Depression and suicide

What are some biological and social factors contributing to depression

◦Genetics

◦Neurotransmitters: lower dopamine, seretoin, and neuroepinephrene

◦Neuroendocrine disturbances

◦Family: disfunction in family unit

◦Environment: traumatic event

What are some psychosocial factors contributing to depression?

◦Psychodynamic: unconscious unmet needs

◦Behavioral: its learned

◦Cognitive: the way you are thinking of things, irrational beliefs

◦Developmental: disruption or delay in dev.

What are some risk factors for depression?

—Prior episode of depression

—Family history of depressive disorder

—Lack of social support

—Lack of coping abilities

—Presence of life and environmental stressors

—Current substance use

—Medical comorbidity

What is Major depressive disorder?

• depression that has 5 or more symptoms for more then 2 weeks.

What are some symptoms for MDD? SIGECAPS

◦Depressed mood* 

◦Diminished interest/pleasure in activities*

◦Unintended weight loss or gain

◦Insomnia or hypersomnia

◦Fatigue

◦Psychomotor agitation or retardation

◦Feelings of guilt or worthlessness

◦Indecisiveness or difficulty concentrating

◦Thoughts of death or suicide

What are some primary assesments to make for depression?

• SAFETY

• assess for suicide risk

what are some biological assesments to make for depression?

• substance and medication use

• history/physical

• behaviors impacted by mDD

• nutrition, sleep

What are some psychosocial assesments to make for depression?

• Mood and affect

• thought content

• cognition and memory

• social support

• family psych hx

• trauma hx

How do the symptoms/expression of depression differ in different developmental stages?

—Childhood: anxious and somatic symptoms. ” headache, I don’t feel good, my stomach hurts”

—Adolescence: irritable, agitated, less interaction with peers

—Senescence: elderly: associated with chronic illness, loss of independence, loss of loved ones and connections, disconnectedness/ isolation.

—Postpartum:

What are some common nursing dx ?

—Risk for suicide

—Complicated grieving

—Low self-esteem

—Powerlessness

—Spiritual distress

—Social isolation

—Disturbed thought processes

—Imbalanced nutrition

—Insomnia

Self-care deficit

What are some nursing interventions for MDD?

◦Maintaining client safety

◦Assisting client through grief process

◦Promoting increase in self-esteem

◦Encouraging client self-control and control over life situation

◦Helping client to reach out for spiritual support of choice

◦Assistance in confronting anger that has been turned inward on the self

◦Ensuring basic needs are met

What is light therapy?

• adding artificial light.

• used for seasonal depression

What is Electroconvulsive therapy? what is it used for? AE?

• treatment resisted depression alternative.

• Producing generalized seziures:

• AE: short-term memory loss, headache, nauseous, muscle pain.

What is the most common type of medication for Depression? SE"? BB warning? How long do it take to work?

• SSRI: selective serotonin reuptake inhibitors

• SE: headache, insomnia, drowsiness/sedation, GI distress, sexual dysfunction, diaphoresis

• BBW: suicidality in children and adolescents due to initial burst of energy, while also having suicidal thoughts. 1-2weeks

• takes about 2-4 weeks before they begin working

What are TCA’s? Safety?

• Tricyclic antidepressants.

• Common SE:

  • Blurred vision

  • dizziness/lightheadedness

  • sedation

  • anticholinergic effects

  • palpations

  • weight gain

  • tremors, restlessness, N/V, confusion, seizues

• They are 3 times more lethal if overdosed.

What are MAOI’s? SE? Interactions and symptoms? what can it cause?

• Monoamine Oxidase Inhibitors

• —Side effects:

  ◦Orthostatic hypotension

  ◦Dizziness

  ◦Headache

  ◦Blurred vision

  ◦Dry mouth

  ◦Constipation

  —Interaction with tyramine-rich foods à hypertensive crisis

  • Increased BP and pounding headache

What are some important medication education?

—Therapeutic effect may not be seen for as long as 4 weeks

—Do not discontinue use of the drug abruptly

—Avoid smoking and drinking alcohol

—Be aware of risks of taking antidepressants during pregnancy

—Avoid other meds with same properties

—MAOIs:  avoid foods with tyramine

—Warn re: activation effects, etc

how does someone get serotonin syndrome? Symptoms? treatment?

• Overactivity of serotonin or impairment of the metabolism of serotonin

• Sx: metal status changes, agitation, fever, shivering, diaphoresis, ataxia, diarrhea, hypertension.

