MOOD DISORDERS AND SUICIDE

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mood disorders

disruptions of mood or predominating emotion. are common mental health problems that often lead to hospitalization and the need for prolonged care throughout the lifespan. causes of these are an interplay of genetics, neurotransmitter dysfunction, brain dysfunction, neuroendocrine issues, environmental factors, and psychological factors. clients who experience these are at an increased risk for suicide and may see it as a form of relief or as a way to resolve emotional turmoil.

depressive disorders

a group of mood disorders characterized by hopelessness/worthlessness/guilt, loss of interest in activities, increased fatigue, sleep disturbances, weight changes, psychomotor changes, difficulty concentrating, and persistent thoughts of death. can range from mild (dysthymia) to severe (major depression). range of disorders can be treated with antidepressants, which often take almost a full month to fully take effect and work by boosting many different neurotransmitters. important for the nurse to encourage the client to participate in self-care, maintain the therapeutic regimen, and move toward a more hopeful mood, or the client may well choose suicide over the pain of continuing to suffer from these disorders. have a high prevalence in those 18 or older, with an increased prevalence in females. can be induced by medical conditions, such as Parkinson's disease, Huntington's disease, Alzheimer's disease, and hypothyroidism.

bipolar and related disorders

clinical manifestations of depression and mania/hypomania. includes bipolar 1, 2, cyclothymic disorder, and substance/medication induced bipolar disorders. characterized by having trouble processing thoughts, speaking quickly (but not necessarily thoughtfully), confused thought content, and decreased cognitive functioning. often diagnosed in early adulthood.

disruptive mood dysregulation disorder (DMDD)

a depressive disorder characterized by chronic, severe, persistent irritability most of the day with frequent temper outbursts in children, adolescents, and adults; must be distinguished from bipolar disorder and disruptive, impulse control, and conduct disorders.

major depressive disorder (MDD)

involves major depressive episodes marked by a severely depressed mood without mania or hypomania episodes; is accompanied by functional changes such as loss of appetite, sleep disturbances, psychomotor changes (decreased energy, difficulty concentrating and making decisions), and possible suicidal ideations. client will have confused thinking and no interest in activities. psychomotor slowing can affect all body movements, facial expressions, and verbal communication. client may need help with ADLs, as both interest in doing them and energy to perform personal hygiene are decreased.

persistent depressive disorder (dysthymia)

disorder characterized by a depressed mood or “feeling down and sad” for most of the day, lasting for at least two years with adults and one year with children and adolescents, that for one reason or another does not meet the criteria for MDD.

premenstrual dysphoric disorder

a depressive disorder marked by manifestations of mood lability, irritation, dysphoria, and anxiety that occurs repeatedly during the premenstrual phase and decreases or resolves with menses

bipolar 1

reoccurring mood episodes of mania, depression, and hypomania (high energy/creativity, decreased need for sleep, and talkativeness) which can progress into a manic cycle (pressured speech, racing thoughts/flight of ideas, high distractibility, expansiveness, or grandiosity with poor judgement). depressive cycle manifestations include depression and irritability. hospitalizations generally occur due to mania and psychotic s/s within these clients such as delusions or poor judgement, which result in difficulties with the law.

bipolar 2

reoccurring episodes of mood fluctuations that cycle between hypomania and depression. the manic episodes these clients experience are not as elevated, but the depressive episodes mimic MDD. these clients are generally hospitalized for depressive s/s and risk for suicide.

cyclothymic disorder

a chronic, fluctuating mood distrubance between hypomania and depression. the manifestations are less severe than those found in bipolar 1 or 2 and can only be determined if the client does not meet diagnostic criteria for depressive disorders or bipolar 1/2.

mood disorder interprofessional care

involves providers (assess severities and suicide risk), physicians (rule out possible medical conditions that may contribute to s/s), psychologists (conduct psychotherapy), psychiatrists (perform talk therapy and prescribe medications), dieticians, OTs (engage clients in activates to build pride in accomplishment), RNs (give meds, provide teaching, and assess client responses to meds and therapy) and LPNs (assist in facilitating groups, reinforcing education, giving meds, and securing a safe environment)

electroconvulsive therapy (ECT)

deliberate induction of seizures under anesthesia to treat depression. considered in cases of treatment-resistant bipolar, depression, and schizophrenia. a pre-procedure workup will include a chest x-ray, an ECG, a complete blood count, a blood urea nitrogen, a urinalysis, and an electrolyte panel. benzos should be discontinued beforehand. client should expect to have several of these treatments over a period of several weeks.

transcranial magnetic stimulation (TMS)

a procedure using magnetic pulses that focus on areas of the cerebral cortex to treat depression. no anesthesia is used, and the only contraindication would be if the client had a metal plate in the area of the head that was being stimulated. procedures only last about 30 min, and the client usually comes for the treatment several times each week for six weeks. clients sometimes report a mild headache after the procedure. during procedure, the client may feel a slight tapping on the head, scalp contraction, and tightening of the jaw.

interpersonal therapy (IPT)

work on personal relationships that might have contributed to depression, such as relationships with family members or friends in order to build or strengthen relationships

suicide

death caused by self-directed injurious behavior with intent to die as a result of the behavior. often seen in clients who are profoundly depressed. the second leading cause of death for those aged 10-34. clients who are less than 19 years of age and older than 45 years of age have an increased risk of this, along with clients who are male. highest rates of this are seen in indigenous peoples, white people, veterans, people in rural areas, and those who work in certain industries like mining and construction. LGBTQ+ community is also at high risk for these behaviors. can be assessed using MILC (means, intent, lethality, and cues and behaviors). first step is always assessing if they have a plan in the first place. in inpatient units, it is the nurse’s responsibility to remove any sharp objects, potential weapons, or items that can be used to complete this. high risk clients may be monitored by staff at least every 15 min (not exactly every 15 as the client may catch on) or required to be always in view of staff during the day. sudden happiness and relief in a depressed client may indicate they have successfully devised a plan for this.

sensitive care

giving care the client needs, considering their individual requirements

equitable care

giving fair and impartial care, not favoring certain clients because they ask for special favors.

beck depression inventory

a 21-item self-assessment of the usual characteristic behaviors and attitudes present in depression, which can be used for adolescents as well as adults.

PHQ-9

quick (9-question), self-administered assessment that clients can fill out to determine the amount and frequency of depression symptoms. suitable for use in a primary care setting and can be administered to all clients easily. there is also a version for teens.

hamilton depression scale

has a version with 17 and a version with 21 questions, so it can be administered by a trained provider in about 30 min.

geriatric depression scale

can be used in older clients. original version has 30 yes/no questions, but a shorter (15-item) version so it can even be used for those clients who are physically ill or suffering from mild/moderate dementia as well as depression. best choice for a client who is suffering from dementia

substance/medication induced depressive disorder

occurs soon after a client begins taking or withdrawing from a substance, with the most common occurrences when the client is using alcohol, phencyclidine, hallucinogens, inhalants, opioids, and amphetamines.