PSYCH EXAM 1- W2B (depression, suicide and self harm)

after ___ episodes of MDD, you are at a greater risk for more recurrent episodes

5

what percentage of reported suicide attempts receive adequate mental health treatment?

56.4

how long is the acute phase of implementation of nursing process for MDD

6-12 weeks

what percentage of suicides are attributable to personality disorder?

8-11

Sexual minority youths were _____ likely to report suicide ideation

more

• White LGB and Hispanic bisexual females _____ likely to be bullied than white heterosexuals

more

what does it mean to focus on the underlying ambivalence during suicide interventions?

most patients still have a part of them that wants to live, so talk to them about the will to live to mitigate the desire not to live

antidepressant with anticholinergic adverse effects

tricyclic antidepressants

3 validated instruments for suicide

columbia-suicide severity rating scale (CSSRS) suicide assessment 5-step evaluation and triage (SAFE-T) cultural assessment of risk for suicide (CARS) (WATCH YOUTUBE VIDEOS OF ASSESSMENTS)

people with depression often have many....

comorbidities (Ex: post heart surgery and breast cancer treatment have high comorbidity with depression Depression has high comorbidities with other physical and mental health disorders)

areas to assess in MDD assessment

• Affect • Thought processes • Mood • Feelings • Physical behavior • Communication • Religious beliefs and spirituality • suicide potential

3 criteria for suicide behavior disorder diagnosis according to DSM-V

• Attempt within last 24 months • Attempt was not initiated in delirium or confusion • Attempt was not undertaken for a religious or political objective

interventions for patients with suicidal ideations

► Determine level of risk ► Focus on the underlying ambivalence ► Observation • Constant observation • 15 minute checks ► Restrict to unit ► Re-assess frequently ► Document and communicate!

psychosocial factors affecting risk of suicide

► Diathesis-stress model—combination of suicidal fantasies and significant loss ► Copycat suicides

nonpharmacologic treatements for depression (7)

► ECT ► Transcranial magnetic stimulation (TMS) ► Vagus nerve stimulation (VNS) ► Deep brain stimulation (DBS) ► Light therapy ► St. John's wort ► Exercise

Biologic factors affecting risk of suicide

► Familial tendency ► Lowered SKA2 gene expression ► Low serotonin levels

why are many patients on CO and restricted to unit?

15 minute checks are insufficient for a person who is actively suicidal and we dont want them to be able to go off the floor and find means of committing suicide

what percentage of suicides are attributable to schizophrenia?

15-20

how many of the following s/s must you have to be diagnosed with persistent depressive disorder?

2 or more

how long must symptoms persist for in order to be considered MDD?

2 weeks to 6 months (minimum)

chronic MDD lasts at least

2 years

what percentage of suicides are attributable to substance use disorders?

3-17

what percentage of suicides are attributable to affective disorders like MDD and bipolar disorder?

32-47

how long is the continuation phase of implementation of nursing process for MDD

4-9 months

Highly effective....the most effective treatment for depression next to TMS...over 90% effective with treatment resistant depressive symptoms

ECT

t/f MDD is typically chronic (lasting more than 2 years)

FALSE (Unusual.....typically untreated it naturally resolves after 18-24 months unless they commit suicide)

what is the goal of nursing interventions for people with MDD?

Getting them back to a period where they are functional and higher QOL and more happy with life

why does a patient's mood increasing quickly make you apprehensive?

HAVING A PLAN FOR SUICIDE CHANGES THE BRAIN AND ALLOWS IT TO BE FREE FROM THE BURDEN OF THE FUTURE, SUCH AN ABRUPT CHANGE IS INDICATIVE OF SUICIDE.....ALSO GIFTING THINGS IS AN INDICATOR OF SUICIDE

protective factor against suicide

HAVING ONE PERSON IN YOUR LIFE WHO IS CONSISTENTLY SHOWING YOU POSITIVE REGARD

why are patients who are newly taking antidepressants at increased risk for suicide?

