Lecture on Mood Disorders and Suicide

Overview

• Focuses on mood disorders and their link to suicide.
• Differentiation of clinical presentations in mood disorders.
• Role of the nurse in managing mood disorders using the nursing process.

Mood Disorders

• Also known as affective disorders.
• Involve pervasive alterations in emotions: depression or mania.
• Interfere with life, causing long-term sadness, agitation, or elation.
• Most common psychiatric diagnoses associated with suicide.
• Primary mood disorders:
  • Major Depressive Disorder (MDD): At least 2 weeks of depressed mood or loss of pleasure.
  • Bipolar Disorder: Mood fluctuates between mania and depression.
  • Types of Bipolar Disorder:
    • Bipolar I: One or more manic/mixed episodes, usually with major depressive episodes.
    • Bipolar II: Major depressive episode with at least one hypomanic episode.

Etiology

• Theories suggest chemical and biological imbalances.
• Triggered by psychosocial stressors and interpersonal events.
• Treatment involves addressing both biological and psychosocial components.

Cultural Considerations

• Hamilton Rating Scale for Depression as a gold standard across cultures.
• Depression symptoms reliable across diverse cultures.
• Cultural attitudes may affect willingness to disclose mental health struggles.

Depression

• Risk factor for suicide.
• Symptoms: anhedonia, weight change, sleep disturbances, energy and concentration issues.
• More common in women and has a familial incidence.
• Treatment options:
  • Medications: Antidepressants (cyclic, MAOIs, SSRIs, atypical).
  • Non-Pharmacologic: CBT, ECT, TMS, VNS, DBS, light therapy, alternative therapies like St. John's Wort.

Nursing Process

• Assessment involves gathering information from clients and their history.
• Important to be slow and patient in assessments.
• Evaluate client's perception of the problem, previous episodes, and treatments.
• General appearance, mood, and thought processes are key observational points.

Bipolar Disorder

• Extreme mood swings, second only to depression in disability.
• More common in highly educated individuals.
• Mania:
  • Symptoms: Elevated mood, grandiosity, impulsivity.
  • May result in poor judgment and lack of insight.
• Treatment:
  • Medications: Lithium or anticonvulsants.
  • Psychotherapy: Useful in mild depressive or normal phases.

Suicide

• Defined as self-directed injury with the intent to die.
• Risk factors: Previous attempts, mental illness, lack of social support.
• Warning signs: Direct/indirect signals of suicidal intent.
• Lethality assessment important in planning for safety and intervention.

Nursing Interventions

• Ensure client safety and establish therapeutic relationships.
• Promote adherence to treatment and coping skill development.
• In bipolar disorder, focus on managing mania safely.

Legal and Ethical Considerations

• Assisted suicide remains a topic of debate.
• Nurse's role is supportive care, not deciding on client’s life span.

Age-Related Considerations

• Disruptive Mood Dysregulation Disorder (DMDD) in ages 6-18.
• Depression and suicide risk are high in older adults.
• ECT is more used in older adults with rapid response.

Community-Based Care

• Nurses often first to identify mood disorders.
• Important to document behavior and promote mental health education.

Self-Awareness

• Nurses must monitor their own feelings to maintain therapeutic relationships.
• Working with manic or suicidal clients can be emotionally taxing.
• Nurses should engage in self-care and awareness to manage their reactions.