• Tx: discontinue re med and treat symptoms.

what are some psychosocial intervetions?

• —Individual psychotherapy

  —Cognitive therapy

  —Behavioral therapy

  —CBT

  —Group therapy

  —Family therapy & teaching

What is persistent depressive disorder?

• —Sad or “down in the dumps”

  —Essential feature: chronically              

• depressed mood for

  –Most of the day

  –More days than not

  –For at least 2 years

Plus two other symptoms low energy, appetite changes, worthlessness

What is suicide and suicide ideation? Suicide attempt

• Suicide

  • Act of intentionally ending one’s own life with explicit or inferred intent to die

• Suicide ideation

  • Thinking about and planning one’s own death

• Suicide attempt

  • Nonfatal, self-inflicted, destructive act in which the intent was to die

What is parasuicide?

• suicidal gesture, but without the intent to die.

  u voluntary, apparent attempt at suicide

  u Aim is not death

  u Varies by intent

  u Commonly called a suicidal gesture

What is lethality?

• the probability a person will successfully complete suicide

• likeihood that a method of death will succeed.

What are some risk factors for suicide?

• Psychological

• Social : lack of support

• Gender: females make more attemtps, Males are more successful in their attempts

• Sexuality: stigmas

• Race and ethnicity: ^ older white men, younger black

• Pandemic impact

• Veteran status

• Psychiatric illness

  • Mood disorders - most common

  • Substance-related disorders

  • Schizophrenia

  • Personality disorders

  • Anxiety disorders

• Severe insomnia

• Alcohol and substance use

• Psychosis with command hallucinations

• Exposure to trauma

• Chronic painful or disabling illness

• Family history of suicide

What are some social theroretical factors for suicide?

• Social distress: lack of social connection, don’t feel like you belong

• Suicide contagion:  where someone Is exposed to a suicide and that increased the risk of them

• Economic disadvantage

What are some protective factors for suicide?

• Family and community support (connectedness)

• skills in problem-solving, conflict resolution, and non-violent ways of

  handling disputes

• Cultural and religious beliefs

• Effective clinical care

• Easy access to clinical care

What are some suicide warning signs?

• Ideation

• Substance Use

• Purposelessness

• Anxiety

• Trapped

• Hopelessness

• Withdrawal

• Anger

• Recklessness

• Mood change

What is suicidal intent?

uPast or present evidence (explicit or implicit) that a person:

uWishes to die

uMeans to kill him/herself, and

uUnderstands the probable consequences of his/her actions or potential actions

What is preparatory behavior?

• making preparations to not be there anymore

• EX: making sure all bills are paid, writing will, giving gifts.

  • collecting pills

  • obtaining a gun

  • going to a bridge but didn’t jump

What are some assesment guidlines for suicide?

uRecognize verbal clues

Suicide threats need to be taken seriously, including overt and covert statements

uRecognize behavioral clues

• Sudden changes: giving away possessions, writing farewell notes, making one’s will/putting affairs in order

• Sudden improvement after being depressed/ withdrawn

• Neglecting personal hygiene

what are some nursing interventions for crisis period?

• follow protocols: suicide prevetions/ observations

• docs Q15min

• encourage pt to discuss feeling/problem solving alternatives

• support or develop a safety plan

Outpatient setting interventions?

• dont leave the perosn alone

• refer for a comprehensive assesment

• enlist the help of family or friends

• schedule frequent appointments

• establish rapport and promote a trusting relationship

What is a safety plan?

• a written list of coping strategies and sources of support

  • Brief

  • in patients own words

  • easy to read

Safety plan steps?

uWarning Signs

• When to use safety plan

• Triggers for suicidal thoughts

uInternal coping strategies

• Problem-solve strategies that can be done on their own, that are likely to be done

uSocial contacts who may distract from the crisis

• Places that help person feel safe; social club

uFamily member or friends who may offer help

• Prioritize list

uProfessionals & agencies to contact for help.

uMaking the environment safe

• Remove firearms; prescriptions, etc.

Safety plan follow up?

uAssess the likelihood that safety plan will be followed

uDiscuss with the patient

• Where safety plan is kept

• Can it be accessed

uEvaluate the format

uReview periodically

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information for family and friends of the suicidal client?

uTake any hint of suicide seriously.

uDo not keep secrets.

uBe a good listener.

uExpress to the client feelings of personal worth.

uRestrict access to firearms or other means of self-harm.