INCREASES ENERGY BEFORE INCREASING MOOD

rules about assisted suicide in the US

Individual states can allow, regulate, or prohibit assisted suicide

what population has significantly higher chance of suicide than their peers?

LGBT Youth and Bullying

difference between males and females in suicide attempts

MALES ARE MORE LIKELY TO USE A DISFIGURING FORM OF SUICIDE.....GSW LESS LIKELY AMONG WOMEN, PILLS CUTTING AND SOMEWHAT STRANGULATION ARE MORE COMMON WITH WOMEN

antidepressant that is rarely used anymore

MAOI

► Recurrent episodes common ► Symptoms cause distress or impaired function ► Episode not attributed to physiological effects ► Absence of a manic or hypomanic episode

MDD

why does the inflammatory process sometimes contribute to depression?

Many relations between gut and gut microbiome and mental health/depression in the brain...two way relationship....serotonin produced in brain AND gut

how do children and adolescents typically present with depression?

May seem active and involved but really hate going to school, have trouble getting out of bed, social impairment, complaining a lot about life, etc.... Different presentation in older people

symptoms of premenstrual dysphoric disorders

Mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating

CAN BE USED AS SECOND LINE OR ADJUNCTIVE WITH SSRI FOR TREATMENT RESISTANT DEPRESSION

SNRI

SLAP MNEMONIC for asking about suicide plan

SPECIFIC LETHAL ACCESSIBLE PROXIMITY (• How SPECIFIC is the plan? • How LETHAL is the planned method? • How ACCESSIBLE is the method? • How close in PROXIMITY are any intervening or helping resources?)

• First-line therapy for MDD • Rare risk of serotonin syndrome

SSRI

when is intervention necessary for premenstrual dysphoric disorders?

When it interferes with function, (missing work at that time, cant enjoy your normally enjoyed activities, etc.)

the aging population typically has what symptoms of depression rather than sadness?

irritability

examples of medical conditions that can cause depressive disorders

kidney failure, Parkinson's disease, and Alzheimer's disease (Symptoms that result from medical diagnoses or certain medications are not considered major depressive disorder)

what is anergia?

lack of energy

Putting animals in position where they cannot escape...not positive stimuli (no social encounters, etc.)...these studies do not occur anymore, unethical.....permanent life time alterations that occur

learned helplessness

treatment for seasonal affective disorder

light therapy

what does anhedonia mean?

loss of interest or pleasure

depression is the leading cause of disability and _______ in the US

lost work days (large economic impact)

during what phase of MDD is it less likely for patients into depression?

maintenance

which gender is more at risk for suicide?

male

treatment for the continuation phase of MDD

medication and therapy

antidepressants that are effective for unconventional depression

monoamine oxidase inhibitors

more likely to commit suicide if a patient has _________

multiple comorbidities

are depression symptoms that result from medical diagnoses or certain medications considered MDD?

no

why do people partake in nonsuicidal self injury?

release of endorphins is powerful and soothes the emotional and the physical pain (tylenol study) Hard to stop self-injuring because the body responds to it like it responds to opioids

DSM-V excludes ___________suicides from its criteria

religious and political (suicide bombing)

nursing diagnosis for nonsuicidal self injury

risk for self-directed harm

This type of prevention occurs after they have attempted suicide...try to mitigate the damage that has occurred and move on from there

secondary

not as well tolerated as Selective serotonin reuptake inhibitors

serotonin norepinephrine reuptake inhibitors

what is a common side effects of depression meds that causes patients to stop taking their meds?

sexual dysfunction

what does covert mean?

something that is not practiced openly/is hidden (they dont outright say it but it is implied)

what does overt mean?

something that is overt and observable (they make a statement)

Even with validated instruments we are not very good at predicting __________....we are better at looking at risk factors and adding it all up,etc. and we are especially not good at _____________ assessments

suicide, culturally tailored suicide

profession at highest risk of suicide

surgeon (and dentist)

how do you differentiate depression with hallucinations vs. schizophrenia?

