuals already diagnosed with a mood disorder.

Geriatric Depression Scale (GDS)

A screening tool specifically designed to assess for symptoms of depression in older adults.

Patient Health Questionnaire (PHQ-9)

A widely used self-administered screening tool for depression severity and possible presence of Major Depressive Disorder.

SIGECAPS (mnemonic)

A mnemonic used to remember the symptoms of depression: Sleep changes, Interest loss, Guilt, Energy loss, Concentration difficulties, Appetite changes, Psychomotor agitation/retardation, Suicidal ideation.

A SAD FACE(S) (mnemonic)

A mnemonic for assessing symptoms of depression: Appetite changes, Sleep changes, Anhedonia, Depressed mood, Fatigue, Agitation/retardation, Concentration, Esteem issues, Suicidal ideation.

ways of asking about concentration

• would you be able to watch a movie or an episode of a sitcom right now? did you used to be able to do that?

• if i gave you a book right now would you be able to read a paragraph? a page?

ICE

• what is your IMPRESSION of what is going on?

• what are your CONCERNS about this

• what is your EXPECTATION with this treatment, and how can we help to meet those?

Tricyclic antidepressants (TCA)

An older class of antidepressant medications that block the reuptake of norepinephrine and serotonin. They have a higher side effect profile than newer antidepressants. They also have a high potential of overdose and suicide. 

Monoamine Oxidase Inhibitors (MAOI)

An older class of antidepressant medications that block the enzyme monoamine oxidase, leading to increased levels of norepinephrine, serotonin, and dopamine. They require strict dietary restrictions to prevent hypertensive crisis so we don’t like those. 

Selective Serotonin Reuptake Inhibitors (SSRI)

A first-line class of antidepressant medications that selectively block the reuptake of serotonin, increasing its availability in the brain. They generally have fewer side effects than TCAs and MAOIs. First like because of lower side effects and overdose potential.

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRI)

Antidepressant medications that block the reuptake of both serotonin and norepinephrine, increasing their availability in the brain.

Norepinephrine and Dopamine Reuptake Inhibitors (NDRI)

Antidepressant medications that primarily block the reuptake of norepinephrine and dopamine.

Serotonin Syndrome

• A potentially life-threatening condition caused by excessive serotonin activity in the central nervous system, often resulting from combining multiple serotonergic drugs.

• symptoms

  • mental status changes 

  • shits and shivers

  • fever

  • muscle breakdown

  • can lead to seizures 

• you take away whatever extra is causing it, treat the symptoms, monitor the vital signs 

Electroconvulsive Therapy (ECT)

A medical procedure, under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure to relieve symptoms of severe depression or bipolar disorder.

Transcranial Magnetic Stimulation (TMS)

A non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.

Vagus Nerve Stimulation (VNS)

A treatment where a device is surgically implanted and sends regular, mild electrical pulses to the brain via the vagus nerve, used for treatment-resistant depression or epilepsy.

Deep Brain Stimulation

A neurosurgical procedure involving the implantation of electrodes within certain brain areas to send electrical impulses that regulate abnormal brain activity, used for severe, treatment-resistant psychiatric disorders.

Light therapy (for depression)

A treatment using exposure to artificial light, typically a light box, to treat seasonal affective disorder (SAD) and sometimes other types of depression.

St. John’s wort

An herbal supplement sometimes used to treat mild to moderate depression, but it can interact with many medications.

Psychotherapy

A general term for treating mental health problems by talking with a psychiatrist, psychologist, or other mental health provider, helpful for mood disorders.

Bipolar Disorder (Biological Factors)

• includes strong genetic heritability, neurobiological imbalances, and neuroendocrine issues. Gender differences also exist (Bipolar I more in males; Bipolar II more in females).

• there are also psychological factors and environmental factors 

Suicidality in Bipolar Disorder

Individuals with Bipolar Disorder have substantially higher lifetime rates of suicidal thought (~60%), plan (~25%), and attempt (~25%) compared to the general population.

Manic Episode

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week.

Hypomanic Episode

A less severe form of a manic episode, characterized by a distinct period of persistently elevated, expansive, or irritable mood and increased activity or energy, lasting at least four consecutive days, that does not significantly impair functioning or require hospitalization.

Major Depressive Episode (Bipolar Disorder)

A period of depressed mood or loss of interest or pleasure, along with significant weight loss/gain or appetite change, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue, feelings of worthlessness/guilt, difficulty concentrating, and thoughts of death/suicide, lasting at least two weeks.

Cyclothymic Disorder

• A chronic mood disturbance characterized by numerous periods of hypomanic symptoms and numerous periods of depressive symptoms that do not meet the criteria for a Major Depressive Episode, lasting for at least two years.

• will range from mild-moderate depressive episodes to hypomanic episodes. they will cycle through the moods faster 

Bipolar I Disorder

• Characterized by one or more mixed or manic episodes, often accompanied by major depressive episodes and sometimes psychosis. Onset is typically around 18 years.

• more common in males 

• more time spent in manic episodes than depressive episodes

Bipolar II Disorder

• Characterized by one or more major depressive episodes and at least one hypomanic episode, but no manic or mixed episodes. Onset is typically around 20 years.

• more time spent in depressive episodes than hypomanic episodes

• more common in females 

Rapid Cyclers (Bipolar Disorder)

A specifier for bipolar disorder indicating that an individual has experienced four or more mood episodes (mania, hypomania, or depression) within a one-year period.

