Professional Documents
Culture Documents
Chapter 15)
• 1. Depressive Disorders
• 2. Manic – Depressive ( Bipolar) Disorder
• 3. Suicidal Behavior
1. Major Depressive disorder – depressive
episode with no manic episodes
1. Major depression, single episode
2. Major depression, recurrent: Repeated
episode of major sadness or depression
separated by long intervals, occurring in
clusters or increasing w/ age
3. Dysthymia: Chronic depressive mood
problems occurring in the absence of a
major depressive or organic or psychotic
diagnosis.
• Differentiation / Category:
• 1. Moderate Depression – crying at night
• Dysthymia – painful depression fro 2 years
• **2. Severe Depression – Crying at early
morning, depression less than 2 weeks
• **3. Major Depression – severe
depression for more than 2 weeks
• ** - both of them have the same
characteristics
C. EMOTIONAL RESPONSES and MOOD DISORDERS
II. DEPRESSION
SUICIDE
Suicide –
Persons with severe mood disturbances must be always be
assessed with potential for suicide. The intensity of anger, guilt
and worthlessness may precipitate suicidal thoughts, feelings or
gestures.
Suicidal Behaviors:
1. Suicide ideation
Thoughts of self-inflicted death either self-reported or reported
to others. The suicidal person may make a statement such
as “will you remember me when I’m gone?”
Active suicidal ideation is when a person thinks about & seek
ways to commit suicide. Passive suicidal ideation thinks about
wanting to die or he or she wishes she were dead but has no
plans to cause his or her death.
• 2. Attempted Suicide - is a suicidal act
that either failed or was incomplete. In an
incomplete suicide attempt, the person did
not finish the act because
• (1.) someone recognized the suicide
attempt as a cry for help & responded &
(2.) the person was discovered & rescued.
C. EMOTIONAL RESPONSES and MOOD DISORDERS
Suicidal Behaviors:
Suicide threat
A direct or indirect warning, either verbal or non-verbal,
that a person is planning to take one’s own life. The suicidal
person may make a statement such as “I’d rather die than….”
C. EMOTIONAL RESPONSES and MOOD DISORDERS
SUICIDE
SUICIDE
Nursing Interventions:
1.Close observation – client should be near nurse’s station
2.Nurse visits every 15 minutes but irregular
3.Environment safety
No sharps, medications locked
No curtain rods, No spoon & fork
No plastic spoon & fork
Provide a “No-suicide contract”
• The nurse NEVER ignores any hint of
suicidal ideation regardless of how trivial
or subtle it seems & the client’s intent or
emotional status.
• Asking clients directly about thoughts of
suicide is important.
Lethality Assessment
• When a client admits to having a “death
wish” or suicidal thoughts, the next step is
to determine potential lethality.
• Ask the ff questions:
• 1. Does the client have a plan? If so, what
is it? Is the plan specific?
• 2. Are the means available to carry out this
plan? ( Ex. If the person plans to shoot
himself, does he have access to a gun &
ammunition?
• 3. If the client carries out the plan, is it
likely to be lethal? (Ex. A plan to take 10
aspirin is not lethal, while a plan to take a
2 week supply of a tricyclic antidepressant
is)
• 4. Has the client made preparations for
death , such as giving away prized
possession , writing a suicide note, or
talking to friends one last time?
• 5. When and where does the client intend
to carry out the plan?
• 6. Is the intended time a special date or
anniversary that has meaning for the
client?
• -- specific & positive answers to these
questions all increase the client’s
likelihood of committing suicide. It is
important to consider whether or not the
client believes his/her method is lethal
even if it is not.
Nursing Interventions
• 1. Authoritative Role – ex. A client may
want to be alone in her room to think
privately. This is NOT allowed while she is
at increased risk for suicide.
• 2. Provide a safe environment – for in-
patients, they must not be allowed access
to materials on cleaning carts, their own
medications, sharp scissors, & pen
knives.
• For suicidal clients, staff members shld
remove any items they can use to commit
suicide such as sharp objects, shoelaces,
belts, lighters, matches, pencils, pens, &
even clothing with drawstrings.
• Staff members observe the clients every
10 mins if the lethality is low: For clients w/
high potential lethality, one to one
supervision by a staff person is initiated.