symptoms improve with treatment for depression, just acute symptoms

this type of prevention occurs after a completed suicide, all that we do for the people around the person who committed suicide and try to prevent it from happening again and help them move forward with a better QOL

tertiary

why do many patients not get the psych help that they need?

they have many comorbidities and you can treat psychiatric complex patients on a med floor but not vice versa, so patients with both are only treated on med floor

intervention after suicidal crisis has occurred

treatment (secondary)

atypical symptom of MDD

weight gain

3 factors contributing to etiology of nonsuicidal self-injury

• Biological factors • Cultural factors • Societal factors

nursing interventions for nonsuicidal self injury

• Caring for injuries • Establishing therapeutic alliance • Teaching coping skills • Promoting reflective dialogue TREATMENT OF UNDERLYING MENTAL HEALTH DISORDERS

types of psychotherapy for MDD

• Cognitive-behavioral therapy (CBT) • Interpersonal therapy (IPT) • Time-limited focused psychotherapy • Behavior therapy

key findings in assessment of patient with MDD

• Depressed mood and anhedonia • Anergia • Anxiety • Psychomotor agitation or retardation • Vegetative signs • Comorbidity: chronic pain

other examples of depressive disorders besides MDD

• Disruptive mood dysregulation disorder • Persistent depressive disorder (previously dysthymia) • Premenstrual dysphoric disorder • Substance/medication-induced depressive disorder • Depressive disorder due to another medical condition

nursing assessment for nonsuicidal self injury

• Importance of empathy • Look for triggers • Self-assessment: transference

planning: six step approach for patients w/ nonsuicidal self injury

• Limit setting for safety • Developing self-esteem • Discovery of motive and its role • Discovering self-control • Replacement with coping skills • Entering maintenance phase

what factors place LGBT youth at increased risk of suicide?

• Online bullying • Name calling • Verbal harassment • Physical harassment

nursing diagnoses relevant for MDD

• Risk for suicide—safety is always the highest priority • Hopelessness • Ineffective coping • Social isolation • Spiritual distress • Self-care deficit

how do you choose an antidepressant for the patient? (5 considerations)

• Symptom profile of the patient • Side-effect profile (e.g., sexual dysfunction, weight gain) • Ease of administration • History of past response • Safety and medical considerations

how to assess for suicidality?

• Verbal and nonverbal clues - Overt statements - Covert statements • Lethality of suicide plan • Self assessment Do you have a plan? • Would you tell me about your plan?

what are some of the symptoms that, if you have at least five (and depressed mood or anhedonia), can diagnose MDD?

• Weight loss and appetite changes • Sleep disturbances • Fatigue • Worthlessness or guilt • Loss of ability to concentrate • Recurrent thoughts of death

Though depression is the most treatable mental health disorder, there are ___________ factors that can make you susceptible and alter your brain before you are even born (2)

epigenetic and genetic

• Black LGB's vulnerability to bullying is ________ white heterosexual youths

equal to

Hard to get people to ________ when they are depressed but it has powerful therapeutic effect

exercise

3 provisions of the recovery model for MDD

focus on the patient's strengths treatment goals are mutually developed based on patient's personal needs and values

the suicide assessment five-step evaluation and triage is a great resource because it has a .....

free mobile app that you can download that leads you through the assessment

examples of biological factors influencing risk of depression?

genetic, biochemical/stress, hormones, inflammatory process, diathesis stress model

opposite of anhedonia?

hedonistic (thoroughly enjoys all pleasures all the time)

statements by patients during assessment that would lead you to believe they want to live

Does not have a plan for the future or if they talk about them in the past tense about things that will be happening in the future

countries that allow assisted suicide (3)

Netherlands, Belgium, Switzerland

what is the typical treatment plan for reported attempts of suicide?

Often an ER visit, stabilization, and referred for follow up, especially if they are saying "I would never do that again" no need to involuntarily commit them

term for loss of interest or pleasure

anhedonia

what two mental illnesses are often diagnoses at the same time?

anxiety and depression

previous name for persistent depressive disorder

dysthymia

important aspect of assessment for patients with MDD

(assessment of) suicide potential

how long must the low-level depressive feelings through most of each day, for the majority of days last in order to be considered persistent depressive disorder in children and adolescents?