Mania

A persistent elevated or irritable mood that significantly impairs functioning, may require hospitalization, and includes symptoms like grandiosity, decreased sleep, pressured speech, flight of ideas, psychomotor agitation, and risk-taking activities.

Hypomania

A mild form of mania that does not markedly impair functioning or necessitate hospitalization, though similar symptoms of elevated mood and increased energy are present to a lesser degree.

Mood Disorder Questionnaire (MDQ)

A screening tool used to help identify individuals who might have bipolar disorder.

Risk Assessment (Bipolar Disorder)

Evaluation of potential risks such as suicide, harm to self or others, and engaging in impulsive or reckless behaviors during manic or depressive episodes.

Lithium Carbonate (for Bipolar Disorder)

A mood stabilizer often used as a first-line pharmacological treatment for bipolar disorder, particularly effective in preventing manic episodes.

Anticonvulsant Therapy (for Bipolar Disorder)

A class of medications, also known as seizure medications, that are effective as mood stabilizers for bipolar disorder, often used when lithium is not tolerated or effective.

Anxiolytic Drugs (for Bipolar Disorder)

Medications used to treat anxiety symptoms that can co-occur with bipolar disorder, though typically not as a primary treatment for the mood swings themselves.

Atypical Antipsychotics (for Bipolar Disorder)

A class of medications used to treat psychotic symptoms, as well as mood stabilization in bipolar disorder, particularly for manic or mixed episodes.

Nutritional Therapy (for Bipolar Disorder)

Includes dietary interventions, such as supplementation with Omega-3 Fatty Acids, which may support mood stability in bipolar disorder.

Edema of hands or feet (Lithium side effect)

A common side effect of Lithium; nursing interventions include monitoring I&O, NaCl intake, elevating legs, and monitoring weight.

Fine hand tremor (Lithium side effect)

A common side effect of Lithium; nursing interventions include providing support, reassuring the client, minimizing stressors, and potentially adjusting to more frequent and smaller doses.

Polydipsia (Lithium side effect)

Excessive thirst, a common side effect of Lithium; nursing interventions include monitoring I&O, reassuring the client, and explaining that it's a normal coping mechanism for polyuria.

Polyuria (Lithium side effect)

Excessive urination, a common side effect of Lithium; nursing interventions include monitoring I&O, reassuring the client, and explaining that it does not indicate physical damage to the kidneys.

Stevens-Johnson Syndrome (SJS)

A rare but serious disorder of the skin and mucous membranes, often a severe reaction to medication, characterized by initial symptoms like fever, sore throat, cough, burning eyes, followed by facial/tongue swelling, hives, skin pain, rapidly spreading rash, and blisters.

Suicide

The intentional act of killing oneself by any means (also referred to as death by suicide or died by suicide).

Suicide attempt

A desperate call for help where an individual intentionally engages in self-harming behavior with varying levels of risk, but does not result in death.

Suicide threat

A more serious verbal statement of intent to commit suicide, usually accompanied by behavioral changes, indicating a higher level of concern than casual statements.

Self-mutilation

Intentional self-injury by cutting, burning, biting, or other means; should not be confused with suicidal ideation, but always requires investigation for suicidal intention.

Epidemiology of Suicide

The study of suicide rates, which are often underreported. In Canada (2019), the rate was 11.5 per 100,000, with higher rates in territories like Nunavut (27.8). Individuals with schizophrenia have a 50 times higher risk.

Biological Factors (Suicide Etiology)

Includes decreased serotonin levels, which are associated with decreased mood and an increased risk of suicide.

Psychosocial Theories of Suicide

Theories by Freud (anger/aggression turned on self), Menninger (suicidal hostility: wish to kill, be killed, die), and Beck (central factor is hopelessness) describe the psychological roots of suicidal behavior.

Cultural Factors (Suicide Etiology)

Societal and cultural norms, beliefs, and stigma surrounding suicide and mental illness can influence suicide rates and behaviors.

Social Factors (Suicide Etiology)

Social isolation, lack of support networks, and other societal stressors or influences that can contribute to suicidal ideation and actions.

Risk and Protective Factors (Suicide Assessment)

An assessment that identifies elements that increase (risk factors) or decrease (protective factors) an individual's likelihood of engaging in suicidal behavior.

ISPATHWARM (mnemonic)

A mnemonic used for assessing warning signs of suicide: Ideation, Substance abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood changes.

SADPERSONS (mnemonic)

A mnemonic used for triaging potential suicidal patients: Sex, Age, Depression, Previous attempt, Ethanol abuse, Rationality loss, Social supports lacking, Organized plan, No spouse, Sickness.

Lethality of Suicide Plan

The evaluation of how deadly a chosen method of suicide is and the extent to which the individual has access to that method or has made preparations.

Suicide Precautions

Interventions implemented to ensure the safety of a client at risk of suicide, such as constant observation, removal of harmful objects, and frequent checks. Contracts are NOT best practice.

Postvention (Suicide)

Interventions and support provided to survivors of suicide (friends, family, community members) after a suicide has occurred.

Debriefing for staff (Suicide)

A process for healthcare professionals to discuss and process their experiences and emotions after a client's suicide or suicide attempt, promoting emotional support and learning.