Mental Health- Chapter 11 & 16

Social isolation

low risk Social isolation is a warning sign, but by itself carries low suicide risk. The nurse should recommend counseling and monitor the person for other warning signs.

If your patient has resiliency and support, then the risk of suicide

Decreases Resiliency and support systems are examples of protective factors associated with decreased potential for suicide.

The nurse is assessing a newly admitted patient for depression. Which predisposing factors would be important to include in the assessment? Select all that apply. Electrolyte disturbances Hormonal disturbances Neuroendocrine disturbances Nutritional deficiencies Genetics

Electrolyte disturbances Hormonal disturbances Neuroendocrine disturbances Nutritional deficiencies Genetics

Which of the following tests are routinely employed in the initial diagnosis of depression? Select all that apply. Electrolyte panel Thyroid function Kidney function Liver function Vitamin B and folate levels

Electrolyte panel Thyroid function Vitamin B and folate levels

Potential warning signs of suicide include which of the following? Select all that apply. Feeling trapped Expression of a suicide plan Hopelessness Social isolation Increasing substance use

Feeling trapped Expression of a suicide plan Hopelessness Social isolation Increasing substance use

Which of the following are appropriate assessment questions to elicit suicidal ideation or intent? Select all that apply. Have you wished you were dead or wished you could go to sleep and not wake up? Have you ever wanted to hurt yourself? Have you had any thoughts of killing yourself? Have you thought about how you would kill yourself? Are you not happy with living?

Have you wished you were dead or wished you could go to sleep and not wake up? Have you had any thoughts of killing yourself? Have you thought about how you would kill yourself?

Other factors besides impulsivity elevate risk of suicidal ideation to an active risk for attempt. Which factors listed below are part of the three-step trajectory and increases a person's risk? Select all that apply. Pain Connectedness Suicidal ideation with no means Hopelessness Resiliency

Pain Hopelessness

Sharon presents with a depressed mood, low self-esteem, decreased energy, and poor concentration, which she tells the nurse she feels like she's "had my whole life." However, over the last few years it is starting to affect her family life. Which DSM diagnosis would Sharon be diagnosed with? Persistent Depressive Disorder Major Depressive Disorder Disruptive Mood Dysregulation Disorder Premenstrual Dysphoric Disorder

Persistent Depressive Disorder

If your patient is between ages 55 and 64, then the risk of suicide

decreases The highest rates of suicide occur in the 45- to 54-year-old age-group and among those 85 and older. Suicide is the third-leading cause of death in the adolescent population and the second-leading cause of death in children ages 10 to 14 years.

Allison is sharing during a group for patients with depression and states, "I feel like I am trapped in this cycle and nothing I do ever works. I just have no control over my life or the situation I am in."Which predisposing factor could be causing Allison's depression?

learning theory The model of "learned helplessness" exists in humans who have experienced numerous failures (either real or perceived). The individual abandons any further attempt to succeed. Learned helplessness predisposes individuals to depression by imposing a feeling of lack of control over their life situations. They become depressed because they feel helpless; they have learned that whatever they do is futile. Learned helplessness can be especially damaging very early in life because the sense of mastery over one's environment is an important foundation for future emotional development.

Which of the following are suicide risk factors that a nurse should assess for? Select all that apply. Age Gender Ethnicity Religion Education

Age Gender Ethnicity Religion

Suicide has many risk factors. Which characteristics below are associated with an increased suicide risk? Select all that apply. African American Divorced Transgender Highest socioeconomic status Muslim

Divorced Transgender Highest socioeconomic status

If your patient feels a lack of connectedness along with pain, then the risk of suicide

Increases Connectedness prevents suicidal ideation from increasing, but when pain and hopelessness are also present, suicidal ideation can become active.

Jan has not responded to any of the antidepressants that she has been prescribed and the provider wants to try a noninvasive procedure that uses electrical waves to stimulate areas in the cerebral cortex. Which procedure best describes what the provider wants to do? Electroconvulsive therapy Vagal nerve stimulation Deep brain stimulation Repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation

If the nurse asks the patient direct questions such as "Have you had any thoughts of killing yourself?" or "Have you been thinking about how you might do this?," then the risk of suicide

Stays the same The nurse needs to ask direct question about suicidal ideation, intent, plan, and means. Asking these questions will not trigger the patient to now think about suicide, but they may help the patient admit that there is a crisis and they need help. It is also important to use the correct terminology such as "suicide" and "death" rather than "not happy with living" or other indirect statements. Use of direct language also communicates to the client that these are acceptable topics to discuss.

