Psychiatric Assessment and Management of Suicide and Mood Disorders Questions & Correct Answers
Hisory of past suidode attempt present in 50-80% of all committed suicides
priotiry intevention is to palce on 1-1 observation with suicide percautiom, the more
Patient verbilizes plan for suicide specific of a plan the more likly pt is to commit
ederly paitents acocunt for 15% of all suicides des[ote ony making up 13% of
Suicide in geriatrics population
Priority for command hallucinations safety and 1-1 observations with continuous monitoring for suicidal harbors
Women more likely to attempt suicde choose less lethal methods like pills
Men more likely to commit successfully chose more lethal options like guns
msyt paericpae in a plan for safety and family should be agree to have constant
Discaharding a aptiet seen for suicidal
observation, if they refuse they are not ready fot discharge
behaviors
clients with major depressive disorder may say they feel numb. Unable to feel any
Numb pleasure. Symptoms present for at least 2 weeks
Dysthymia persistent descriptive disorder lasting at least 2 years
Younger than 3 s/s depression feeding problems, tantrums, lack of playfulness or emotional expression
5 s/s depression - accident proneness, phobias, excessive self approach
Age 3 (disapproval)
Ages 6 8 s/s depression - physical complaints, aggressive behavior, clinging behavior
Ages 9 12 s/s depression - excessive worry and morbid thoughts
often dismissed or attributed to be normal adjustment of growth
Concern for adolescents with depressive
symptoms
FDA label on antidepressants stating they may increase risk suicidality in children
Black box warning and adolescent
must administer 100% o2 in order to prevent anoxia resulting of med induced
Electroconvulsive therapy paralysis of respiratory muscles
Consent for ECT always decision of patient and if they refuse it must be respected
avoid food high in tyramine.. NYE foods, colas, chocolate, sour cream / cream
MAOIs cheese, and diet pills
alteration in mood expressed with elation, inflated self esteem, grandiosity,
Mania hyperactivity, and accelerated thinking and speech, can be substance induced
Finger foods = pts with BPD/ mania can
have difficulty sitting to eat a meal or drink,
important to give to go style food to help
maintain nutrition
Medication compliance important to prevent relapse in bipolar disorder 1 w/ mania
Bipolar disorder treatment modality independent management is premise of recovery model for BPD
Mania / mood stabilizing agent lithium. Common side effect is weight gain
Lithium toxicity persistent nausea and vomiting, ataxia, blurred vision, tinnitus
Sodium maintain intake during lithium therapy and maintain fluids, helps prevent toxicity
client identifies goals and develops treatment plan with clinicians, work on strategies
to manage, and clinician serves as support symptoms to help client achieve goals
Recovery model BPD
psych. Clients who are hospitalized for psych have higher risk of suicidal idealation.
Personality disorders and suicde
Insomnia can increase suicide risk
Socioeconomic risk factor rural areas, financial strain, unemployment, living in rural areas, unemployment
, Psychiatric Assessment and Management of Suicide and Mood Disorders Questions & Correct Answers
creates need for follow up, wise to prescribe no more than a 3 day supply of
Provider provides no refill for rx. Of suicidal
medication in clients experiencing suicidal depression. Teach family s/s of suicide
client
Be direct. Talk openly and matter-of-factly about suicide. Listen actively and
encourage the expression of feelings, including anger. Express feelings of personal
Communication for a client expressing worth to the client. It is important to not be judgemental or provoke guilt or discount
wish to attempt their feelings.
restrict firearms or other means sof self harm from the home ex. Dad has a hidden
key to firearms. Make sure it is removed from his access and hidden by other
Removing means of harm member of household
50% of depression may be bipolar illness
Why is depression more common to lack of social connectedness
experience
Focus of therapy Alleviate symptoms and strengthen coping skills
First antidepressant prescription between 30-50% of clients do not respond to initial medication
most common manic co morbidity with BPD, medications exacerbate mania and
ADHD should only be admin after bipolar symptoms have been controlled
cheerful, rapid ideas, increased motor activity, not severe enough to cause
Hypomania stage 1 impairment in social or occupational functioning
acute mania marked impairment of functioning, usually requires hospitalization, may
Hypomania stage 2 hallucinate and have delusion
grave form of disorder characterized by intensified symptoms, more rare with med
Delirious mania
patients may have depression, but also have weight loss. Increased HR, and heat
sensitivity etc. could indicate hypothyroidism but overshadowed by diagnosis
Diagnostic overshadowing regarding mental illness
these pts die an est. 25 years earlier than general population, 60% of these deaths
Mortality in pts with mental illness are r/t preventable causes
when a patient needs medication and counseling for mental health they must see a
Psychiatrist psychiatrist... because psychologists cannot prescribe meds.
