Group Therapy, Depression, Suicide, Grief - Week 3

Group Process

The verbal and nonverbal communication that occurs during group sessions Includes how the work progresses and how members interact w/ one another

Group Norm

The way the group behaves during sessions Over time it provides structure for the group

Hidden Agenda

Some group members--or the leader—might have goals different from the stated group goals that can disrupt group processes

Subgroup

Small number of people within a larger group who function separately from the group

Homogeneous Group

All members share a certain chosen characteristic

Heterogeneous Group

Members do not have a shared chosen characteristic

Orientation phase

Primary focus ! Define the purpose and goals of the group

Working phase

Primary focus ! Promote problem-solving skills to facilitate behavioral changes

Termination phase

Primary focus ! This marks the end of group sessions

Maintenance roles

Made to help maintain the purpose and process of the group

Task roles

Various tasks taken within the group process

Individual roles

Tend to prevent teamwork

Group Roles

Often taken to promote their own agenda

Nuclear families

Include children who reside with married parents

Single-parent families

Include children who live with a single adult that can be related or nonrelated to the children

Adoptive families

Children who live with parents who have adopted them

Blended families

Children who live with one biological or adoptive parent and a nonrelated stepparent who are married

Extended families

Children living with one biological or adoptive parent and a related adult who is not their parent

Other families

Children living with related or nonrelated adults who are neither biological nor adoptive parents

Scapegoating

A member of the family with little power is blamed for problems within the family

Blaming

Members blame others to shift focus away from their own inadequacies

Triangulation

A third party is drawn into the relationship with two members whose relationship is unstable

Manipulating

Members use dishonesty to support own agendas

Placating

One member takes responsibility for problems to peace at all costs

Distracting

A member inserts irrelevant information during attempts at problem solving

Multigenerational issues

These are emotional issues or themes within a family that continue for at least three generations

Enmeshed boundaries

Thoughts, roles and feelings blend so much that individual roles are unclear

Generalizing

Members use overall descriptions in describing family encounters

Rigid boundaries

Rules and roles are completely inflexible

DEPRESSIVE DISORDERS

A single episode or recurrent episodes of unipolar depression

Major Depressive Disorder (MDD)

Inability to feel pleasure—Anhedonia

Persistent Depressive Disorder (PDD)

A milder form of depression that usually has an early onset and lasts > 2 years for adults

Seasonal Affective Disorder (SAD)

Usually during winter

! Often occurs in living spaces near the poles

! Light therapy (10,000-lux light) for 30 min/day QD or BID

! Used to adjust to lack of daylight

! Light therapy reinforces circadian rhythm

! Pineal gland releases melatonin at more regular intervals as a result

! Can cause headache and jitteriness

Premenstrual Dysphoric Disorder (PMDD)

Very small percentage of menstruating clients (2 - 6%)

! Must be severe enough to interfere with daily ability to thrive

! Same symptoms PMS but much more severe

! Treatment

! Fluoxetine or Paroxetine

! Exercise

! Diet

! Relaxation therapy

Substance-Induced Depressive Disorder

Depression directly related to use of or withdrawal from drugs or ETOH

Psychomotor agitation

! Vegetative findings

Change in eating

Expected Findings

Isolative

Expected Findings

Usually anorexia

Expected Findings

Slowed speech

Expected Findings

Increased intake in PDD

Expected Findings

Delayed response

Expected Findings

May seem too tired to speak

Expected Findings

Constipation

Expected Findings

Sleep disturbances

Expected Findings

Low libido

Expected Findings

Electroconvulsive Therapy

Uses electrical current to induce a brief seizure

Serotonin

Exact mechanism is unknown, but thought to enhance effects of neurotransmitters

Dopamine

Exact mechanism is unknown, but thought to enhance effects of neurotransmitters

Norepinephrine

Exact mechanism is unknown, but thought to enhance effects of neurotransmitters

Bipolar w/ rapid cycling

4 or more episodes within 1 year

Atropine sulfate or glycopyrrolate

IM injection of an anticholinergic is administered 30 minutes prior to procedure

Etomidate or propofol

Short-acting anesthetic is administered at the time of procedure

Succinylcholine

Muscle relaxant is then administered to paralyze the client's muscles during the seizure activity

Retrograde amnesia

The loss of memory of events leading up to the procedure

Confusion

Occurs immediately following the procedure

Transcranial Magnetic Stimulation

Provides electrical stimulation through the vagus nerve to the brain through a device

Vagus Nerve Stimulation

Every 5 minutes for a duration of 30 seconds

Selective Serotonin Reuptake Inhibitors

Selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space

Serotonin Syndrome

TOO MUCH SEROTONIN

Precautions & Interactions

Monoamine oxidase inhibitors (MAOIs)

Concurrent use of warfarin

Can displace warfarin bound proteins increasing warfarin levels

NSAIDs

Increase warfarin levels

Desvenlafaxine

Type of SNRI

Venlafaxine

Type of SNRI

Due to norepinephrine's effects on peripheral vascular system

Causes HTN

Duloxetine

Type of SNRI

Mirtazapine

Type of SNRI

SNRIs

Serotonin Norepinephrine Reuptake Inhibitors

Amitriptyline

Type of TCA

Nortriptyline

Type of TCA

Imipramine

Type of TCA

Trimipramine

Type of TCA

Desipramine

Type of TCA

Clomipramine

Type of TCA

Doxepin

Type of TCA

Amoxapine

Type of TCA

Tricyclic Antidepressants

Block reuptake of norepinephrine and serotonin in synaptic space

TCAs

Can take 10 - 14 days longer before TCAs begin to work

Toxicity of TCAs

Cholinergic blockade, Dysrhythmia, Can lead to coma and death

Monoamine Oxidase Inhibitors

MAOIs

MAOIs

Manifestations: Headache, N/V, Tachycardia, Elevated BP, Diaphoresis, ALOC

Selegiline patch

Apply topical glucocorticoid for rash at transdermal site

Selegiline

Pregnancy Risk Category C

Transdermal selegiline

CNS stimulation

Carbamazepine and Oxcarbazepine

Increases blood levels of MAOI

Atypical Antidepressants

Bupropion

St. John's Wort

Flower processed into tea or tablets, Used for mild depression due to affect on serotonin

Antidepressant Discontinuation Syndrome

N/A

Females

More likely to attempt suicide

Males

More likely to complete suicide

Increased suicide risk

Active military personnel/veterans, LGBT, Comorbid serious mental illness, Older adults, Biological factors

Family Hx of suicide

Risk Factors

Physical chronic disorders/illnesses

Risk Factors

Cultural factors

Risk Factors

Native Americans

Risk Factors

Alaskan Natives

Risk Factors

Environmental factors

Risk Factors

Access to lethal methods

Risk Factors

Lack of access to adequate mental health care

Risk Factors