Aidan has been diagnosed with disruptive mood dysregulation disorder. Which of the following symptoms would the nurse expect to find during assessment? Select all that apply. Temper outburst Depressed mood Irritable mood Suicidal ideation Issues at school

Temper outburst Irritable mood Issues at school

Presenting symptoms that increase a person's risk for suicidal behavior include which of the following using the IS PATH WARM mnemonic? Select all that apply. Trapped Ideation Purpose Subjective data Anger

Trapped Ideation Anger

If your patient is a male, then his risk of suicide

increases More women than men attempt suicide, but men more often die by suicide (about 70% for men and 30% for women). These rates reflect the lethality of the means that men use.

The nurse is assessing Valerie to determine the best plan of care. Valerie is depressed and her thinking demonstrates significant negative distortions such as mind reading and personalization.Which treatment would be most appropriate for Valerie?Make the connection. Drag and drop the predisposing factor, disorder, or treatment exemplified by the patient scenario.

cognitive therapy In cognitive therapy, the individual is taught to control negative thought distortions that are common in mood disorders. In the cognitive model, depression is characterized by a triad of negative distortions related to expectations of the environment, self, and future. The environment and activities within it are viewed as unsatisfying, the self is unrealistically devalued, and the future is perceived as hopeless. The general goals in cognitive therapy are to obtain symptom relief as quickly as possible, assist the client in identifying dysfunctional patterns of thinking and behaving, and guide the client to evidence and logic that effectively tests the validity of the dysfunctional thinking. Following are examples of automatic thoughts that may be common negative cognitive distortions in depression: Personalizing: "I'm the only one who failed." All or nothing thinking: "I'm a complete failure." Mind reading: "He thinks I'm foolish." Discounting positives: "The other questions were so easy. Any dummy could have gotten them right."

Withdrawing from friends, stating they feel trapped with no way out, and increased substance use

high risk Withdrawing from others, feeling trapped, and increased substance use are maladaptive coping mechanisms in a crisis. The person has not stated they have suicidal ideation or a plan, but the nurse should be concerned about these symptoms as they are potential warning signs of suicide.

If your patient has a family history of suicide, then the risk of suicide

Increases Higher risk is associated with a family history of suicide, especially in a same-gender parent. Individuals who have made previous suicide attempts are also at elevated risk. About one-half of individuals who die by suicide have previously attempted suicide and about half die on the first attempt. For this reason, all individuals with suicidal ideation should be assessed carefully.

If your patient is white, then the risk of suicide

Increases Whites have the highest age-adjusted suicide rates, and American Indians represent the second-highest rates.

Rita has had recurrent major depressive disorder for 10 years and she has not responded well to any of the medications that have been prescribed. Her provider has recommended a procedure that will target specific areas in the cerebral cortex with high- and low-frequency waves.Which treatment has the health-care provider prescribed for Rita?Make the connection. Drag and drop the predisposing factor, disorder, or treatment exemplified by the patient scenario.

Repetitive transcranial magnetic stimulation Repetitive transcranial magnetic stimulation (rTMS) is a procedure that is used to treat depression by stimulating nerve cells in the brain by using very short pulses of magnetic energy to stimulate nerve cells at localized areas in the cerebral cortex, similar to the electrical activity observed with ECT, but does not result in generalized seizure activity. It is noninvasive and considered generally safe. High-frequency waves are used to stimulate the left prefrontal cortex, and low-frequency waves are used to stimulate the right prefrontal cortex. This combination has been shown most effective in treating depression. A typical course of treatment consists of 40-minute sessions, three to five times a week for 4 to 6 weeks.

Aidan, a 12-year-old boy, presents to the clinic with his mother. He is having frequent outbursts at home and school. These outbursts are so bad that he is currently suspended for his aggressive behaviors. Aidan's mother reports that he is irritable all the time and she just doesn't know what to do.What disorder does Aidan have?Make the connection. Drag and drop the predisposing factor, disorder, or treatment exemplified by the patient scenario.

disruptive mood dysregulation disorder Some symptoms of childhood depression may include hyperactivity, delinquency, school problems, psychosomatic complaints, sleeping and eating disturbances, social isolation, delusional thinking, and suicidal thoughts or actions. Children with depression are more often irritable rather than dysphoric and are less likely to identify themselves as depressed. Disruptive mood dysregulation disorder (DMDD) is manifested with severe recurrent (three or more times per week) temper outbursts (verbally or aggressively) that are inconsistent with developmental level in multiple settings (school, home, with friends).