Recognition of mental illness important competency for nurses in any role. Necessary education
evaluation of pt for conditions before they become clinically significant, always do
Screening purpose privately 1-1 in quiet area
remember that as a nurse if a paiennt states yes to any questions your first step is
to ask if they are having any current thoughts of suicide right now prior to any other
Horowitz suicide risk screening intervention
assess for and demonstrate sensitivity to impact of trauma on current behavior or
relationships in every aspect of intervention, nurse should recognize risk of
Trauma informed care unwttingly retraumatizing pt if there is a lack of awareness of sensitivity to pts
trauma
pts who use in repose to command hallucinations need immediate medial attention
NSSIB non suicidal self injuring behavior because they are more likely to attempt suicide
Methamphetamine withdraw; associated with a higher risk for suicide
SBIRT for opioids screening, brief intervention, and referral to treatment
ED or prompt care pts with su stance use disorder most likley to first seek treatment in these settings
attitude of devaluating a person bc of particular characteristic or illness.. Important
Stigmatization to interact with the client with non bias
Hisory of past suidode attempt present in 50-80% of all committed suicides
priotiry intevention is to palce on 1-1 observation with suicide percautiom, the more
Patient verbilizes plan for suicide specific of a plan the more likly pt is to commit
ederly paitents acocunt for 15% of all suicides des[ote ony making up 13% of
Suicide in geriatrics population
Priority for command hallucinations safety and 1-1 observations with continuous monitoring for suicidal harbors
Women more likely to attempt suicde choose less lethal methods like pills
Men more likely to commit successfully chose more lethal options like guns
msyt paericpae in a plan for safety and family should be agree to have constant
Discaharding a aptiet seen for suicidal
observation, if they refuse they are not ready fot discharge
behaviors
clients with major depressive disorder may say they feel numb. Unable to feel any
Numb pleasure. Symptoms present for at least 2 weeks
Dysthymia persistent descriptive disorder lasting at least 2 years
Younger than 3 s/s depression feeding problems, tantrums, lack of playfulness or emotional expression
5 s/s depression - accident proneness, phobias, excessive self approach
Age 3 (disapproval)
Ages 6 8 s/s depression - physical complaints, aggressive behavior, clinging behavior
Ages 9 12 s/s depression - excessive worry and morbid thoughts
often dismissed or attributed to be normal adjustment of growth
Concern for adolescents with depressive
symptoms
FDA label on antidepressants stating they may increase risk suicidality in children
Black box warning and adolescent
must administer 100% o2 in order to prevent anoxia resulting of med induced
Electroconvulsive therapy paralysis of respiratory muscles
Consent for ECT always decision of patient and if they refuse it must be respected
avoid food high in tyramine.. NYE foods, colas, chocolate, sour cream / cream
MAOIs cheese, and diet pills
alteration in mood expressed with elation, inflated self esteem, grandiosity,
Mania hyperactivity, and accelerated thinking and speech, can be substance induced
Finger foods = pts with BPD/ mania can
have difficulty sitting to eat a meal or drink,
important to give to go style food to help
maintain nutrition
Medication compliance important to prevent relapse in bipolar disorder 1 w/ mania
Bipolar disorder treatment modality independent management is premise of recovery model for BPD
Mania / mood stabilizing agent lithium. Common side effect is weight gain
Lithium toxicity persistent nausea and vomiting, ataxia, blurred vision, tinnitus
Sodium maintain intake during lithium therapy and maintain fluids, helps prevent toxicity
client identifies goals and develops treatment plan with clinicians, work on strategies
to manage, and clinician serves as support symptoms to help client achieve goals
Recovery model BPD
psych. Clients who are hospitalized for psych have higher risk of suicidal idealation.
Personality disorders and suicde
Insomnia can increase suicide risk
Socioeconomic risk factor rural areas, financial strain, unemployment, living in rural areas, unemployment
, Psychiatric Assessment and Management of Suicide and Mood Disorders Questions & Correct Answers
creates need for follow up, wise to prescribe no more than a 3 day supply of
Provider provides no refill for rx. Of suicidal
medication in clients experiencing suicidal depression. Teach family s/s of suicide
client
Be direct. Talk openly and matter-of-factly about suicide. Listen actively and
encourage the expression of feelings, including anger. Express feelings of personal
Communication for a client expressing worth to the client. It is important to not be judgemental or provoke guilt or discount
wish to attempt their feelings.
restrict firearms or other means sof self harm from the home ex. Dad has a hidden
key to firearms. Make sure it is removed from his access and hidden by other
Removing means of harm member of household
50% of depression may be bipolar illness
Why is depression more common to lack of social connectedness
experience
Focus of therapy Alleviate symptoms and strengthen coping skills
First antidepressant prescription between 30-50% of clients do not respond to initial medication
most common manic co morbidity with BPD, medications exacerbate mania and
ADHD should only be admin after bipolar symptoms have been controlled
cheerful, rapid ideas, increased motor activity, not severe enough to cause
Hypomania stage 1 impairment in social or occupational functioning
acute mania marked impairment of functioning, usually requires hospitalization, may
Hypomania stage 2 hallucinate and have delusion
grave form of disorder characterized by intensified symptoms, more rare with med
Delirious mania
patients may have depression, but also have weight loss. Increased HR, and heat
sensitivity etc. could indicate hypothyroidism but overshadowed by diagnosis
Diagnostic overshadowing regarding mental illness
these pts die an est. 25 years earlier than general population, 60% of these deaths
Mortality in pts with mental illness are r/t preventable causes
when a patient needs medication and counseling for mental health they must see a
Psychiatrist psychiatrist... because psychologists cannot prescribe meds.
Recognition of mental illness important competency for nurses in any role. Necessary education
evaluation of pt for conditions before they become clinically significant, always do
Screening purpose privately 1-1 in quiet area
remember that as a nurse if a paiennt states yes to any questions your first step is
to ask if they are having any current thoughts of suicide right now prior to any other
Horowitz suicide risk screening intervention
assess for and demonstrate sensitivity to impact of trauma on current behavior or
relationships in every aspect of intervention, nurse should recognize risk of
Trauma informed care unwttingly retraumatizing pt if there is a lack of awareness of sensitivity to pts
trauma
pts who use in repose to command hallucinations need immediate medial attention
NSSIB non suicidal self injuring behavior because they are more likely to attempt suicide
Methamphetamine withdraw; associated with a higher risk for suicide
SBIRT for opioids screening, brief intervention, and referral to treatment
ED or prompt care pts with su stance use disorder most likley to first seek treatment in these settings
attitude of devaluating a person bc of particular characteristic or illness.. Important
Stigmatization to interact with the client with non bias
