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ch15 pysc

anergia lack of energy
euthymic mood average affect & activity
define mood dix aka:affective dix. pervasive alterations in emotions that are manifested by depression, mania, or both
what is the most common psyc Dx associated with suicide? Mood Dix. depression is the most important risk factor for it
what is the primary mood dix? Bipolar Dix; formerly known as manic-depressive illness
how long does a major depressive episode last? at least 2 weeks, during which pt is depressed & has no pleasure in all activities.
for a Dx of depression, four of the following charectaristics must be present: changes in appetite or weight, sleep, or psychomotor activity; dec energy, worthlessness/guilt, diff thinking/concentrating, suicudal thinking
Biploar Dix when a persons mood cycles b/t extremes of mania & depression
define mania distinct period where mood is abnormally & persistantly elevated, expansive, or irritable (usually 1wk)
3 s/s accompanying mania inflated self-esteem or grandiosity, dec need for sleep, pressured speech, flight of ideas, distractability, dec priorities, ^risky behavior
pressured speech unrelenting, rapid, often loud talking without pauses
flight of ideas racing, often unconnected, thoughts
hypomania same as mania BUT they do not impair the persons ability to function & there is no psychotic features
mixed Bipolar episode both mania & depresison nearly everyday for 1 week
Bipolar I dix 1 or+ manic or mixed episodes usually accompanied by major depressive episodes
Bipolar II dix 1 or+ major depressive episodes accompanied by at least 1 hypomanic episode
dysrythmic dix 2yrs of depressed mood for more days than not w/other less severe s/s that dont meet crit for major dep episode
cyclothymic dix 2yrs of numerous periods of both hypomanic s/s that dont meet crit for Bipolar
substance-induced mood dix prominant & persistant mood changes that is a direct physiologic result of ETOH, other drugs, or toxins
Mood dix due to general medical condition disturbance in mood that is a direct result of medical condition ie:degenerative neurologic conditions, cerebrovascular disease, metabolic or endocrine conditions etc
Seasonal Affective Dix Fall or Spring: ppl experience ^sleep, appetite, carb craving, weight^, interpersonal conflict, heaviness in extremeties (FALL). insomnia, weight dec, poor appetite(SPRING)
Postpartum psychosis psychotic episode onset 3wks after delivery. fatigue, sadness, lability, poor memory/confusion progressing to delusions/hallucinations. Medical emergency!
genetic theories implicates that transmission of depression in 1st degree relatives are at twice the risk for developing depression. genetics alone arent only facotr
neurotransmitters responsible for dpresison dec serotonin & norepinephrine
neuroT implicated in mania ^ norepinephrine
children w/depression often appear cranky, school phobia, hyperactivity, learning dix, failing grades, antisocial
adolescence w/dep may abuse drugs, join gangs, engage in risky behaviors, underacheivers, drop out of school
somatic ailments that accompany dep physiologic s/s: headache, backache, heart problems, "nerves"
stats of dep ^in younger women than men but ^in older men than older women
untreated episode of dep lasts 6-24months before remitting. high recurrance rate
is ECT safe for pregnant women? yes. it is intended for pts who dont respond to antidepressants. Unilateral dec memory loss, bilateral results more quickly, but w/more memory loss
psychotherapy interpersonal theory: relationships ie:greif reactions, role diputes, role transitions
cognitive therapy focuses on how person thinks abt self, others & future & interprets experince.
cognitive distortion:absolute, dichotomous thinking tendency to view everything in polar categories ie:all or none, black/white
cognitive distortion: arbitrary inference drawing specific conclusion w/out sufficinet eveidence ie:jumping to negative conclusion
cog distortion: specific abstraction focusing on single, small detail while ignoring the big pitcure
cog distortion: overgeneralization forming conclusions based on too little or too narrow experience ie:if 1 experince was bad, all will be bad
magnification & minimalization over or undervaluing significance of particular event ie:1 small negative event is world ending while 1 big positive event is nothing
personalization tendancy to self-reference external events w/out basis ie:thinking everything is abt you, even if its not
psychomotor retardation slow verbal comm. often 1 or 2 word answers very slowly
latency of response pt takes 30seconds to respond. may answer IDK b/c there too fatigued or overwhelmed to think of an answer.
psychomotor agitation ^ body m ovement & thoughts ie:pacing, accelerated thinking, argumentativeness
anhedonia losing any sense of pleasure from activites they formerly enjoyed
apathy not caring abt self, activities, or much of anything
depressed affect sad, flat. sit alone staring into space or lost in though. minimal interaction w/few words spoken to others
thought process dep appears to be in slow motion. are negative & pessamistic in thinking. self-deprecating remarks. they ruminate
ruminate to repeatedly go over the same thoughts (beating themselves up)
sensorium in dep some are usually oriented X3, but some may have trouble with Orientation if they are psychotic or withdrawn. memory impairment common
roles/relationships dep often withdraw form familiy & social relationships. family gets frustrated often
depression rating scales used to create Dx picture: self-rating: Zung slef rating Dep Scale, Beck Dep Inventory.