Craig, age 42, presents to his primary care provider with feelings of sadness, overeating, sleeping too much, and difficulty concentrating. He states that this has been going on for years and he just can't take it anymore.What disorder does Craig have?Make the connection. Drag and drop the predisposing factor, disorder, or treatment exemplified by the patient scenario.

dysthymia Dysthymia, also known as persistent depressive disorder, is classified as moderate depression. For a diagnosis of dysthymia, symptoms should have been occurring for at least 2 years and there must be at least two symptoms along with feeling depressed. Affective symptoms associated with dysthymia include feelings of sadness, dejection, helplessness, powerlessness, hopelessness; gloomy and pessimistic outlook; low self-esteem; and difficulty experiencing pleasure in activities. Behavioral symptoms include sluggish physical movements (i.e., psychomotor retardation); slumped posture; slowed speech; limited verbalizations, possibly consisting of ruminations about life's failures or regrets; social isolation with a focus on the self; increased use of substances possible; self-destructive behavior possible; and decreased interest in personal hygiene and grooming. Cognitive symptoms include slowed thinking processes; difficulty concentrating and directing attention; obsessive and repetitive thoughts, generally portraying pessimism and negativism; and verbalizations and behavior reflecting suicidal ideation. Physiological symptoms include anorexia or overeating; insomnia or hypersomnia; sleep disturbances; amenorrhea; decreased libido; headaches; backaches; chest pain; abdominal pain; low energy level; and fatigue and listlessness.

The nurse is assessing 16-year-old Emma for depression and finds out that both her mother and maternal grandmother have a history of major depressive disorder.Which predisposing factor could be causing Emma's depression?

genetics A genetic link has been suggested in numerous studies on depression; however, a definitive mode of genetic transmission has yet to be demonstrated. Twin studies suggest a strong genetic factor in the etiology of depression. Research findings suggest that although twin studies do identify a significant genetic risk, genetics does not explain all depressions. Family studies have shown that major depression is seven times more common among first degree biological relatives of people with the disorder than among the general population. The evidence to support an increased risk of depressive disorder in individuals with positive family history is compelling.

Roland was recently admitted for a suicide attempt. On further assessment, the nurse discovers that he stopped hanging out with friends and going bowling about 4 weeks ago, he has lost about 10 pounds in the last 2 weeks, he can't sleep at night, and he feels like he has no energy.What disorder does Roland have?Make the connection. Drag and drop the predisposing factor, disorder, or treatment exemplified by the patient scenario.

major depressive disorder Major depressive disorder (MDD) is characterized by depressed mood or loss of interest or pleasure in usual activities, impaired social and occupational functioning that has existed for at least 2 weeks, no history of manic behavior, and symptoms that cannot be attributed to use of substances or a general medical condition. Five symptoms in total must be met, and one of the five has to be either depressed mood or lack of interest or pleasure in activities (anhedonia). The other symptoms include significant weight loss or gain, or decrease or increase in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, decreased concentration, and recurrent thought of death or suicidal ideation or attempt.

Daryll's provider ordered a dexamethasone suppression test. Daryll asks the nurse what this test is for.Which predisposing factor for Daryll's depression is the provider testing for?

neuroendocrine disturbances Neuroendocrine disturbances may play a role in the etiology or persistence of depressive disorders. This notion has arisen in view of the marked disturbances in mood observed with the administration of certain hormones or in the presence of spontaneously occurring endocrine disease. In clients who are depressed, the normal system of hormonal inhibition fails on the hypothalamic-pituitary-adrenocortical axis, resulting in hypersecretion of cortisol. Elevated serum cortisol is the basis for the dexamethasone suppression test that is sometimes used to determine whether an individual has somatically treatable depression. Other neuroendocrine disturbances include problems with the hypothalamic-pituitary-thyroid axis causing thyroid dysregulation.

The nurse is assessing Sheeba, who has depression. The nurse is reviewing the patient's laboratory values and found that Sheeba is deficient in vitamin D and B vitamins.Which predisposing factor could be causing Sheeba's depression?

nutritional deficiencies Deficiencies in proteins, carbohydrates, vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B6 (pyridoxine), vitamin B9 (folate), vitamin B12, vitamin D, iron, zinc, calcium, chromium, iodine, lithium, selenium, and potassium have all been associated with producing symptoms of depression. Individuals with anorexia nervosa, who have significant nutritional deficiencies, commonly have comorbid depression as well. Some electrolytes have also been implicated in depression, such as too much sodium bicarbonate, calcium, and potassium, or too little magnesium and sodium.

Aimee is being seen for her women's health check-up. On nursing assessment, you find that she is complaining of depressed mood and "just not wanting to do anything" the week before her period. She says these symptoms are interfering with her life.What disorder does Aimee have?

premenstrual dysphoric disorder The essential features of premenstrual dysphoric disorder (PMDD) include depressed mood, excessive anxiety, mood swings, and decreased interest in activities during the week before menses, improving shortly after the onset of menstruation, and becoming minimal or absent in the week after menses. The major difference between the diagnosis of PMDD and the regular premenstrual mood changes that many women experience is a matter of intensity and frequency of symptoms. The symptoms of PMDD are severe enough to interfere with one's ability to function socially, at work, or school and they are recurrent for the majority of menstrual cycles throughout the year.

Feelings of hopeless with suicidal ideation, a plan, and means

very high risk Suicidal ideation with a plan and means represents multiple high-risk warning signs for suicide. This person needs to seek immediate help from emergency medical or mental health professionals.