This means that clients are in direct sight
of & no more than 2 to 3 feet away from a
staff member for all activities.
Including going to the bathroom
• No – suicide or no self-harm contracts
– clients agree to keep themselves safe &
to notify staff at the first impulse to harm
themselves ( at home, clients agree to
notify their caregivers; the contract must
identify back up people in case caregivers
are unavailable.
• These contracts are not a guarantee of
safety
C. EMOTIONAL RESPONSES and MOOD DISORDERS
SUICIDE
Suicidal Behaviors:
Suicide attempt
Any self-directed actions taken by a person that will
lead to death if not stopped
Treatment
• Major Antidepressants include:
• 1. Cyclic anti depressants
• 2. Monoamine Oxidase Inhibitors
• 3. Selective Serotonin Reuptake Inhibitor
• ( SSRI)
• 4. Atypical antidepressants
• 1. Cyclic antidepressants ( Tricyclic)
• - relieve symptoms hopelessness,
helplessness, anhedonia, inappropriate
guilt, suicidal ideation, & daily mood
variations
• - takes 6 weeks to reach full effect
because they have a long serum half-life.
( there is a lag period of 1 to 4 weeks
before steady plasma levels are reached
and the client’s symptoms begin to lessen.
• Tricyclic antidepressants are
contraindicated in severe impairment of
liver function & in myocardial infarction.
• - cannot be given with MAOi’s bec of their
anticholinergic side effects
• Overdosage of tricyclic antidepressants
occurs over several days & results in
confusion, agitation, hallucination,s,
hyperpyrexia & inceased reflexes,
seizures, coma
• Ex.
• 1. Amitriptylin ( Elavil)
• 2. Amoxapine ( Asendin)
• 3. Doxepin ( Sinequan)
• 4. Imipramine ( Tofranil)
• 5. Desipramine ( Norpramine)
• 6. Nortriptyline ( Pamelor)
• Atypical Antidepressants
• - are used when the client has an
inadequate response to or side effects
from SSRI’s.
• Ex. Venlafaxine ( Effexor)
• Duloxetine ( Cymbalta)
• Bupropion ( Wellbutrin)
• Nefazodone ( Serzone)
• Mirtazapine ( Remeron)
• 2. Monoamine Oxidase Inhibitors,
• - used infrequently because of its fatal side
effects & interactions with numerous drugs.
The most serious side effect is
hypertensive crisis, a life threatening
condition that can result when a client taking
MAOI’s ingests tyramine containing foods.
S/Sx: occipital headache, hypertension,
nausea, vomiting, chills, sweating,
restlessness, nuchal rigidity, dilated pupils,
fever & motor agitation. This can lead to
hyperpyrexia, cerebral hemorrhage & death.
Precaution:
MAOI’s have some serious interactions which can
possibly lead to death w/ certain other medications &
foods. Patients must avoid eating certain tyramine
containing foods like cheeses, pickled foods, & red
wine, alcohol, Na rich foods, condiments,
chocolates while taking theses drugs. Eating these
foods can cause high blood pressure.( hypertensive
) crisis Avoid some non-prescriptive medications
particularly some cold remedies & diet pills.
- Patient must wait for 14 days after stopping
taking MAOI’s before taking another anti depressant
• There is a 2-4 week lag period before
MAOI’s reach therapeutic levels.
• Ex.
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)
• Osocarboxazid (Marplan)
3. SSRI
• - action is specific to serotonin reuptake
inhibition, these drugs produce few
sedating anticholinergic & cardiovascular
side effects
• Ex.
• Fluoxetine ( Prozac)
• Sertraline ( Zoloft)
• Paroxetine ( Paxil)
• Citalopram ( Celexa)
• Escitalopram ( Lexapro)
Antidepressants – used to reduce anger, irritability, impulsive behavior
& depression
Selective Serotonin Reuptake Inhibitors ( SSRI’s)
1. -It balances certain brain chemicals ( neurotransmitters) that can
worsen symptoms of borderline personality disorder when
unbalanced.
2. It blocks the re-uptake of serotonin
3. Plays an important role in anxiety & mood disorders &
schizophrenia
. MANIA
III. MANIA
III. MANIA
III. MANIA
III. MANIA