Hamilton Rating Scale for Dep clinician rates pts behavior ie:dep mood, guilt, suicide, insomnia. also diunal variations, depersonalization, paranoid s/s, obsession
Dep Intervention SAFETY!!! suicide precautions (removal of harmful items, ^supervision)
therapeutic comm rn-pt can use silence as a tool if pt is not interacting. Validate feelings yet still promote participation.
assess ability to perform ADLs global task, if not met, build competency by concrete instructions, if not met, assist pt.
reestablish balanced nutrition: offer foods frequently & in small amts. sit quietly during meals to promote eating.
promote sleep monitor amt of hours slept as well as whether they feel refreshed on awakening
communication active listening, let pt share burden to provide relief, validate feelings. Do NOT attempt to "fix" problems, they belittle pt
education/family teaching depression is an illness, not a lack of willpower or motivation. encourage both meds+therapy, support groups benefit
Biploar Dix: s/s of mania pts are euphoric, grandiose, energetic, & sleepless, poor judgements/rapid thoughts, actions, speech.
onset/clinical course of Biploar dix onset often early 20s (usually amoung highly educated ppl), but could be in 50s
psychopharm bipolar dix lifetime regimen of antimanic(lithium) or anticinvulsant mood stabilizers. only dix where meds can prevent acute cycles of bipolar behavior
lithium salt that competes for salt receptor sites but affects Ca, K & Mg ions as wello as glucose metabolism. stops destruction of Dop, norepi
lithium levels 1.5-2 s/s N/V, diarrhea, dec coordination, drowsy, slurred speech, muscle weakness. withold next dose; call dr, serum lith level
lith level 2-3 s/s ataxia, blurred vision, tinnitus, giddiness, confusion, muscle fasiculation, hyperreflexia, myoclonic twitches, incontinance. withold future doses, call dr stat serum level. gastric lavage IV saline/elec
lith level 3.0 & ^ cardiac arrhythmia, hypotension, peripheral vascular collapse, seizures, dec LOC, coma. all previous interventions + lith ion excretion augmented w/aminophylline, mannitol, or urea. Dialysis
bipolar dix general appearance/motor behavior may wear clothes that reflect ^mood ie: bright clothes, provocadive, flamboyant. heavy makup, shirtless guys. **pressured speech** loud speech invading personal space
mood/affect bipolar often irritable or aggressive when ppl set limits to behavior. emotionally labile
thought process/content bipolar flight of ideas, circumstaniality, tangentiality thinking. starts many projects at once but doesnt finish them. does not consider risks or resouces. they start projects as they occur in thought process
ex: bipolar thought process shopping sprees, using credit card when broke, promiscuous unprotected sex, gambling, impulsive trips, illegl endevours, speeding. may think there God
sensorium bipolar may be oriented to person/place but RARELY to time.
judgement/insight bipolar easily angered when they percieve censorship form others. may say there "fine". often blame difficulties on others. rarely think beofre speaking or acting
self-concept bipolar exaggerated slf-esteem may cover defensive chronic low self-esteem
roles/relationships bipolar too distracted & hyper to pay attention to their kidsor ADLs. unaware of overpowering & confrontational interactions. need for social interaction leads to promiscuity, often invade ppls personal space labile emotions
physiologic/self-care bipolar goes days without sleep or food & dont even realize it, even to the point of physical exhaustion. ignores personal hygiene
Intervention bipolar SAFETY. then self-esteem & socialization. Provide a safe environment, assess for suicidal ideation. establish external controls empathetically & nonjudgey
meeting physiologic needs dec environmental stimuli to assist relaxation ie: dark room or tepid bath. nutrition: give finger foods ^cal/protien(shakes, bars, sandwiches)
comm. bipolar use short-clear sentances, break info into small segments & ask them to repeat it, printed info related to rules/expectations, rights, staff names, education. put comm responsibility on nurse not pt. explain relationships b/t topics
promoting appropriate behaviors distract pt to rearrange chairs or walk. do not respond judgey to lack of clothing or inappropriate behavior. dec "competition" for RNs attention
is lithium metabolized? No! its reabsorbed by proximal tubule & excreted in urine. Narrow therapeutic index
suicide (involves ambivolence) higher rates for men b/c methods are more effective. women tend to take pills, men shoot themselves. separeted or divorced white women & young men are at risk
active suicidal ideation thinking abt killing oneself & explores ways to do so
passive suicidal ideation thinking abt it, but not developing a plan for it
risk factors for suicide relative that has commited. family may feel it gives "permission" for them to do the same
direct vs indirect ideation suicide the nurse NEVER ignores any suicidal ideation no matter how trivial it may seem. Direct:i want to die" indirect"i give up"
***lethality assessment*** does pt have a plan?*are means avalible to carry it out?*if they carry it out? is it lethal?*has pt made precautions for death?*where/when do they plan it?*is it intended on a specail date or anniversary?
Intervention for suicide be authoritative role:keep pt safe,suicide precautions, increased supervision.
lethality for supervision is lethality id low, pt should be oberved every 10 minutes, if its high, 1:1
Created by: 1225581002