NRS 203 Mental Health 9. Lecture 19

Mood Disorders and Suicide Overview

  • This content is covered in chapters 15, 16, and 23.

  • Mood disorders encompass occasional feelings of being low, tired, and a desire to isolate oneself, driven by inertia, exhaustion, agitation, noise intolerance, and slow thinking processes.

  • During such low periods, individuals might still carry out family and social responsibilities despite feeling irritable.

  • Fluctuations in mood are common, with many people casually using the term "depressed" when discussing daily stressors, which does not equate to clinical depression.

Definition of Mood Disorders

  • Also known as affective disorders, they are pervasive alterations in emotions that manifest as:

    • Depression

    • Mania

    • Interference in the individual’s daily life, leading to long-term sadness and agitation.

Major Categories of Mood Disorders

Major Depressive Disorder (MDD)

  • Characterized by:

    • A single episode or recurrent episodes of depression resulting in significant change in normal functioning.

    • Must exhibit at least five specific symptoms nearly every day for a minimum of two weeks:

    • Depressed mood

    • Difficulty sleeping or excessive sleeping

    • Decreased ability to concentrate or indecisiveness

    • Suicidal ideations

    • Increase or decrease in motor activity

    • Inability to feel pleasure

    • Significant increase or decrease in weight (more than 5% of body weight over one month).

  • Specific Classifications Include:

    • Psychotic features: presence of auditory hallucinations or delusions.

    • Postpartum onset: Begins within four weeks of childbirth.

    • Seasonal Affective Disorder (SAD): Occurs during winter months, often treated with light therapy.

    • Chronic features: Depressive episodes lasting more than two years are classified as dysthymic disorder, which is a milder form of depression.

    • For adults, a dysthymic disorder lasts at least two years, and for children, at least one year, with a minimum of three depressive symptoms.

Causes of Major Depressive Disorder

  • Possible causes include:

    • Genetics: Identical twins show up to a 60% chance of both being affected.

    • Neurotransmitter deficiencies, particularly serotonin and norepinephrine.

    • Sleep abnormalities.

Risk Factors for Major Depressive Disorder

  • Risk factors include:

    • Significant family history.

    • Personal history of depression.

    • Gender: females are twice as likely as males.

    • Age: individuals 65 or older.

    • Stressful life events.

    • Presence of medical illnesses.

    • Poor social support networks.

    • Comorbid substance abuse.

    • Postpartum period.

Nursing Process and Assessment for MDD

  • Assessment tools include the Hamilton Rating Scale for Depression.

  • Evaluate signs and symptoms such as:

    • Lack of energy

    • Lack of pleasure from previously enjoyed activities

    • Affective flattening or persistent sadness

    • Anxiety

    • Poor grooming and hygiene

    • Decreased communication

    • Psychomotor retardation

    • Somatic complaints (e.g., gastrointestinal issues).

  • Always assess for suicide risk.

Nursing Diagnoses for MDD

  • Common diagnoses include:

    • Ineffective coping

    • Hopelessness

Interventions for MDD

  • Remain alert for signs of suicide risk.

  • Maintain safety for at-risk clients through one-on-one supervision.

  • Use therapeutic communication strategies:

    • Make observations without posing direct questions.

    • Give clear, simple, concrete instructions.

  • Promote daily living activities by assisting clients as necessary.

  • Help ensure adequate sleep, rest, and nutrition.

  • Engage clients in enjoyable activities.

  • Allow time for responses, as reaction time may be slower.

  • Educate clients about antidepressant medications and the importance of exercise.

Bipolar Disorder Overview

  • Characterized by extreme mood swings between episodes of mania and depression.

  • Episodes of mania necessitate inpatient treatment and include:

    • Hypomania: a less severe form of mania lasting at least four days with 3-4 manic symptoms.

    • Mixed episodes: simultaneous experiences of manic and depressive symptoms.

    • Rapid cycling: four or more episodes of mania within a year.

Types of Bipolar Disorder

  1. Bipolar I Disorder: Involves at least one manic episode alternating with major depression.

  2. Bipolar II Disorder: Involves hypomanic episodes alternating with major depressive episodes.

  3. Cyclothymia: Involves at least two years of repeated hypomanic episodes along with minor depressive episodes.

Causes of Bipolar Disorder

  • Possible causes include:

    • Genetics

    • Chemical imbalances in serotonin, norepinephrine, and dopamine

    • Hypothyroidism.

Assessment of Mania Symptoms

  • Signs include:

    • Euphoria

    • Agitation

    • Irritability

    • Increased talking and activity level

    • Insomnia

    • Pressured speech

    • Exaggerated self-esteem

    • Racing thoughts and distractibility

    • High-risk activities resulting from poor judgment and impulsivity.

Assessment of Depressive Episode Symptoms

  • Signs include:

    • Flat affect

    • Tearfulness

    • Lack of energy

    • Lack of pleasure

    • Poor personal hygiene.

  • Assess for suicidal thoughts throughout the assessment.

Nursing Diagnoses for Bipolar Disorder

  • Include:

    • Risk for self-harm

    • Ineffective coping

Interventions for Bipolar Disorder

  • Support clients in heightening safety.

  • Reduce environmental stimuli.

  • Provide opportunities for physical activity.

  • Offer high-calorie and high-protein finger foods.

  • Give step-by-step reminders for personal hygiene and dressing using short, simple communication.

  • Set behavior limits when necessary, promote rest, and reduce stress.

Understanding Suicide

  • Suicide is the intentional act of ending one’s own life.

  • In the U.S., men account for approximately 72% of suicides, making the rate three times higher than for women, even though women are four times more likely to attempt suicide.

  • Suicide is the second-leading cause of death among individuals aged 15 to 24, with incidents rising in this age bracket.

  • Suicidal ideations refer to having thoughts regarding ending one’s own life.

Common Suicide Myths

  • Misconceptions surrounding suicide include:

    • "People who talk about suicide never commit it."

    • "Suicidal individuals only wish to harm themselves and not others."

    • "There’s no way to help someone who genuinely wants to end their life."

    • "Mentioning suicide to them will prompt action."

    • "Ignoring verbal threats of suicide challenges the person to act."

Nursing Process in Suicide Prevention

  • Assessment methods include:

    • Looking for verbal and non-verbal clues.

    • Checking the client's skin for previous self-harm indicators (lacerations, scratches, scars).

    • Evaluating the lethality of the suicide plan:

    • Is there a specific plan?

    • Are the means available to carry it out?

    • Could it be lethal if executed?

    • Has the client made preparations, like writing a suicide note?

    • Is there a specific date or meaning attached to the intended time for the act?

Nursing Diagnoses Related to Suicide Risk

  • May include:

    • Risk for violence

    • Ineffective coping

    • Hopelessness.

Interventions for Suicide Prevention

  • No-suicide contract: A verbal or written agreement wherein the client vows not to harm themselves and to notify staff of any urges to harm.

  • Establish trust and a therapeutic relationship.

  • Limit the amount of time at-risk clients are alone.

  • Foster a support system.

  • Safety is the top priority with a focus on establishing suicidal precautions.