(at least) 1 year

how long must the low-level depressive feelings through most of each day, for the majority of days last in order to be considered persistent depressive disorder in adults?

(at least) 2 years

how does religion affect depression risk?

...this can be a protective factor (bias in that community against bias and stronger network to prevent suicide) or a risk factor depending on the way that faith community view depression

how long is the maintenance phase of implementation of nursing process for MDD

1 year or more

A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding? A. Psychomotor retardation B. Psychomotor agitation C. Vegetative sign D. Anhedonia

A

Jeff was just diagnosed with a major depressive disorder. Which medication is the health care provider most likely to start the patient on? A. SSRI B. SNRI C. Tricyclic antidepressant D. Monoamine oxidase inhibitor

A

what disorders are nonsuicidal self injury prevalent in?

Associated with personality disorders and trauma and suicidality, strong physiological component.....release of endorphins is powerful and soothes the emotional and the physical pain

A person with which psychiatric problem is most likely to complete suicide? A. Personality disorder B. Major depression C. Substance abuse D. Schizophrenia

B

Gina is hospitalized for suicidal ideation after two suicide attempts. For the first 2 days of hospitalization, the patient eats 20% of meals and stays in her room between groups. By the fourth day, the nurse observes that the patient is more sociable, is eating meals, and has a bright affect. Considering Gina's behavior on the fourth day of hospitalization, which factor should the nurse consider? A. The patient is showing improvement and may be ready for discharge. B. The patient may have decided to commit suicide; the nurse should reassess suicidality. C. The patient is feeling rested, supported by the therapeutic milieu, and less depressed. D. The patient is benefiting from the antidepressant she has been taking for 4 days.

B

Which assessment finding in a patient with major depression represents a vegetative sign? A. Restlessness B. Hypersomnia C. Feelings of guilt D. Frequent crying

B

Which question would be a priority when assessing for symptoms of major depression? A. "Tell me about any special powers you believe you have." B. "You look really sad. Have you ever thought of harming yourself?" C. "Your family says you never stop. How much sleep do you get?" D. Do you ever find that you don't remember where you've been or what you've done?"

B

goal of nonsuicidal self injury intervention

Changing maladaptive coping skills like self-injury (don't enhance QOL, decrease it in the long term)....find new ways to help them cope that doesn't cause distress eventually treat underlying mental health disorder through long term talk therapy and meds

outcomes criteria after nursing intervention for nonsuicidal self injury

Coping, social support, self-esteem

symptoms of persistent depressive disorder

Decreased appetite or overeating, insomnia or hypersomnia, low energy, poor self-esteem, difficulty thinking, and hopelessness

Jeff, 19, is brought to the hospital after a suicide attempt. His parents found him in his back yard, wearing his favorite black jeans and black t-shirt, but with one of his father's neckties. He had overdosed on some of his "mother's pills", but his stomach was pumped in time. He has just been admitted to your floor for 24-hour suicide observation. During intake, Jeff doesn't speak much, but his parents are able to list the following symptoms they have observed: • Weight loss and appetite changes • Insomnia • Fatigue • Worthlessness or guilt • Loss of interest in his college classes and even the online games he usually plays with friends • "Constant sadness" Jeff's parents have described his lack of interest in things he used to enjoy, like games with his friends, and his classes, which he used to like. This may be best described by the term A. Inappetance B. Impetance C. Indolence D. Anhedonia

D

Which method of suicide has the highest lethality? A. Ingesting pills B. Cutting one's wrists C. Inhaling natural gas D. Self-inflicted gun shot wound

D

shared symptoms of all depressive disorders

Sadness, emptiness, irritability, somatic (body) concerns, and impairment of thinking, impacted ability to function

why is finding the right depression med such a long process?

Some people are not suited for certain meds, looking into genetics to see if that plays a role, most people they try one see how you respond then try another etc. until you find a new one.....takes 4-6 weeks for a SSRI to reach full efficacy so this is a long process

Person does not experience depressive symptoms in the absence of drug or alcohol use or withdrawal

Substance-induced depressive disorder

which are more effective, talk therapies or medications?

TALK THERAPIES ARE EFFECTIVE AS ARE MEDS BUT NEITHER IS AS EFFECTIVE ALONE AS THEY ARE IN COMBINATION GETS THEM THROUGH THAT EPISODE AND PREVENTS RELAPSE Changes the way that you think about life and approach things and changes the way you think about life

Doesn't induce same seizure activity as ECT but induces same type of changes using magnet rather than electrical activity

TMS (transcranial magnetic stimulation)

why is it so important to try to address a patient's suicide plan?

They usually have one plan, if you address and mitigate that plan they usually (but not always ) will NOT come up with another plan and go through with it

Saddness doesn't mean depression, impacting ________ greater than _________ happening most of the time experiencing this symptoms is depression....when dealing with grief it is depression after ________ with impacted _________

ability to function, 2 weeks, months, ability to function

3 phases of implementation of nursing process for MDD

acute continuation maintenance

2 areas to keep in mind when assessing patients for/with MDD

age considerations (children/adolescents and older adults) self assessment (feeling what the patient is feeling)

factors influencing the etiology of depression

biological (genetic, biochemical/stress, hormones, inflammatory process, diathesis stress model) psychological (cognitive theory, learned helplessness)

what race has highest risk of suicide completion?

caucasians

...indicator of depression, can result from depression and can lead to depression, often when depression is treated this is also resolved

chronic pain

common comorbidity for patients with MDD

chronic pain

psychological factors influencing risk of depression?

cognitive theory learned helplessness

what is the leading cause of disability in the US?

depression (children and adolescents and older adults)

in addition to the 5 symptoms, you must also have ______ or _______ in order to be diagnosed with MDD

depressed mood, loss of interest or pleasure (anhedonia)

highest contributing factor to risk of a completed suicide

history of attempts

what demographic group often has atypical symptoms of depression (more irritability less sadness)

older adults

what age group is more at risk for suicide?

older adults (increasing age)

planning for a patient with MDD should be geared toward....

patient's phase of depression particular symptoms patient's personal goals

Wasn't recognized for a long time, was typically subclinical (didn't lead to suicide, people who are mostly considered debbie downers, don't think of themselves as worth a lot, tired, don't want to hang out with you, but they do need some form of intervention)

persistent depressive disorder

Low-level depressive feelings through most of each day, for the majority of days

persistent depressive disorder (dysthymia)

interventions with a circle of survivors left by individuals who completed suicide to reduce the traumatic aftereffects

postvention (tertiary)

Symptom cluster in last week prior to onset of a woman's period; include Symptoms decrease significantly or disappear with the onset of menstruation

premenstrual dysphoric disorders

3 levels of intervention for suicide

prevention treatment postvention

activities that provide support, information, and education to stop suicide

prevention (primary)

how does marriage affect suicide risk?

protective factor

some patients with MDD experience restlessness and move quickly, but most patients with MDD experience___________

psychomotor agitation or retardation

advanced practice interventions for MDD

psychotherapy and group therapy

patient education for MDD?

► Counseling and communication ► Health teaching and health promotion ► Promotion of self-care activities ► Teamwork and safety

how to diagnose MDD?

► Five (or more) of the following in 2-week period • Weight loss and appetite changes • Sleep disturbances • Fatigue • Worthlessness or guilt • Loss of ability to concentrate • Recurrent thoughts of death ► PLUS—at least one symptom is also either • Depressed mood or • Loss of interest or pleasure (anhedonia)

risk factors for suicide

► Psychiatric disorders ► Alcohol or substance use disorders ► Male gender ► Increasing age ► Race (85% to 90% Caucasians) ► Religion ► Marriage ► Profession ► Physical health

interventions for suicide

► Psychosocial interventions ► Psychobiological interventions ► Safety and teamwork ► Health teaching and health promotion ► Case management ► Documentation of care ► Postvention for survivors of completed suicide